Download Communicable Diseases Bulletin

Quarterly Summary Report
Fourth Quarter – 2012 (Oct – Dec)
Volume 3; Issue Number 4; 2012
Communicable
Diseases Bulletin
800 555
www.haad.ae
Foreword
We all know how hard it is to graduate as a medical doctor, and how challenging
is your life to continue in this field. Nevertheless, we love challenges and difficult
paths, and we are always ready to do the best to reach there; simply because we
believe it is worth it!
Yes, it is really a wonderful job to save lives and help people and this is basically
what we do as physicians. However, have we ever seen the actual impact we do
in the real life? Yes, much of what we do does save lives and help others, but there
are some unintentional harms that we need to be very cautious about, such as our
antibiotic prescribing practices.
Antimicrobial resistance is an increasingly growing problem everywhere and truly
became one of the most important public health challenges of our today’s life.
Sadly, we as physicians stand as one of the main reasons behind this problem. Our
reckless prescribing behavior, despite all alarming calls by the health community,
causes uncontrolled escalation of antibiotic resistance, with continuous emergence
of new resistant bacterial strains that used to be easily treated in the near past. The
list of resistant strains is growing and many of them are acquired as healthcare
associated infections (HAI); they cause difficult to treat illnesses, with several
unfavorable consequences including long-term disabilities and death. Moreover,
they lead to long hospitalizations, and the costs on the health care systems are
terribly tremendous.
We seriously need to work together at all levels of health care, to stop this medical
practice problem, and prevent its associated infections, towards a better confront
of antimicrobial resistance.
Dr. Farida Al Hosani, Manager
Communicable Diseases Department
Health Authority – Abu Dhabi
Tel: 02 4193208
Fax: 02 4496966
Email: [email protected]
Page 2
Quarterly Summary Report: 4th Quarter - 2012
Table of Contents
Item
Content
I
Foreword
2
II
Table of contents
3
III
Notified illnesses in Abu Dhabi Emirate by region
(Quarter 4, 2012)
4
IV
Notified illnesses in Abu Dhabi Emirate by age &
gender (Q4, 2012)
5
V
Monthly trends for selected notified diseases in Abu
Dhabi Emirate (Q1-Q4/2012 Vs 2010 and 2011)
6
VI
Visa screening applicants in Abu Dhabi Emirate
(Q4 /2012)
7
VII
Topic of the volume: Foodborne illnesses and
HAAD efforts
8-11
VIII
Sharing Reports: Reported infectious diseases –
2012 End of Year Selected Figures!
12-14
IX
Activities
15-18
X
Flash news
19-20
XI
The volume “Flash- on-an-Illness”: Influenza
21-22
Quarterly Summary Report: 4th Quarter - 2012
Page
Page 3
Table 1: Notified Illnesses in
Abu Dhabi Emirate by Region (Quarter 4, 2012)
Cases
Abu
Dhabi
Eastern Western
Region Region Cumulative in Abu Dhabi Emirate
( Q1-Q4 )
Quarter 4
Q1
Q2
2012
Q3
Q4
Year Total
2012 2011 2010
AFP *
5
0
1
7
6
2
6
21
14
11
Brucellosis
12
3
1
20
58
41
16
135
73
52
Chickenpox
880
187
59
2791
4635
1
0
0
0
1
5
1
7
9
11
130
108
15
253
374
267
253
1147
667
561
Haemophilus influenzae invasive
0
0
0
0
0
0
0
0
23
14
Hepatitis A
75
25
2
53
51
73
102
279
138
193
Hepatitis B
136
43
1
131
194
160
180
665
655
711
Hepatitis C
113
26
3
107
169
109
142
527
559
668
Influenza
80
76
10
79
31
20
166
296
238
248
Malaria * ¶
286
233
78
265
692
1160
597
2714 2760
1415
Measles *
31
3
1
14
2
5
35
56
55
50
Meningitis (bacterial)
8
0
0
9
11
12
8
40
31
39
Meningitis (viral)
16
0
0
6
14
16
16
52
38
36
Mumps
33
15
6
37
69
38
54
198
194
221
Pertussis
3
0
0
9
27
14
3
53
39
73
Rubella *
6
0
0
2
6
4
6
18
43
22
Scabies
176
60
1
195
176
151
237
759
585
654
Shigellosis
5
1
0
7
9
10
6
32
41
51
Tetanus
1
0
0
1
0
0
1
2
3
1
Tuberculosis (Pulmonary) *
44
23
9
89
93
92
76
350
452
450
Tuberculosis (Extra-Pulmonary)
26
7
3
43
55
57
36
191
180
175
Typhoid /Paratyphoid
61
10
3
130
129
110
74
443
394
347
Other diseases
307
63
24
327
373
316
394
1410 1342
968
Total
2435
883
217
4575
7175
3979
3535
19264 20281 14400
Grand total including
ruled out notifications
2714
955
266
4889
7522
4371
3935
20717 21373 14949
Cholera
Foodborne illnesses **
1317 1126
9869
11748 7429
Illnesses covered by national control programs (only confirmed cases and cases that cannot be ruled out are included in the table)
Refers to Foodborne illnesses other than those reported separately in the list of notified diseases (See page 6 and 10 for further
clarifications on the apparent increase during 2012)
All notified malaria cases are “imported”
Reported Haemophilus influenzae cases during last two years were not meeting the case definition of the invasive type.
Indicates increase or decrease in number of notified cases during the 4th quarter of 2012 compared to previous quarters
Indicates increase or decrease in numbers of notified cases over Q1-Q4 2012 compared to the cumulative over previous two years
Close to 20% decrease in cases of chickenpox in 2012 (Vs.2011) is a good achievement that can be attributed to the introduction of Varicella vaccine.
A confirmed outbreak of measles occurred in Abu Dhabi Region during December 2012 – January 2013 (interventions taken, and outbreak contained)
Page 4
Quarterly Summary Report: 4th Quarter - 2012
Table 2: Notified Illnesses in
Abu Dhabi Emirate by Age & Gender (Q4, 2012)
Cases
Total
1
AFP
23
3
1
1
1
1
6
4
24 143 148 135 141 31
84
69 199 18
83
3
6
1
3
13
16
3
21
1
3
423
11
17
33
44
15
23
8
15
9
32
8
19
3
9
3
3
0
1
90
163
253
0
0
0
51
51
102
2
56
124
180
1
Haemophilus influenzae
15
Hepatitis A
13
29
Hepatitis B
26
3
7
3
4
1
1
1
7
6
28
47
14
39
5
19
2
10
1
1
7
28
6
33
8
27
8
16
5
2
35
107
142
3
27
12
8
12
6
11
1
3
3
3
83
83
166
141 11 213
2
130
1
58
1
23
1
1
22
575
597
9
26
35
3
5
8
5
11
16
25
29
54
1
2
3
4
2
6
56
181
237
1
5
6
0
1
1
27
49
76
11
25
36
22
52
74
166
228
394
Hepatitis C
Influenza
7
11
17
Malaria
Measles
1
Meningitis bacterial
1
Meningitis viral
4
Mumps
1
7
4
Rubella
1
Scabies
1
17
9
11
5
5
3
4
3
8
5
8
1
6
2
Pertussis
2
5
8
1
1
1
1
2
2
10
2
2
6
7
1
1
1
1
1
2
2
1
3
1
5
8
12
1
Shigellosis
1
18
9
1
38
11
1
1
1
56
11
32
5
1
20
1
1
1
7
1
1
1
Tetanus
0
Tuberculosis (Pulmonary)
Tuberculosis
(Extra-Pulmonary)
3
1
2
1
1
703 1126
1
1
Cholera
Foodborne Illness
3
1
1
Brucellosis
Chickenpox
1
0
11
7
12
22
2
12
0
4
0
1
6
3
13
4
4
1
2
2
3
0
1
1
Typhoid /Paratyphoid
Fever
1
1
5
3
2
6
1
6
10
25
3
7
Other Diseases
6
5
46
44
20
24
13
18
52
56
20
46
0
15
1
Total
58
73 274 298 244 276 96 341 250 728 101 425 40 197 18
85
16 15 1097 2438 3535
4
8
17
3
3935
* The highlighted cells (with red numbers) indicate the age/gender categories that had the largest numbers of reported cases for the given illness.
The grand total for Quarter 4 after including all ruled out notifications.
Quarterly Summary Report: 4th Quarter - 2012
Page 5
Monthly Trends for Selected Notified Diseases
in Abu Dhabi Emirate
(Q1-Q4/2012 Vs 2010 and 2011)
The number of reported cases increased during the
last quarter of 2012. However, those cases were not
linked (only eight patients had history of contact with
other cases). More than two thirds had travel history.
The risk was not specified in quarter of the cases.
About 30% of all Q 4 cases got hospitalized.
There is a remarkable decline in number of reported
cases over the last quarter of 2012. Additionally, more
than three quarters of them were not confirmed by
culture. Travel history was reported in only 34% of
those cases (almost all confirmed cases had a travel
history).
Hepatitis A
70
Typhoid/Paratyphoid
2011
80
2012
50
Number of notified cases
Number of notified cases
2010
60
40
30
20
10
2010
70
2011
60
2012
50
40
30
20
10
0
Jan
Feb
Mar
Apr May
Jun
Jul
Aug
Sep
Oct
0
Nov Dec
Jan
Feb
Mar Apr May Jun
MONTH
The trend over the three years shows increase in
reported cases during the first and last quarters of
each year. Such increase was even more prominent
during the last quarter of 2012, but it is believed that
the actual number of cases is even more (it is one of
the most under-reported illnesses). Find more figures
about influenza in page 22.
Influenza
Sep Oct Nov
450
2011
2012
80
60
40
20
2010
400
2011
350
2012
300
250
200
150
100
50
0
Jan
Feb
Mar Apr May
Jun
Jul
Aug
Sep
Oct Nov
Dec
Jan
Feb
Mar Apr May
Jun
Jul
Aug
Sep
Oct Nov
These two figures make it clear that most of the apparent increase in reported foodborne illnesses during
2012 was due to rotavirus infections that are not
necessarily foodborne.
Notified Foodborne illnesses due to
Rotavirus infection
2010
2011
2012
100
80
60
40
20
Causes
of these
foodborne
illnesses
during
2012:
Foodborne illnesses
(after excluding Rotavirus cases)
100
2010
2011
2012
90
Number of notified cases
Number of notified cases
120
80
70
60
50
40
30
Salmonella
156
Adenovirus
16
Campylobacter 3
Unspecified
463
20
10
Jan
Feb
Mar Apr May Jun
Jul Aug
Dec
MONTH
MONTH
0
Dec
Malaria
500
2010
100
0
Aug
Malaria keeps almost the same picture like last year, however all cases are imported that mostly develop after being
back from home countries. A new geographic information
system (GIS) is going to be implemented shortly by HAAD
for more vigilant surveillance of breeding sites.
Number of notified cases
Number of notified cases
120
Jul
MONTH
Sep Oct Nov
Dec
0
Jan
Feb
Mar Apr May Jun
MONTH
Jul
MONTH
Aug
Sep Oct Nov
Dec
Note: HAAD surveillance officers investigate individual cases, assess for outbreaks, and take action whenever indicated.
Page 6
Quarterly Summary Report: 4th Quarter - 2012
Visa Screening in Abu Dhabi Emirate
(Q1-Q4-2012)
Visa screening is mandatory for all expatriates applying for work and/or residence in Abu
Dhabi Emirate. It consists mainly of screening for Human Immunodeficiency Virus (HIV), pulmonary tuberculosis, and leprosy. Screening for Hepatitis B and syphilis are limited to a few
occupational categories. HAAD Visa Screening Standard is available at
http://www.haad.ae/HAAD/LinkClick.aspx?fileticket=DDCVCmde9R0%3d&tabid=819
Around quarter a million people or more apply for visa medical screening every three months
in Abu Dhabi Emirate. During the fourth quarter of 2012, a total of 271,499 applicants were
screened in all HAAD-licensed Screening Centers (a total of ten centers in the three regions
of Abu Dhabi).
No. of Applicants
300000
288915
New
Renew
Total
279722
900
271499
245033
250000
800
No. of Applicants/ 100,000
350000
Prevalence per 100,1000 visa screening
applicant in Abu Dhabi Emirate, 2012 *
Visa screening applicants in Abu Dhabi
Emirate, 2012
200000
150000
100000
Overall
New
Renew
700
600
500
400
300
200
50000
ph
ili
s
ro
sy
Sy
er
cu
Tu
b
Quarter
Le
p
B
Q4
He
Q3
HI
Q2
V
0
Q1
pt
iti
s
0
lo
sis
100
Disease
The table below shows the number and prevalence of positive cases among new and renewal
visa applicants during the fourth quarter of 2012.
HIV
Number
Prevalence *
Overall Prevalence
Hepatitis B
Tuberculosis
Leprosy
Syphilis***
New
Renew
New
Renew
New
Renew
New
38
5
150
8
119
42
0
0
205
0
27.8
3.7
530
42.6
87.0
31.2
0
0
723.8
0
15.8
335.3
59.3
Renew
0
New
Renew
435
* Prevalence: In the Prevalence bar chart and the table above, the term prevalence refers to the number of positive
cases per 100,000 visa screened applicants.
For Hepatitis B and Syphilis: it applies to tested occupational categories (a total of 47126 in quarter 4, and 194097
during the whole year of 2012).
For TB: it refers to active TB cases
Quarterly Summary Report: 4th Quarter - 2012
Page 7
TOPIC OF THE VOLUME
Foodborne illnesses and HAAD efforts!
Background
Foodborne illnesses are a well-known public health problem that occurs in all countries;
from most to least developed ones. However, the lack of reliable data makes it difficult to
estimate the burden of foodborne illnesses worldwide. This is mainly due to the different
definitions used in various studies, most diarrheal illnesses are not reported to public health
authorities, and only few illnesses can be definitely linked to food. The WHO estimated that
there are about two billion cases of diarrheal disease worldwide and around 1.8 million die
annually from diarrheal diseases. A great proportion of these cases are attributed to contamination of food and drinking water.
The WHO is currently working on initiating a Global Strategy for the surveillance of foodborne diseases by urging member states to set up laboratory-based surveillance systems
that cover outbreaks and sporadic cases, and to monitor contamination of food by chemicals and microorganisms.
The United Arab Emirates, with its main health bodies including the Health Authority of Abu
Dhabi (HAAD), are not far away from those international efforts, and HAAD is currently working intensively on enabling the establishment of a national public health reference lab, that
can effectively serve in better diagnosis and reporting of many illnesses including the foodborne ones.
Foodborne illnesses – The common missed outbreaks!
Too often, outbreaks of foodborne illnesses go unrecognized or unreported. This is due to
many factors including the fact that most people who fall sick do not seek medical care
because the symptoms are usually mild and self-limited; specific diagnostic tests are usually
not available and/or not easy to perform; and only a small number of those who get diagnosed are reported. Therefore, reported foodborne illnesses are literally the tip of the iceberg for actual cases in the community.
The below two figures show the situations of underreporting and usual scenarios for such
cases, which can further explain why foodborne illnesses are generally underestimated and
specification of causative pathogens are usually not reached.
Usual Scenairo Timeline for Foodborne illnesses
Reported Cases
Confirmed
Lab tests for
organisms
Ingesting
contaminated
food
Specimen obtained
People seek care
Stool sample
collection
Hours -7 Days
- Seeks medical care in 1-5 days
- The health facility might do testing in 1-5 days
Becoming sick
Possible identification of pathogen in 1-3 days
People become ill
The cause gets
specified
Infection in the Population
This indicates that public health efforts are continually needed to enhance both testing and
reporting of those illnesses, so that health bodies and related stakeholders can take proper
and timely intervention.
Page 8
Quarterly Summary Report: 4th Quarter - 2012
Foodborne illnesses, Food poisoning, Gastroenteritis -The Definitions Dilemma!
According to WHO, foodborne illnesses (FBI) can be defined as diseases that are commonly
transmitted through food. They comprise a broad group of illnesses caused by microbial pathogens, parasites, chemical contaminants, and biotoxins. A foodborne illness is therefore an infection
or intoxication that results from eating food contaminated with microorganisms or their toxins. It also
includes allergic reactions and other conditions where food acts as a carrier of the allergen.
While not all gastroenteritis is foodborne, and not all foodborne diseases cause gastroenteritis, food
poisoning is a foodborne illness that is caused by the ingestion of preformed toxins.
A variety of methods have been used to ascertain the proportion of illnesses caused by foodborne
agents using a syndromic case definition of gastrointestinal disease and/or pathogen specific
causes likely to be attributable to food consumption. Therefore, ascertaining the burden of those
diseases is usually not straightforward and should always be interpreted with caution.
Gastroenteritis is the most frequent clinical syndrome that can be attributed to a wide range of microorganisms, including bacteria, viruses, and parasites. The following are the most common pathogens that cause foodborne illnesses:
• Bacteria: Salmonella, Campylobacter jejuni, Clostridium perfringens, and E.coli.
• Viruses: Enterovirus, Hepatitis A, Hepatitis E, Norovirus, and Rotavirus.
• Parasites: Platyhelminthes (Taenia saginata, Taenia solium) , Nematode(Ascaris lumbricoides,)
and Protozoa (Entamoeba histolytica, Giardia lamblia).
According to the US Center for Diseases Control and Prevention (CDC), more than 250 known diseases can be transmitted through food. Unknown or undiscovered agents have been estimated to
cause 81% of all food-borne illnesses and related hospitalizations. Viral infections make around one
third of cases of food poisoning in developed countries.
Important Foodborne Outbreaks in the World!
The below table shows the world largest outbreaks that occurred over the last five years, with the
causative organisms, number of infected people, and deaths.
Year
Event
2008
Canadian listeriosis outbreak in cold cuts
2008
United States salmonellosis outbreak in peanuts
2011
Germany E. coli O104:H4 outbreak
2011
United States listeriosis outbreak in cantaloupes
Agent
Vehicle
infected
Death
Listeria
Cold cuts
> 50
22
Salmonella
Peanuts
> 200
9
> 4300
52
146
30
E. coli O104:H4 Fenugreek sprouts
Listeria
Cantaloupe
Figures from Abu Dhabi
The list of reportable infectious diseases includes many infections in which food can be a vehicle of
transmission. Those illnesses are either appearing in the list as separate reportable disease entities
(like typhoid/paratyphoid fever, brucellosis, hepatitis A, shigellosis, and other), or reported under
the category of “Foodborne illness” with requesting specification of the pathogen in the blank
space next to it.
During 2012, the total notifications received under the category of foodborne illnesses in Abu Dhabi
Emirate were 1147 cases (compared to 667 cases in 2011). However, the apparent large increase
is due to rotavirus infections that have been reported under this group. This can be misleading,
since a good proportion of rotavirus infections are not necessarily foodborne. However, reported
foodborne illnesses in the two years after excluding rotavirus, are comparable (527 and 638 cases
in 2011 and 2012 respectively).
Quarterly Summary Report: 4th Quarter - 2012
Page 9
Foodborne/Food poisoning incidents
On average, about ten outbreaks of food poisoning incidents are reported per year in the Emirate of Abu Dhabi. During 2012, the following 14 incidents of medium to large food poisoning
outbreaks have been identified; nine of them were reported from Abu Dhabi region, four from the
western region, and one from the Eastern Region (smaller incidents of 3 or less clustered cases
have not been included here). Of those listed in the table, the smallest incidents involved five
family members who developed food poisoning after eating from the same restaurant; and the
largest one involved 113 laborers living in the same camp. All cases and outbreaks were reported to ADFCA, who investigated the suspected food and premises, took a corrective action as
needed, and provided HAAD with a feedback report.
No Month
No. of Cases/No. reported Stool results
Abu Dhabi Region
1
January
12 students /12
No stool samples tested (developed after going in a trip and eating from a fast
meal restaurant, reported by the school nurse but did not go to hospital-mild cases)
2
February
20 labors/2
Stool culture Negative for 2 cases (only 2 cases were reported)
3
February
25 labors/25
4
April
10 labors/2
5
May
11 students/10
6
July
22 labors/10
7
August
9 family members/4
Stool culture positive for Salmonella species group E
8
August
50 hotel staff/3
3 cases tested, 1 grew Salmonella enterica, 1 had negative stool culture, 1 had
negative stool culture but had E.histolytica trophozoites in routine stool analysis
9
December 113 labors/39
Stool culture Negative
Stool culture Negative
Stool culture Negative (developed after going in a trip)
Stool culture Negative
Negative stool cultures -25 cases tested
Eastern Region
1
Stool culture positive for Salmonella species group B
November 5 households/5
Western Region
No stool samples tested
1
January
8 labors/8
2
April
14 labors/5
3
July
37 people/5
4
July
19 labors/19
No stool samples tested
Stool cultures Negative
Stool cultures Negative
HAAD Communicable Disease Department is making it a top priority for this year to improve
the capacity and infrastructure for outbreak response management by all health bodies in
the Emirate of Abu Dhabi (this is for all illnesses including the foodborne ones).
400
Notifications received under the category of
"Foodborne illness"
450
350
Number of cases
250
200
150
100
350
Nationals
300
Expatriate
250
200
150
100
0
Page 10
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Causative pathogens
eb
ia
sls
Gi
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di
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50
s
Number of cases
400
Nationals
Expatriate
Western Region
300
Foodborne illnesses that are notified as separate
disease entities
Infectiuos Disease
Quarterly Summary Report: 4th Quarter - 2012
The role of
physicians in
investigating
the causative
organisms is
crucial, and all
care should
be taken to do
that.
Foodborne illnesses – HAAD Requirements!
HAAD classified Foodborne illness as a “Category A” reportable disease!
Requiring immediate reporting!
The primary goal of this reporting requirement is the prompt identification of any unusual clusters of the
disease that have possibly been developed by ingesting a contaminated food. Isolation of the pathogen
from the suspected food specimens would usually need to be done within 72 hours; therefore immediate
reporting will allow the Food Control Authority to do necessary investigation and testing on time, hence
preventing bigger outbreaks in the community.
Reporting of foodborne illnesses should not be undervalued at all. Although in most of the cases the illness
is mild, some illnesses can be very serious, requiring hospitalization, and might cause long-term disability
and even death.
HAAD Efforts to Improve Actions
Investigation of foodborne illnesses and related outbreaks requires a multidisciplinary approach where all
stakeholders need to get involved and take their roles to ensure timely control and prevention.
Once a foodborne illness is reported to the Health Authority of Abu Dhabi, the surveillance team starts
performing a case-based epidemiological investigation to identify the source of infection, risk factors, and
possible epi-linkage among cases, especially when there is clustering by time or place.
HAAD immediately reports any suspected foodborne illness or incident to Abu Dhabi Food Control Authority (ADFCA) to investigate the suspected food. ADFCA team goes on a field visit to the implicated place
to take food specimens and inspect the food establishment. This helps in identifying the source of infection and take appropriate preventive measures to avoid repeated occurrence of such incident in the future.
More vigorous actions might be taken by ADFCA, which may include a warning letter or even closing the
food establishment if those violations were recurring ones.
Health care providers report Foodborne illnesses to
HAAD (e-notification/phone)
Abu Dhabi Food Control Authority
(ADFCA)
Automated reporting
from HAAD to
ADFCA will start
soon!
Do Not Delay notification of Foodborne illnesses
This may result in deterioration of food specimens!
Quarterly Summary Report: 4th Quarter - 2012
Page 11
Sharing Reports:
Reported infectious diseases –2012
End of Year Selected Figures!
Chickenpox by Age group in Abu Dhabi Emirate (2011-2012)
2011
IR*100,000
Frequency
2012
IR*100,000
Age group
Frequency
0-4
3708
2485.8
2719
1690.6
5-9
3088
2440.7
2744
2139.1
10-14
769
764.0
657
646.9
15-19
303
340.8
238
259.0
20-24
916
368.6
775
298.9
25-29
1342
308.9
1176
254.7
30-34
792
220.9
740
195.0
35-39
455
169.4
426
155.1
40-44
214
104.7
202
96.1
45-49
89
66.1
88
63.4
50-54
40
40.4
55
55.4
55-59
19
32.2
27
42.9
60-64
12
49.1
10
37.5
65-69
1
9.9
5
43.4
70-74
1
15.5
2
28.9
75+
2
58.4
0.0
0.0
Total
11751
506.3
9864
407.2
Good news! The impact
of introducing the varicella vaccine started to
be seen: The incident
rate of chickenpox has
declined from 506 per
100,000 in 2011 to 407
per 100,000 in 2012.
However, a natural
secular change can also
be a reason for that,
therefore we may need a
few more years for such
effect to be more clear.
A decrease of 20%
from last year!
Note: This is a real time data, so figures abstracted at different points of time can show small difference
Disease
Childhood Diseases (<15 years) Abu Dhabi 2011-2012
Frequency
2011
Rate*100,000
Frequency
2012
Rate*100,000
Chickenpox
7565
325.9
6120
252.6
Hepatitis A
82
3.5
194
8.0
Hepatitis B
8
0.3
4
0.2
Influenza
115
5.0
145
6.0
Measles
27
1.2
46
1.9
Mumps
128
5.5
116
4.8
Pertussis
39
1.7
53
2.2
Rubella
8
0.3
5
0.2
Tuberculosis (Pulmonary)
6
0.3
7
0.3
Page 12
Quarterly Summary Report: 4th Quarter - 2012
Viral Hepatitis incident Rate in Abu Dhabi
Emirate (2011-2012)
35.0
27.4
Cases / 100.000
30.0
2011
2012
25.0
21.3
17.9
20.0
15.0
12.7
11.6
10.0
5.9
5.0
0.0
Hepatisi A
Hepatisi B
Hepatisi C
Type
Overall, there is an increase in rate of reported hepatitis cases from 36.5/100,000 in 2011 to 60.4/100,000
in 2012 (an increase of about 65 %). This needs further investigation to understand whether this is due
to better detection and reporting, or it indicates a real
increase in acute or newly detected cases. It should
be note that, this figure includes both suspected and
confirmed cases
It is interesting to find that the rate of reported Hepatitis B cases across ages has a totally different profile
among nationals and expatriates. The rate among
expatriates increases almost steadily with an increase
in age; while among nationals the rate increases
largely after the age of 20 years and continue to
show a relatively high rate among other age groups.
Knowing that in UAE, Hepatitis B vaccine was first
introduced in Oct 1991, can explain such age profile
among nationals.
Hepatitis B Incident Rate among Expatriates by
Age in Abu Dhabi Emirate (2011-2012)
Hepatitis B Incident Rate among Nationals by
Age in Abu Dhabi Emirate (2011-2012)
2011
140.0
140.0
2012
120.0
Cases / 100.000
100.0
2012
80.0
60.0
40.0
100.0
80.0
60.0
40.0
20.0
20.0
0.0
0.0
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
40-74
75+
Cases / 100.000
2011
120.0
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
40-74
40.0
Age Group
Age Group
Reported Infectious Diseases in Abu Dhabi Emirate, 2012 by Gender, Nationality, and Region
Relative % and (Rate/100,000)
By Gender
Females
Males
By Nationality
Nationals
Expatriates
By Region
Abu Dhabi Region
Western Region
Eastern Region
11%
27%
33%
(1185)
(930)
67%
(744)
(1149)
25%
(1067)
73%
64%
(694)
(711)
Quarterly Summary Report: 4th Quarter - 2012
Page 13
2500
Females
Notification rates of Influenza cases by age
and gender Abu Dhabi, 2012
250.0
Males
Females
150.0
40-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
0.0
25-29
0
20-24
50.0
15-19
500
5-9
100.0
10-14
1000
0-4
This should
remind us of
the
importance of
flu vaccine
for the elderly
to avoid
complications.
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
40-74
75-79
85+
Cases/100,000
1500
All these
rates come in
line with the
age-specific
rates in other
places
Age in years
Age in years
Notification rates of Hepatitis A Cases by age
and gender Abu Dhabi, 2012
90.0
80.0
Females
300.0
Notification Rates of Pulmonary TB Cases by age
and gender Abu Dhabi, 2012
Males
Females
Males
250.0
70.0
60.0
Cases/100,000
50.0
40.0
30.0
200.0
150.0
100.0
20.0
50.0
10.0
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
0.0
0.0
0-4
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
40-74
75-79
80-84
85+
Cases/100,000
Males
200.0
2000
Cases/100,000
As shown in
page 12, we
started to see
a decline in
reported
cases (mostly
among the
age group
0-4 (the
vaccine
introduced in
2011).
Notification rates of Chickenpox cases by age
and gender Abu Dhabi, 2012
Age in years
Age in years
Top ten notified illnesses in Abu Dhabi 2012, by relative percentages out of total
notifications
Influenza
1.60%
Amebiasis
2.10%
Tuberculosis (Pulmonary)
2.10%
Hepatitis C Unspecified
2.30%
Typhoid/ Paratyphoid Fever
2.30%
Hepatitis B Unspecified
2.70%
Scabies
Foodbornw Illness
Malaria
51.10%
Page 14
3.90%
5.90%
14.10%
Chickenpox
Quarterly Summary Report: 4th Quarter - 2012
Activities
The Communicable Diseases Department at HAAD conducted several trainings during the fourth quarter of 2012; these included:
1) Outbreak Management Training
Workshop
In collaboration with the Omani Ministry of Health, HAAD
Communicable Diseases Department conducted a four-day
training course on outbreak management, during the period
Oct 21-24 2012. The course aimed to develop skills and
capacity amongst HAAD staff and other stakeholders that are
involved in outbreak situations, through a specially structured
field-oriented program. A total of 35 participants attended
the course; these included staff from HAAD, UAE Ministry of
Health, Dubai Health Authority, SEHA health facilities, Zayed
Military Hospitals, private health sector, Abu Dhabi Food
Control Authority (ADFCA), and the National Crisis and Emergency Management Authority (NCEMA). The participants were
trained in all aspects of outbreak management, to enable
them put into practice the right methods elaborated in the
course modules. Various techniques of training were used,
including presentations, case studies, role play, exercises,
demonstration, and interaction among participants.
2) Cold Chain Training Workshops
for School Nurses:
HAAD Communicable Disease Department conducted three
training workshops for school health nurses in the Emirate of
Abu Dhabi. The workshops were held during the last third of
December in the regions of Abu Dhabi (Al Ain -23rd December 2012, Western Region -25th December 2012, and Abu
Dhabi Region - 26th December 2012). The aim of the training
workshops was to increase the awareness of school nurses
on the subject of cold chain and its importance, cold chain
monitoring devices, vaccine refrigerators and storage temperatures, and icepacks conditioning. A total of 170 school
nurses attended the workshop in Abu Dhabi, 140 in Al Ain,
and 47 in the western region.
Quarterly Summary Report: 4th Quarter - 2012
Page 15
3) HIV Workshop with Stakeholders
The Health Authority – Abu Dhabi (HAAD), in coordination
with the Red Crescent and Ministry of Health, conducted in
December 17 2012 a workshop on HIV/AIDS, to discuss with
the strategic partners the implementation of the National HIV
Program and the main challenges facing it. The workshop;
named “Human Immunodeficiency Virus - Roles and Challenges”, indicated that all parties need to work together in
raising community awareness about HIV/AIDS, combating
the misconceptions about the disease, encouraging voluntary
testing for HIV, establishing social support groups to provide
proper counseling and advising to people living with HIV, and
protecting the rights of infected people as mentioned in the
Ministerial Decree No. 29 for the year 2010. The workshop
has also shared the UAE Red Crescent experience of raising
awareness through the so called (Y-peer program) in which
a group of youth volunteers commit to educate their peers
through a number of recreational activities, with the aim of
raising awareness on many health-related issues including
prevention of AIDS and other sexually transmitted diseases.
4) On-site Training on E-Infectious
Diseases Notifications and Programs
On Dec 2012, a team of the Communicable Diseases Department made a field visit to Delma Hospital in Delma Island at
the Western Region. The visit included on-site training for the
staff, on the electronic notification of infectious diseases, and
the importance of complying with HAAD requirements on a
number of disease control programs. A special focus was
given to the implementation of the TB Control Program and
its reporting mechanisms, along with HAAD DOT Standard to
control this challenging disease. The training has also emphasized on the importance of the Acute Flaccid Paralysis (AFP)
surveillance, and the necessity of abiding by the WHO requirements of reporting suspected AFP cases and the active
search for doubtful ones, which is the milestone of the Polio
Eradication Program worldwide, to ensure maintaining the
Polio-free status in UAE especially that two areas in a nearby
countries are still endemic with polio.
Page 16
Quarterly Summary Report: 4th Quarter - 2012
Communicable Diseases Department activities 2012 − in pictures!
Outbreak management Course - Dr. Farida Al Hosani closure speech
HAAD and stakeholders discuss implementation of HIV program
Series of meetings to implement TB DOT program in Abu Dhabi
Premarital screening scientific program for service providers
Mobile vaccination campaigns in Primary Healthcare Centers
A field visit with Malaria Elimination group to explain UAE experience
Quarterly Summary Report: 4th Quarter - 2012
Page 17
Active surveillance and field visits by the team
Active surveillance and field visits by the team
Active surveillance and field visits by the team
Communicable Diseases Officers conducting investigations for received
notifications
Discussing HIV law and suggested work on obstacles
With stakeholders for better outbreak response capacity
Page 18
Quarterly Summary Report: 4th Quarter - 2012
Flash News
HAAD Alert Circular on Coronavirus:
In the 30th of Dec. 2012, the Health Authority of Abu Dhabi issued alert circular to all healthcare
facilities in the Emirate of Abu Dhabi, to raise awareness about an unusual type of coronavirus
that has been isolated (last WHO report indicates a total of 14 confirmed cases globally, including
eight deaths; updated Mar 6, 2013) . HAAD circular required health professionals in Abu Dhabi to
immediately report any case that fits the case definition. The case definition and the process to
follow for a suspected coronavirus infection were both attached to the circular. Healthcare facilities
were also asked, in the same circular, to report any case admitted to the ICU and that fits the case
definition of novel coronavirus infection to HAAD Operation Center immediately by phone (024193666) or by email [email protected]. The circular is available at:
http://www.haad.ae/haad/tabid/183/Default.aspx (dated 30 Dec 2012).
Release of HAAD Standard for Thiqa List of Preventive Interventions:
Consistent with HAAD’s vision for World-class quality healthcare including health protection and
promotion, HAAD approved the revised HAAD Standard for Thiqa List of Preventive Interventions
Version 1.2. This standard ensures alignment with HAAD clinical care standards concerning preventive interventions such as immunizations and screening (for both communicable and non-communicable health conditions), and includes references to the respective standards. This standard
applies to all HAAD licensed healthcare providers wishing to provide services in support of the
Thiqa preventive interventions, and as consistent with DAMAN’s network arrangements (effective
from January 2013). The standard and full list of covered services is available at
http://www.haad.ae/haad/tabid/819/Default.aspx (dated Jan 2013).
New version! HAAD Childhood and Young Adult Immunization Standard
HAAD Communicable Diseases Department has just issued the new standard for Childhood
and Young Adult Immunization - version 0.9, to establish the requirements for recommended
safe immunization practices. The standard includes HAAD Immunization schedule and additional
vaccines for special purposes like Travel and Haj vaccines. It details the requirements for vaccine
handling and management service, vaccine administration, required healthcare professionals training, immunization for groups with special health needs, and management, monitoring and reporting of adverse events following immunization to ensure the quality and safety of the immunization
services in the Emirate of Abu Dhabi. In addition, the standard includes the duty to report and
submit immunization data to HAAD electronic Immunization Information System (IIS), and explains
the type of requested data with emphasizing on the importance of data accuracy and validation.
Reporting immunization data would be very crucial to understand and detect immunization gaps,
and ensure improvement in immunization coverage. The new standard is available at
http://www.haad.ae/haad/tabid/819/Default.aspx (dated Jan 2013).
Updated HAAD Standard for DOT Program
HAAD has revised Version 0.9 of its standard for Directly Observed Treatment (DOT) of patients
with tuberculosis. The revision took into consideration lessons learnt during implementation of
Version 0.9, and feedback from stakeholders. The new version requires mandatory compliance
with the requirements of the standard, provides a detailed payment mechanism, and includes the
Patient Consent Form in Arabic. The standard is available at
http://www.haad.ae/haad/tabid/819/Default.aspx (dated Nov 2012)
Quarterly Summary Report: 4th Quarter - 2012
Page 19
New CDC iPad application “Solve the Outbreak”!
The Centers for Disease Control and Prevention (CDC) has very recently announced the release of a new iPad app that lets users assume
the role of a disease outbreak investigator by navigating three fictional
outbreaks based on real-life events. According to the CDC Director Dr.
Tom Frieden, this application shows the challenges of solving outbreaks
and how CDC outbreak investigators work on the front lines and fly at
a moment notice to investigate mysterious outbreaks, and to save lives and protect people. In
the game, participants become familiar with health tips, definitions and information about epidemiology. Users earn points and can post their results on Facebook and Twitter to challenge other
participants. The application is available in the iTunes store at:
https://itunes.apple.com/US/app/id592485067 .
Hepatitis B infection despite vaccination as infants
Infection with hepatitis B virus (HBV) is a global health concern even with the universal vaccination
success against the virus in infants. The World Health Organization (WHO) estimates two billion
individuals worldwide have HBV infection, with 360 million are chronic carriers of the hepatitis B
surface antigen (HBsAg). A recent research on 8,733 senior high school students, who were assessed for hepatitis B surface antigen (HBsAg) and antibodies to HBsAg (anti-HBs), reveals that a
significant number of adolescents lose their protection from HBV infection, despite having received
a complete vaccination series as infants. The study found that teens with high-risk mothers (those
positive for HBeAg) and teens whose immune system fails to remember a previous viral exposure
(immunological memory) are behind HBV reinfection. Among students who did not receive HBIG,
recipients of 1 to 2 doses of HBV vaccine were about three folds more likely to have HBsAg than
those who received four doses of the vaccine. Among HBIG recipients, the HBsAg-positive rate
was significantly higher in subjects with maternal hepatitis B e antigen (HBeAg) positivity and who
received HBIG off-schedule (HEPATOLOGY Jan 2013; published earlier at 10.1002/hep.25988).
New CDC Alerts and Guides - for two growing Antibiotic-Resistant Bacteria!
• Carbapenem-resistant Enterobacteriaceae (CRE): Enterobacteriaceae are a family of bacteria
that normally live in water, soil, and the human gut (Klebsiella and Escherichia coli are examples of these bacteria). CRE are Enterobacteriaceae that have developed high levels of resistance to antibiotics, including last-resort antibiotics called carbapenems; resulting in untreatable or difficult-to-treat multidrug-resistant organisms.
• Multi-drug resistant Neisseria gonorrhoeae: is a growing public health threat in many areas.
The CDC indicated several steps that are to be taken by public health bodies and their partners, to delay the emergence of cephalosporin-resistant strains, decrease the public health
consequences of expanded resistance, and prevent a return to the era of untreatable gonorrhea.
To all microbiologists, infection control professionals, and public health bodies!
Page 20
CDC Alert and Guideline on
CDC recommendations on
Carbapenem-resistant Enterobacteriaceae
The growing Multidrug-Resistant Gonorrhea
www.bt.cdc.gov/HAN/han00341.asp
http://www.cdc.gov/mmwr/pdf/wk/mm6206.pdf
Quarterly Summary Report: 4th Quarter - 2012
The volume “Flash- on-an-Illness”:
Influenza
Illness and cause: Influenza is a contagious respiratory illness caused by influenza viruses that infect the
nose, throat, and lungs. It can cause mild to severe illness, and at times can cause complications and may
lead to death.
Infectivity: Influenza viruses spread primarily by direct person to person transmission through large-particle
droplets when infected people cough, sneeze or talk, and their sprayed droplets land in the mouths or
noses of people who are nearby (at one meter distance or less). A person can also be infected by touching
contaminated objects and then touching his mouth, eyes, or nose. Airborne transmission via small-particle
residue of evaporated droplets that might remain suspended in the air for long periods of time is thought to
be possible, although supporting data are limited. The incubation period is 1—4 days. Most healthy adults
can infect others beginning 1 day before and up to 10 days after onset of symptoms; generally infectivity
decreases rapidly by 3-5 days. Young children might shed the virus several days before illness onset and for
more days after, and severely immunocompromised people can shed virus for weeks or months.
Clinical picture: Influenza mostly cause mild illness, do not need medical care or antiviral drugs, and recover
in less than two weeks. Symptoms and signs include fever, chills, cough, sore throat, runny or stuffy nose,
body aches, headaches, fatigue, and sometimes vomiting and diarrhea especially in children. Some people
are at high risk of developing influenza complications (old people, young children, pregnant women, and
people with certain health conditions); these mainly include pneumonia, bronchitis, sinusitis, and otitis media.
Influenza may also cause chronic health problems to become worse.
Diagnosis: Rapid influenza diagnostic tests (RIDTs) are immunoassays that can identify the presence of
influenza A and B viral nucleoprotein antigens in respiratory specimens, and display the result as positive or
negative in 15 minutes or less. However, RIDTs have limited sensitivity and negative results should be interpreted with caution (i.e. possibly false negative). Some RIDTs distinguish between influenza A or B virus, but
do not provide information on influenza A virus subtype. When needed, respiratory specimens should be collected from ill persons (whether positive or negative by RIDT) and sent to a public health laboratory for more
accurate influenza testing. The reference standards for laboratory confirmation of influenza virus infection are
reverse transcription-polymerase chain reaction (RT-PCR) or viral culture. This is usually recommended when
there is a need to confirm or rule out influenza diagnosis, or when there is a history of recent exposure to
pigs, birds, or other animals, where novel influenza A virus infection is possible.
Treatment: Influenza antiviral drugs can be used to treat or to prevent influenza. The two medications Zanamivir and Oseltamivir are the most recommended for currently circulating influenza strains. The best way to
prevent the flu is by getting the influenza vaccine each year.
Occurrence: The global burden of seasonal influenza is estimated to approximates 600 million cases per
year; 3 million cases of severe illness and up to half million deaths annually. Influenza viruses are continuously
changing antigenically. As of the end of January 2013, a report by FluNet (a global tool for influenza virological
surveillance, which uses data from National Influenza Centres”NICs” of the WHO Global Influenza Surveillance
and Response System “GISRS” and other national influenza reference laboratories from 96 countries, areas
or territories), it has been mentioned that close to 80,000 specimens have recently been tested. More than
20,000 were positive for influenza viruses (82% influenza A and close to 18% influenza B). Of the influenza
A viruses, about 32% were influenza A (H1N1) pdm09, and 68% were influenza A (H3N2). Of the B viruses,
about 90% belong to the B-Yamagata lineage and 10% to the B-Victoria lineage.
Below figures show the epidemiology of influenza in Abu Dhabi Emirate based on reported cases during
2012.
Quarterly Summary Report: 4th Quarter - 2012
Page 21
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Quarterly Summary Report: 4th Quarter - 2012
Page 22
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Editorial Board
- Dr. Farida Al Hosani (Manager, Communicable Diseases Department, HAAD)
- Dr. Mariam Al Mulla (Senior Officer, Communicable Diseases Department, HAAD)
- Dr. Ahmed Abdulla (Senior Officer, Communicable Diseases Department, HAAD)
- Dr. Badreyya Al Shehhi (Senior Officer Vaccines, Communicable Diseases Department, HAAD)
- Dr. Kamal Jaafar (Senior Regional Officer, Communicable Diseases Department, HAAD)
- Dr. Ahmed Khudhair (Senior Regional Officer, Communicable Diseases Department, HAAD)
- Dr. Lamees Abu Haliqa (Senior Regional Officer, Communicable Diseases Department, HAAD)
- Dr. Bashir Aden (Senior Officer, Surveillance Section, HAAD)
- Dr. Ghada Yahia (Senior Regional Officer, Communicable Diseases Section, HAAD)
Scientific Board
- Dr. Iain Blair (Associate Professor, Community Medicine, UAEU)
- Prof. Tibor Pal (Professor, Department of Medical Microbiology, UAEU)
- Dr. Agnes Sonnevend (Assistant Professor, Department of Medical Microbiology, UAEU)
- Dr. Ahmed Al Suwaidi (Consultant Pediatric Infectious Diseases, Assistant Professor, UAEU)
- Dr. Rayhan Hashmey (Consultant Infectious Diseases, Tawam Hospital)
- Dr. Bashir Aden (Senior Officer, Surveillance Section, HAAD)
- Dr. Jamal Al Mutawa (Manager, External Services Department, HAAD)
We are glad to invite your participation in this bulletin,
please contact:
Dr. Ghada Yahia
Communicable Diseases Department
Health Authority – Abu Dhabi
Tel: 03 7041130
Fax: 03 7679556
Email: [email protected]
Quarterly Summary Report: 4th Quarter - 2012
Page 23