Mamunur Malik

Human Monkeypox Outbreak Caused by Novel Virus Belonging to Congo Basin Clade, Sudan, 2005

TOC Summary: This virus should be considered endemic to the wetland areas of Bentiu, Unity State, Sudan.

Chikungunya outbreak in Al-Hudaydah, Yemen, 2011: Epidemiological characterization and key lessons learned for early detection and control

Little is known about the occurrence of chikungunya fever in the Eastern Mediterranean Region of the World Health Organization (WHO). In January 2011, the Ministry of Public Health and Population (MoPH&P) of Yemen reported to WHO an increasing number of “dengue-like” acute febrile illnesses of unknown origin from one of its coastal governorates. An epidemiological investigation was conducted in Al-Hudaydah governorate between 23 and 26 January 2011 by a joint team of WHO, the MoPH&P of Yemen and the U.S. Naval Medical Research Unit (NAMRU-3) in Cairo, Egypt. The investigation led to the detection of an outbreak of chikungunya in Yemen which was the first time ever from any of the 22 countries in the Eastern Mediterranean Region of WHO. Appropriate public health control measures were strengthened following the investigation, and the outbreak was contained. This paper provides a short description of the outbreak and its epidemiological characteristics and highlights the important lessons that were learned for early detection and control of chikungunya in countries where competent vectors for transmission of the virus exist.

Current status of Crimean-Congo haemorrhagic fever in the World Health Organization Eastern Mediterranean Region: issues, challenges, and future directions

Summary Crimean-Congo haemorrhagic fever (CCHF) is the most widespread, tick-borne viral disease affecting humans. The disease is endemic in many regions, such as Africa, Asia, Eastern and Southern Europe, and Central Asia. Recently, the incidence of CCHF has increased rapidly in the countries of the World Health Organization Eastern Mediterranean Region (WHO EMR), with sporadic human cases and outbreaks of CCHF being reported from a number of countries in the region. Despite the rapidly growing incidence of the disease, there are currently no accurate data on the burden of the disease in the region due to the different surveillance systems used for CCHF in these countries. In an effort to increase our understanding of the epidemiology and risk factors for the transmission of the CCHF virus (CCHFV; a Nairovirus of the family Bunyaviridae) in the WHO EMR, and to identify the current knowledge gaps that are hindering effective control interventions, a sub-regional meeting was organized in Muscat, Oman, from December 7 to 9, 2015. This article summarizes the current knowledge of the disease in the region, identifies the knowledge gaps that present challenges for the prevention and control of CCHFV, and details a strategic framework for research and development activities that would be necessary to curb the ongoing and new threats posed by CCHFV.

Current and future distribution of Aedes aegypti and Aedes albopictus (Diptera: Culicidae) in WHO Eastern Mediterranean Region

BackgroundAedes-borne diseases as dengue, zika, chikungunya and yellow fever are an emerging problem worldwide, being transmitted by Aedes aegypti and Aedes albopictus. Lack of up to date information about the distribution of Aedes species hampers surveillance and control. Global databases have been compiled but these did not capture data in the WHO Eastern Mediterranean Region (EMR), and any models built using these datasets fail to identify highly suitable areas where one or both species may occur. The first objective of this study was therefore to update the existing Ae. aegypti (Linnaeus, 1762) and Ae. albopictus (Skuse, 1895) compendia and the second objective was to generate species distribution models targeted to the EMR. A final objective was to engage the WHO points of contacts within the region to provide feedback and hence validate all model outputs.MethodsThe Ae. aegypti and Ae. albopictus compendia provided by Kraemer et al. (Sci Data 2:150035, 2015; Dryad Digit Repos, 2015) were used as starting points. These datasets were extended with more recent species and disease data. In the next step, these sets were filtered using the Köppen–Geiger classification and the Mahalanobis distance. The occurrence data were supplemented with pseudo-absence data as input to Random Forests. The resulting suitability and maximum risk of establishment maps were combined into hard-classified maps per country for expert validation.ResultsThe EMR datasets consisted of 1995 presence locations for Ae. aegypti and 2868 presence locations for Ae. albopictus. The resulting suitability maps indicated that there exist areas with high suitability and/or maximum risk of establishment for these disease vectors in contrast with previous model output. Precipitation and host availability, expressed as population density and night-time lights, were the most important variables for Ae. aegypti. Host availability was the most important predictor in case of Ae. albopictus. Internal validation was assessed geographically. External validation showed high agreement between the predicted maps and the experts’ extensive knowledge of the terrain.ConclusionMaps of distribution and maximum risk of establishment were created for Ae. aegypti and Ae. albopictus for the WHO EMR. These region-specific maps highlighted data gaps and these gaps will be filled using targeted monitoring and surveillance. This will increase the awareness and preparedness of the different countries for Aedes borne diseases.

Burden of acute respiratory disease of epidemic and pandemic potential in the WHO Eastern Mediterranean Region: A literature review.

There are gaps in the knowledge about the burden of severe respiratory disease in the Eastern Mediterranean Region (EMR). This literature review was therefore conducted to describe the burden of epidemicand pandemic-prone acute respiratory infections (ARI) in the Region which may help in the development of evidence-based disease prevention and control policies. Relevant published and unpublished reports were identified from searches of various databases; 83 documents fulfilled the search criteria. The infections identified included: ARI, avian influenza A(H5N1), influenza A(H1N1)pdm09 and Middle East respiratory syndrome coronavirus (MERS-CoV) infection. Pneumonia and ARIs were leading causes of disease and death in the Region. Influenza A(H1N1) was an important cause of morbidity during the 2009 pandemic. This review provides a descriptive summary of the burden of acute respiratory diseases in the Region, but there still remains a lack of necessary data.

Middle East respiratory syndrome coronavirus: current knowledge and future considerations.

A literature review of publically available information was undertaken to summarize current understanding and gaps in knowledge about Middle East respiratory syndrome coronavirus (MERS-CoV), including its origin, transmission, effective control measures and management. Major databases were searched and relevant published papers and reports during 2012-2015 were reviewed. Of the 2520 publications initially retrieved, 164 were deemed relevant. The collected results suggest that much remains to be discovered about MERS-CoV. Improved surveillance, epidemiological research and development of new therapies and vaccines are important, and the momentum of recent gains in terms of better understanding of disease patterns should be maintained to enable the global community to answer the remaining questions about this disease.

Design and implementation of a national public health surveillance system in Jordan.

Understanding and improving the health status of communities depend on effective public health surveillance. Adoption of new technologies, standardised case definitions and clinical guidelines for accurate diagnosis, and access to timely and reliable data, remains a challenge for public health surveillance systems however and existing public health surveillance systems are often fragmented, disease specific, inconsistent and of poor quality. We describe the application of an enterprise architecture approach to the design, planning and implementation of a national public health surveillance system in Jordan. This enabled a well planned and collaboratively supported system to be built and implemented using consistent standards for data collection, management, reporting and use. The system is case-based and integrated and employs mobile information technology to aid collection of real-time, standardised data to inform and improve decision-making at different levels of the health system.

Zika virus: no cases in the Eastern Mediterranean Region but concerns remain.

Following the WHO declaration on 1 February 2016 of a Public Health Emergency of International Concern (PHEIC) with regard to clusters of microcephaly and neurological disorders potentially associated with Zika virus, the WHO Regional Office for the Eastern Mediterranean conducted three rounds of emergency meetings to address enhancing preparedness actions in the Region. The meetings provided up-to-date information on the current situation and agreed on a set of actions for the countries to undertake to enhance their preparedness and response capacities to Zika virus infection and its complications. The most urgent action is to enhance both epidemiological and entomological surveillance between now and the coming rainy seasons in countries with known presence of Aedes mosquitoes. Zika virus like other vector-borne diseases poses a particular challenge to the countries because of their complex nature which requires multidisciplinary competencies and strong rapid interaction among committed sectors. WHO is working closely with partners and countries to ensure the optimum support is provided to the countries to reduce the risk of this newly emerged health threat.

Influenza in the Eastern Mediterranean Region: identifying the unknowns for detection and control of epidemic and pandemic threats.

Acute respiratory illnesses and influenza-like illnesses (ILI) are a significant cause of morbidity and mortality worldwide. Data from developed countries reveal that seasonal influenza can affect up to 15% of the population presenting with upper respiratory tract infections and may result in up to 500 000 deaths worldwide annually. Despite their public health importance, little was known about the aetiology of these illnesses in the countries of the WHO Eastern Mediterranean Region (EMR).

Interpreting Results From Environmental Contamination Studies of Middle East Respiratory Syndrome Coronavirus

TO THE EDITOR—Middle East respiratory syndrome coronavirus (MERS-CoV) continues to pose a threat to human health among populations in contact with infected dromedary camels and globally through the travel of persons who acquired infection from areas with enzootic dromedary infection. Transmission of MERS-CoV is categorized as zoonotic, with repeated introductions into the human population after contact with infected dromedaries, resulting in limited human-to-human transmission, notably in healthcare settings [1] The MERS-CoV outbreak in South Korea in 2015, resulting in 186 cases and 38 deaths [2], reminds us that the introduction of a single case into an unsuspecting healthcare system can trigger a very large outbreak with serious public health and socioeconomic consequences. Although we have known for quite some time that nosocomial transmission is responsible for more than half of reported MERS-CoV cases worldwide [1], we know little about how transmission occurs in healthcare settings. We have suspected, and our involvement in several missions to affected countries in the Kingdom of Saudi Arabia, Jordan, and South Korea has confirmed, that delayed recognition and slow isolation of infected patients, extended stays in overcrowded emergency rooms, and suboptimal adherence to infection prevention and control procedures have been responsible for secondary cases in these settings [3], but the role of environmental contamination has received relatively little attention. Researchers in Korea have recently published studies [4, 5] evaluating environmental and/or air contamination by MERS-CoV and should be commended for their efforts to evaluate the hospital outbreaks in their country. Taken together, these results from Kim et al [4]and others [5–6]suggest thatMERSCoV can persist on the surfaces in contaminated environments, such as patient rooms and equipment, and underscore the critical importance of adequate and thorough disinfection of patient rooms during and after their treatment in healthcare settings. Although the findings from Kim et al [4] are very interesting and raise questions about the potential presence of MERSCoV in the air, they provide no evidence of airborne transmission. Some concerns have been expressed that the claimed “virus isolation” did not yield virus isolates but rather was based on reverse-transcription polymerase chain reaction detection of infected cells [7]. Kim et al [4] did go further to demonstrate passage of virusinfected cells leading to detectable viral antigen detection, which is better evidence of replicating virus. We are aware of a number of other environmental studies conducted in hospitals that have found surface contamination but have not been able to isolate virus from air samples. These studies have not yet been published in the peer-reviewed literature. It is important that these and any negative results are also published, or else we will be left with a skewed selection of positive findings. The partial inconsistencies in results between studies will need further examination. In particular, it is important that future studies include “negative controls”with comparable sampling and testing strategies applied in settings where patients with MERS were not housed. To fully understand the possible role of environmental contamination, including the possible detection of MERS-CoV in the air, additional studies must be conducted to see whether these results can be replicated— for example, in hospitals in the Middle East where patients with MERS-CoV are treated, to evaluate virus persistence in hospital environments. A more complete understanding of the results of environmental and air contamination studies will have important implications for the application of infection prevention and control measures [8] currently used in hospitals treating patients with MERS-CoV, possibly leading to more detailed recommendations.