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.
Page 6
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)