Contribution of laboratories in the WHO Eastern Mediterranean Region to the selection of candidate seasonal influenza vaccine, 2010-2015

The World Health Organization [WHO] formulates recommendations for viruses to be included in vaccines for the influenza seasons in the northern and southern hemispheres on the basis of analyses by its collaborating centres [CCs]. This report describes the contribution of influenza laboratories and national influenza centres in countries in the WHO Region for the Eastern Mediterranean to the selection process of seasonal and pre-pandemic influenza virus subtypes. Data submitted by 22 countries to FluNet and FluID between September 2010 and June 2015 were analysed. National Influenza Centres [NICs] in 12 countries [55%] reported data, 5 [23%] to both FluNet and FluID and 7 [32%] only to FluNet. The WHO CC in London characterized 78% of the samples, and the CC in Atlanta, characterized 21%. The contribution of influenza laboratories and NICs from this Region to global influenza surveillance is appreciable. However, enhancing the contribution through initiatives such as the Pandemic Influenza Preparedness Framework is still needed

Capacity of the national influenza surveillance system in Afghanistan, a chronic conflict setting

Influenza surveillance is needed to monitor potential public health threats from the emergence of novel influenza viruses. This study assessed the capacity and performance of the national influenza surveillance system in Afghanistan from 2007 to 2014. Data were collected by review of hospital registers and the National Influenza Centre [NIC] database, interviews with influenza focal points at 9 influenza sentinel surveillance sites and the Centre staff, and observation of the sites. Out of 6900 specimens collected, influenza virus was detected in 253 [3.6%], predominantly H1N1 [63%]; most of these cases were detected during the 2009 pandemic. The NIC had the capacity for virus isolation and PCR identification and performed reasonably until 2011 when support of the Naval American Medical Research Unit 3 was withdrawn. The limitations identified in the system indicated the need for: more complete data, improved technical competence and trained human resources, updating of the infrastructure/facilities, and the presence of standard operating procedures throughout surveillance

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 epidemic- and 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

H1N1 influenza pandemic of 2009 in the Eastern Mediterranean Region: lessons learnt and future strategy

A novel strain of influenza A virus H1N1 surfaced in Mexico in April 2009 and quickly spread across the globe, turning an epidemic into a pandemic. Within two months, the World Health Organization [WHO] declared an international health emergency and raised the threat bar from level V to level VI, i.e. containment to mitigation. During this time, the WHO Regional Office for the Eastern Mediterranean worked closely with its Member States, other stakeholders and WHO headquarters to manage the situation. This report examines the steps taken as part of this response. Programme documents were reviewed and key personnel interviewed for this study. A hallmark of the response was the establishment of the Strategic Health Operations Centre to bring together experts from different technical backgrounds at regional level. Several lessons were learnt that can provide the basis for standard operating procedures, protocols and guidelines for emergency events in future

Characteristics of severe acute respiratory infection associated hospitalization in Yemen, 2014/15

This study aims to describe etiological agents, demographic details of patients, seasonality and underlying conditions among patients hospitalized due to viral severe acute respiratory infection [SARI] in Yemen. We carried out a retrospective descriptive analysis of data from January 2014 to December 2015. Nasopharyngeal swabs were taken from each patient for laboratory testing. A total of 1346 diagnostic specimens were tested, of which 733 [54%] were positive for influenza viruses. Influenza A[H3] and A[H1N1] pdm09 predominated. Respiratory syncytial virus [RSV] was reported predominantly among children [41%]. Males [61%] were more affected than females. The median age was 1 year [range 0.5-94.0]. The median length of hospitalization was 6 days. Chronic cardiovascular disease was the most commonly reported underlying condition, but 67% had no documented underlying disease. Respiratory viruses, particularly RSV, adenovirus and influenza, were commonly associated with hospitalization for SARI

Estimation of the contribution of private providers in tuberculosis case notification and treatment outcome in Pakistan

To improve involvement of the private sector in the national tuberculosis [TB] programme in Pakistan various public-private mix projects were set up between 2004 and 2009. A retrospective analysis of data was made to study 6 different public-private mix models for TB control in Pakistan and estimate the contribution of the various private providers to TB case notification and treatment outcome. The number of TB cases notified through the private sector increased significantly from 77 cases in 2004 to 37 656 in 2009. Among the models, the nongovernmental organization model made the greatest contribution to case notification [58.3%], followed by the hospital-based model [18.9%]. Treatment success was highest for the district-led model [94.1%] and lowest for the hospital-based model [74.2%]. The private sector made an important contribution to the national data through the various public-private mix projects. Issues of sustainability and the lack of treatment supporters are discussed as reasons for lack of success of some projects

Treatment outcomes of various types of tuberculosis in Pakistan, 2006 and 2007

Measuring treatment outcome is important for successful tuberculosis [TB] control programmes. The purpose of this study was to examine the outcomes of various types of TB cases registered in Pakistan over a 2-year period and compare those outcomes among the different provinces and regions of the country. A retrospective, cohort study was conducted in which TB treatment outcome reports were reviewed. Of the 349 694 pulmonary TB cases registered in Pakistan during 2006 and 2007, 309 154 [88.4%] were treated successfully. Treatment success was significantly higher in new smear-positive cases and lower in retreatment cases. Among the provinces and regions, treatment success was significantly higher in 4 out of 8 provinces. Treatment success needs to be improved, particularly in retreatment cases. The national TB control programme should review the provincial and regional programmes and learn lessons from well-performing programmes. Patient factors that may affect the treatment outcome should be also studied

Report: communicable diseases in the Eastern Mediterranean Region: prevention and control 2010-2011

One-third of all morbidities and mortalities in the Eastern Mediterranean Region are attributed to communicable diseases. A continued situation of war and conflict, and growing political unrest in the Region, coupled with factors such as travel and migration, and insufficient infrastructure and inadequate technical and managerial capacity of the programmes are the major challenges. Despite these challenges, the Region continued making progress towards the elimination of specific diseases such as lymphatic filariasis, measles, malaria, schistosomiasis and dracunculiasis during 2010-11. Coverage for vaccine-preventable diseases was enhanced. Preparedness and response to emerging [e.g. dengue fever in Pakistan and Yemen] and re-emerging [e.g. cholera in Sudan] infections was improved. The Region has continued its efforts for controlling tuberculosis and curbing HIV/AIDS. Looking ahead, the Region aims to improve surveillance and response capacities, legislation issues, coordination, bio-risk and bio-security and quality management in the coming years

Promoting public-private mix for TB-DOTS: a multi-country study from the WHO Eastern Mediterranean Region

This study was carried out to document the implementation status of public-private mix [PPM] in 6 member countries of the World Health Organization Eastern Mediterranean Region, with a particular focus on advocacy, communication and social mobilization [ACSM] specific to PPM. Interviews and focus group discussions were held with staff of national tuberculosis control programmes and partners. Four PPM models were being practised. For all models, ACSM specific to PPM was at the elementary stage. Participants perceived that promoting private partners was difficult, specific policy guidelines were deficient and human resources and capacity for both initiatives were lacking across the region. Building ACSM capacity is required along with the development of guidelines and the implementation of country-specific communication plans to carry out local-level advocacy, strategic communication and effective social mobilization to maximize the benefits of PPM

Clinico hematologic features of immune thrombocytopenic purpura and its association with autoimmune disorders

Immune thrombocytopenic purpura [ITP] is a clinical syndrome in which a decreased number of circulating platelets [thrombocytopaenia] manifests as a bleeding tendency, easy bruising [purpura], or extravasation of blood from capillaries into skin and mucous membranes [petechiae]. Present study was done to observe the clinico-haematological features of ITP in Adults and to analyse the association of autoimmune disorders with ITP in Pakistani patients. It was a cross-sectional descriptive study conducted at Shaikh Zayed Hospital, Lahore, from 1st January 2006 to 30[th] June 2007. The study included 44 adult patients of both genders diagnosed as having ITP according to WHO guidelines. Bone marrow biopsy was carried out in all patients and other causes of thrombocytopaenia were carefully excluded. Antinuclear antibodies, rheumatoid factor, HBs Ag, anti HCV, HIV were also done. The data was analysed by SPSS version 10. Results showed peak incidence in third decade with female to male ratio of 3.1:. Bleeding and bruising were common symptoms of ITP. Seven [15.9%] of 44 patients had serological evidence of systemic autoimmune disorders, i.e., SLE or RA. Platelet count was significantly lower in SLE patients than in entire cohort. It was concluded that adult ITP is predominantly seen in young females, presents with bleeding from more than 2 sites and may be associated with autoimmune disorders at the time of diagnosis

Hyper eosinophilic syndrome; a case series

Hyper eosinophilic syndrome [HES] is a subset of idiopathic eosinophilia that fulfils the criteria of a persistent [>6 months] increase in absolute eosinophil count [AEC] [>1.5x10[9]/l] associated with target organ damage. Recently it was classified into myeloproliferative and lymphoid variants. Present study is aimed to study the clinico morphological features and variants of HES and their response to various therapeutic modalities. In Pakistani population. It is a case series conducted at Haematology department, Shaikh Zayed hospital, Lahore during 4 years from Jan 2005 to Dec 2008. This study included 8 adult patients of HES diagnosed on history, clinical features and elevated absolute eosinophil count [AEC]. Seven of 8 patients were of lymphoid-HES and 1 was of myeloproliferative-HES. M: F ratio is 7:1, mean age of presentation was 37 years in lymphoid- HES and 69 years in myeloproliferative -HES. Presenting features were fatigue, weight loss, fever, SOB, paraesthesia and skin rash. Mean AEC in l-HES was 16109/l and in myeloproliferative- HES was 22.7x109/l. Organ damage was seen in cardiovascular, gastrointestinal [GIT], respiratory and nervous systems. All of the lymphoid-HES responded to steroids. In conclusion, early diagnosis and targeted therapy improve outcome in HES

Uropathogens and their susceptibility pattern: a retrospective analysis

OBJECTIVE: To determine the frequency and antibiotic susceptibility pattern of uro-pathogens. SETTING: Department of Pathalogy, Ziauddin Medical Hospital Laboratory, Karachi. METHOD: A retrospective analysis was done on all the urine samples sent for culture and sensitivity during a seven months period. Two thousand eight hundred and forty four urine samples were received and inoculated in cysteine lactose electrolyte deficient agar [CLED]. Positive samples were identified, processed and antibiotic susceptibility was carried out. Data was analyzed using Microsoft Excel 97. E. coli [45.6%] was the leading uropathogen followed by candida spp. [10.5%], enterococcus spp. [10.2%]. For E. coli ampicillin, ceftazidime, nitrofurantoin and gentamycin sensitivity was 26%, 20%, 79.5%, 65% respectively. Enterococcus isolates showed 60% resistance to ampicillin. The resistant pattern of uro-pathogens causing urinary tract infections to common antimicrobial agents is changing and must be taken into account when selecting treatment strategies. Therefore, antibiotic policy should be made according to local surveillance data

Health for all by the year 2000

1. Based on World Health Assembly Resolution, the World Health Organization [WHO] and UNICEF together with representatives of member governments launched a compaign in 1978 to achieve Health for all by the year 2000" through primary health care. The objective of this compaign was to increase the political commitment of member countries to address to the health needs of their people.2. In this article the various aspects of putting the objective into practice with the available resources and existing constraints and limitations in the member countries of the Eastern Mediterranean Region is high-lighted