Quarterly Summary Report Third Quarter 2012 (Jul Sep) Volume 3; Issue Number 3; Communicable Diseases Bulletin

Quarterly Summary Report Third Quarter – 2012 (Jul – Sep) Volume 3; Issue Number 3; 2012 Communicable Diseases Bulletin 800 555 www.haad.ae Fore...
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Quarterly Summary Report

Third Quarter – 2012 (Jul – Sep) Volume 3; Issue Number 3; 2012

Communicable Diseases Bulletin

800 555

www.haad.ae

Foreword While reviewing the list of infectious diseases reported to HAAD, I would encourage you to think of the following: Are we prepared for a next outbreak? We started to learn more about the trends of certain infectious diseases in our community by strengthening the infectious diseases surveillance. We noticed an increase in the total number of notifications received in the current years after the introduction of the electronic system for infectious diseases notifications (e – IDN). Looking at the cases reported with foodborne illnesses shows that we have now a real-time reporting mechanism that allows early detection and timely investigation of foodborne outbreaks. However, we need to work together for a systematic and better-coordinated outbreak response and control measures towards any outbreaks/epidemics that might hit the community. Being prepared for outbreaks is a multidisciplinary effort that we need to improve by understanding the role of different parties inside and outside the health field; this would include the role of our organization and that of each individual and authority, from early reporting of a case/s, investigation, planning for action, coordination and monitoring, and collective actions to control the outbreak.

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: 3rd 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 3, 2012)

4

IV

Notified illnesses in Abu Dhabi Emirate by age & gender (Q3, 2012)

5

V

Monthly trends for selected notified diseases in Abu Dhabi Emirate (Q1-Q3/2012 Vs 2010 and 2011)

6

VI

Visa screening applicants in Abu Dhabi Emirate (Q3 /2012)

7

VII

Topic of the volume: Measles and Rubella- WHO elimination efforts

VIII

Sharing Reports: Abu Dhabi Emirate Antimicrobial Resistance Surveillance Program: Key Findings 2011

IX

Activities

13-14

X

Flash news

15-16

XI

The volume “Flash- on-an-Illness”: Hepatitis B

17-18

Quarterly Summary Report: 3rd Quarter - 2012

Page

8-11 12

Page 3

Table 1: Notified Illnesses in Abu Dhabi Emirate by Region (Quarter 3, 2012)

Cases

Abu Dhabi

Eastern Western Region Region

Quarter 3

Cumulative in Abu Dhabi Emirate ( Q1-Q3 ) Q1

Q2

58

2012

Year Total

2011 2010 2011 2010

Q3

TOTAL

15

11

6

14

11

41

119

54

39

73

52

AFP *

2

0

0

Brucellosis

30

8

3

20

Chickenpox

872

297

148

2791

5

0

0

0

1

5

6

5

5

9

11

147

86

34

253

374

267

894

575

426

667

561

Haemophilus influenzae invasive

0

0

0

0

0

0

0

23

0

23

14

Hepatitis A

54

17

2

53

51

73

177

100

123

138

193

Hepatitis B

116

40

4

131

194

160

485

544

572

655

711

Hepatitis C

87

21

1

107

169

109

385

473

507

559

668

Influenza

18

2

0

79

31

20

130

187

166

238

248

Malaria * ¶

585

405

170

265

692

1160

2117

2129

973

2760

1415

Measles *

4

1

0

14

2

5

21

38

41

55

50

Meningitis (bacterial)

7

4

1

9

11

12

32

23

31

31

39

Meningitis (viral)

15

1

0

6

14

16

36

33

28

38

36

Mumps

27

6

5

37

69

38

144

161

177

194

221

Pertussis

10

3

1

9

27

14

50

30

46

39

73

Rubella *

4

0

0

2

6

4

12

41

19

43

22

Scabies

119

31

1

195

176

151

522

451

520

585

654

Shigellosis

9

1

0

7

9

10

26

29

42

41

51

Tetanus

0

0

0

1

0

0

1

3

1

3

1

Tuberculosis (Pulmonary) *

60

20

12

89

93

92

274

372

327

452

450

Tuberculosis (Extra-Pulmonary)

45

10

2

43

55

57

155

149

130

180

175

Typhoid /Paratyphoid

85

23

2

130

129

110

369

272

257

394

347

Other diseases

238

44

34

327

373

316

1016

1039

683

1342

968

Total

2539

1020

420

4575

7175

3979 15729 17295 11497 20281 14400

Grand total including ruled out notifications

2780

1118

473

4889

7522

4371 16782 18128 11810 21373 14949

Cholera Foodborne illnesses **

7

6

2

4635 1317

8743 10553 6378 11748 7429

Illnesses covered by national control programs (only confirmed cases and cases that cannot be ruled out are included in the table) Foodborne illnesses other than those specified in the list All notified malaria cases are “imported” Indicates increase or decrease in number of notified cases during the 3rd quarter of 2012 compared to previous quarters Indicates increase or decrease in numbers of notified cases over Q1-Q3 2012 compared to the cumulative over previous two years

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Quarterly Summary Report: 3rd Quarter - 2012

Table 2: Notified Illnesses in Abu Dhabi Emirate by Age & Gender (Q3, 2012)

Cases

Total 1

AFP 5 32

2

10

1

2

7

7

1

1

4

51 133 118 149 146 54 132 69 295 15

93

6

15

Cholera Foodborne Illness

3

2

Brucellosis Chickenpox

2

1

17

41

35

14

14

8

17

1

2

20

52

6

16

5

10

1 2 1

4

1

1

1

3

2 1

Haemophilus influenzae 7

Hepatitis A

9

20

Hepatitis B 1 2

Malaria Measles

1

Meningitis bacterial

1

3

Meningitis viral

5

2

Mumps Pertussis

7

Scabies

3

Shigellosis

267

0

0

0

33

40

73

9

26

6

16

1

4

2

3

56

104

160

1

4

8

25

2

29

5

16

5

10

2

2

23

86

109

2

1

2

4

2

1

1

11

9

20

5

208

1

125

43

1

2

1

1

2

1

2

1 1

2

3

1

1

1

6

3

1

2

7

6

3

9

24

3

3

1

1

1

1

2

4

51

1

10

4

22

1

6

5

3

9

12

8

8

16

16

22

38

8

6

14

1

3

4

24

127

151

5

5

10

0

0

0

36

56

92

11

46

57

1

30

80

110

1

111

205

316

1

1

5

1

1

1

1

9

17

13

15

2

2

11

5

19

6

10

3

10

8

1

2

1

1

5

3

1113 1160 3

3

2

47 2

1

2

1

Tuberculosis (Extra-Pulmonary)

165

41

12 288 10 431

1

102

29

8

1

5

12

Tetanus Tuberculosis (Pulmonary)

3

9

1 1

2

2

16

Rubella

856 1317

1

6

1

461

1

3

1

41

5

2

5

27

3

1

5

14

6

2

5

2

2

1

1

2

19

Hepatitis C Influenza

0

2

Typhoid /Paratyphoid Fever

1

Other Diseases

3

4

1

5

1

Total

59

89 234 219 241 229 125 558 201 1051 76 487 42 240 13

87

13 15 1004 2975 3979

6

3

3

3

7

12

5

31

4

18

4

9

25

24

20

9

16

28

28

64

13

42

4

28

3

4371 * 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 after including all ruled out notifications.

Quarterly Summary Report: 3rd Quarter - 2012

Page 5

Monthly Trends for Selected Notified Diseases in Abu Dhabi Emirate (Q1-Q3/2012 Vs 2010 and 2011) Although cases of chickenpox have decreased compared to 2011, the trend of seasonality is very similar over the three years.

Chickenpox

2500

Salmonella Rotavirus Unspecified Adenovirus Other Total

49 78 131 8 1 267

Foodborne Illnesses 2010 2011

2000

160

2012

Number of notified cases

Number of notified cases

Similar to last two years, a new peak occurred during the month of July, but it was also much smaller than that of Q2.

1500

1000

500

140

2010

120

2011 2012

100 80 60 40 20 0 Jan

0 Jan

Feb

Mar

Apr May

Jun

Jul

Aug

Sep

Oct

Feb

Mar Apr May

Jun

Jul

Aug

Sep Oct Nov

Dec

MONTH

Nov Dec

MONTH

More than 90% were confirmed (Anti HAV IgM positive), and a travel history was reported by more than two thirds of the cases. Close to three quarters were children 1-14 years old.

Hepatitis A

2011

40

2012

35 30 25 20 15 10

2010

80

2011

70

2012

60 50 40 30 20 10

5 0

Typhoid/Paratyphoid

2010

45

Number of notified cases

Number of notified cases

50

Reported cases in quarter 3 continued to be less than the same period over last two years; with more than half the confirmed cases had a travel history.

0 Jan

Feb

Mar Apr May

Jun

Jul

Aug

Sep Oct Nov

Jan

Dec

Feb

Mar Apr May

MONTH

The seasonality of influenza is almost the same over the three years, where cases start to increase in September and usually peak in the first quarter of the year.

Jul

Aug

Sep

Oct Nov

Influenza

Malaria

500

2010

450

50

Number of notified cases

2010 2011

40

2012

30 20 10

Dec

All reported cases were imported, with no single case of endogenous transmission.

60

Number of notified cases

Jun

MONTH

2011

400

2012

350 300 250 200 150 100 50

0

Jan

Feb

Mar Apr May Jun

Jul Aug

Sep Oct Nov

Dec

0

Jan

Feb

MONTH

Mar Apr May Jun

Jul

Aug

Sep Oct Nov

Dec

MONTH

Note: HAAD surveillance officers investigate individual cases, assess for outbreaks, and take action whenever indicated.

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Quarterly Summary Report: 3rd Quarter - 2012

Visa Screening in Abu Dhabi Emirate (Q3-2012) 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 third quarter of 2012, a total of 245,028 applicants were screened in all HAAD-licensed Screening Centers (a total of ten centers in the three regions of Abu Dhabi). Visa screening applicants during third quarter 2012 300000 245028

250000 193385

No. of Applicants

200000

137820

150000

107208 100000 51643 50000

0

Male

Female

New

Gender

Renew

Total

Visa Status

The table below shows the number and prevalence of positive cases among new and renewal visa applicants during the third quarter of 2012. Hepatitis B*** Tuberculosis**

HIV Number Prevalence * Overall Prevalence

Leprosy

Syphilis***

New

Renew

New

Renew

New

Renew

New

34

5

198

8

76

29

0

0

230

0

24.7

4.7

710.4

52.3

55.1

27.1

0

0

825.2

0

15.9

477.1

42.9

Renew

0

New

Renew

532.7

* Prevalence: the number of positive cases per 100,000 visa screened applicants ** This refers to active TB cases only *** Applies to tested occupational categories

Quarterly Summary Report: 3rd Quarter - 2012

Page 7

TOPIC OF THE VOLUME Measles and Rubella – WHO elimination efforts! Background Inspite of available safe and effective vaccines, infections with measles, rubella, and congenital rubella syndrome (CRS) remain important causes of morbidity and mortality in many parts of the world. Measles is one of the most infectious human diseases and can cause serious illness, lifelong complications, and death. Before the availability of the vaccine, more than 90% of children used to be infected with measles before the age of 15 years, and these infections were estimated to cause more than two million deaths and up to 60 000 blindness cases worldwide. Despite all control efforts, the last global estimates indicated that in 2008 about 164,000 people died from measles, most of whom were children. In comparison, rubella infection causes a relatively mild disease in children. However, women infected with rubella during pregnancy can severely affect their fetuses, resulting in fetal death, or a combination of anomalies like heart disease, blindness, and deafness; that is collectively called congenital rubella syndrome (CRS). According to global estimates, the number of children born with CRS in 2008 is exceeding 110,000; making rubella a leading cause of preventable congenital defects. WHO global elimination efforts The success of countries in the Americas in stopping the spread of measles, urged the WHO with four other partners to launch the Measles Rubella Initiative in 2001 (formerly, Measles Initiative) to provide technical and financial support to different regions and countries to accelerate control activities and achieve the following elimination goals:

Global goals and milestones for Measles and Rubella elimination GOALS By end 2015 1) Reduce global measles mortality by at least 95% (compared to 2000) 2) Achieve regional goals on measles and rubella/CRS* elimination. By end 2020 Achieve measles and rubella elimination in at least five WHO regions.

Global MILESTONES by end of 2015! 1- Measles incidence < 5 Cases/Million a year 2- Vaccination coverage with first routine dose (MCV 1)** > 90% at National Level > 80% in Every District 3- Establish rubella/CRS elimination goal in at least three additional WHO regions. 4- Establish a target date For GLOBAL ERADICATION OF MEASLES

* CRS: Congenital Rubella Syndrome.

Page 8

** MCV1 (Measles Containing Vaccine – first dose)

Quarterly Summary Report: 3rd Quarter - 2012

The figure below shows WHO Regions and targeted years to achieve Measles and Rubella Elimination. (Years in black for measles; years in red for rubella)

Source: Global measles and rubella strategic plan: 2012-2020, WHO 2012

Elimination efforts in our region! As can be seen in the figure above, the Eastern Mediterranean Region of the WHO (EMRO) has defined 2015 as a target for measles elimination. Additionally, it is in the process of adopting a target for rubella elimination by 2020. EMRO has passed through the following main stations in elemination efforts:

1997

EMRO* Regional Committee passed a resolution to eleminate measles by 2010

1999

• EMRO developed a five-year plan for measles elemination based on the WHO-UNICEF joint startegy for measles mortality reduction. • Plan key elements included: 90% coverage of MCV1 in alldistricts; ensure second dose through one catchup campaign followed by follow-up campaigns every 3-4 years or introducing a second dose into routine EPI; stengthened surveillance;and optimal management ofchildren with measles.

2004

• Regional consultation to review progress in measles elemination and update regional plan and goals, And • Included recommendations on the prevention of congenital rubella syndrome (CRS). • In the previous 5-year plan, countries were encouraged to prevent CRS but there was no specific regional strtegy for that, and recommendations for use of rubella vaccine were not elucidated

2011 2012

EMRO revised the previous resolution of measles elemination by 2010, postponed the measles elemination target to 2015 • Regional Consultation on Rubella/CRS proposed 2020 as a target for rubella/CRS elemination from all countries of EMRO region. • Regional Committee endorsed rubella/CRS elemination target by 2020. • 15 countries from EMRO region have already established elimination target.

* EMRO: Eastern Mediterranean Regional Office of the WHO

Quarterly Summary Report: 3rd Quarter - 2012

Page 9

Incidence of Measles and Rubella/ 100,000 population in UAE 1990-2010 70

UAE – Situation and Elimination Plans

MEASLES

60

RUBELLA

50

Incidence

1998 United Arab Emirates developed a National Measles Elimination Plan in 1998. The plan aimed to eliminate endogenous transmission of measles in the UAE by 2005, by:

40 30 20 10

• Reducing susceptibility to infection • Improving surveillance

2007 The UAE developed its National Plan for Elimination of Measles, Rubella, and prevention of transmission of Congenital Rubella Syndrome (2007-2012). The plan had the following objectives: Year

• Interrupt endogenous transmission of measles. • Eliminate endogenous transmission of rubella. • Prevent congenital rubella infection (1/100,000 at sub-national level) Lower rates indicate under-reporting of suspected cases by healthcare providers! 60 50

MEASLES

RUBELLA

Targeted Outcome!

Incidence

• Measles incidence (confirmed/import related)