Successes and challenges of HIV/AIDS program in Oman: 1984-2015

We sought to provide an epidemiological situation of HIV in Oman and assess the ongoing impact of the program established in 1987 using data collected from national health reports between 1984 and 2015. Since the report of the first AIDS case in Oman in 1984, the numbers have steadily increased. Eighty percent of the cases were reported between 1996 and 2015. By the end of 2015, there were 2879 people known to be living with HIV [PLHIV] giving a prevalence of < 1%. More males were affected than females [p < 0.001]; 69.7% of affected males and 73.1% of females were aged 20-49 years. The highest HIV rate was in the Musandam governorate. Most [66.8%] new HIV infections were caused via unprotected sex, 8.3% from mother-to-child, 4.3% by intravenous drug abuse, 3.2% via blood transfusion, and 17.4% by unknown causes. PLHIV on antiretroviral drug therapy [ART] increased 57.0% by the end of 2015 [p < 0.0001]. A 23.0% reduction in mortality due to HIV was noted [p < 0.0001]. Maternal-to-child transmission per 100 000 live births were 11, 9, 17, 10, 6, and 4 from 2009 to 2014, respectively. In 2015, 67.6% of PLHIV knew their HIV status, 65.0% were on ART, and 48.0% achieved virological suppression. There is an urgent need to focus on the quality and coverage of treatment, as well as care and support to HIV patients with special attention to high-risk groups

Assessment of safe injection practices in health facilities in Oman

Background: Unsafe injection practices put patients and providers at risk of infectious and noninfectious adverse events. A 2001 Ministry of Health survey on injection practices in Oman indicated that, while overall standards were good, in some areas there was a need for improvement.

Aim: We aimed to evaluate injection safety practices to determine whether facilities meet the requirements for practices, equipment, supplies and waste disposal, and to identify unsafe practices.

Methods: We conducted a national cross-sectional survey in 2007 using the World Health Organization tool to evaluate injection safety practices. Using 2-stage cluster sampling, 80 government and 61 private health facilities were randomly selected and evaluated.

Results: There was no shortage of injection equipment nor evidence of attempts to sterilize disposable devices. Care providers immediately disposed of the used needle/syringe in sharps containers. Phlebotomy devices were taken from sealed packets in 96% of facilities. In private facilities, 66.3% of the care providers were fully immunized against hepatitis B. Wearing a new pair of gloves for phlebotomy was observed in only 46% of government and 38% of private health facilities. Many health facilities lacked alcohol-based handrub.

Conclusions: Many injection safety aspects were satisfactory. However there are still opportunities for improvement. Actions are required to make alcohol-based handrub and appropriate sharps containers available and to provide hepatitis B vaccine and training to health care workers in all facilities

Strategic approaches towards pertussis control in Oman

Objectives: Pertussis is a highly contagious disease that causes severe and serious symptoms among infants and young children with fatalities observed in early infancy. The disease is milder among adolescents and adults. In this paper, we describe the progress made towards pertussis control in Oman and the challenges ahead to achieve control and maintain it

Methods: Pertussis data were collected between 1981 and 2015 from various sources including Annual Health Reports, annual Ministry of Health progress reports, and Community Health and Diseases Surveillance Newsletter, which provided information for the calculation of different pertussis indicators

Results: Diphtheria-tetanus-whole cell pertussis 3 [DTwP3] vaccination coverage rose from 19% in 1981 to 97% in 1992 and has been at >/= 97% until 2015. The overall incidence of pertussis dropped dramatically from an average of 771 cases per 100 000 population from 1981 through 1985, to 21 cases per 100 000 population between 2011 and 2015 [p < 0.001]. Since 1987, pertussis cases were cyclical, with peaks every three to five years with three major outbreaks reported in some parts of the country. Between 2011 and 2015, 831 cases were notified of which 785 [94.4%] met the pertussis case definition. Of these 785 cases, 625 [79.7%] were in children aged < 12 months [average rate 185 per 100 000 population], and almost all were hospitalized. Of the 625, 357 [57.1%] were aged < 2 months [average incidence of 600/100 000 population], 129 [20.6%] were 2-3 months old [average incidence of 202/100 000 population], 80 [12.8%] were 4-6 months [average incidence of 119/100 000 population], and 59 [9.4%] were 6-12 months old [average incidence is 22/100 000 population]. There were 160/785 [20.3%] cases reported in children >/= 12 months old [average rate 4/100 000 population]. Downward trend rates were reported in the 5-14 year age group and a very low disease rate was observed in the > 15 years group. Since 2007, no deaths recorded were attributed to pertussis

Conclusions: Oman has a high coverage of DTP3; however, pertussis control remains a challenge among infants < 12 months old. Therefore, tetanus, diphtheria, and acellular pertussis [Tdap] vaccination of pregnant women is likely to be the best strategy for preventing the disease in infants

Snapshot of influenza surveillance, vaccine recommendations, and vaccine access, drivers, and barriers in selected middle eastern and north african countries

Objectives: Influenza is a vaccine-preventable acute respiratory viral infection that causes epidemics annually around the globe. A regional influenza stakeholder network [MENA-ISN] comprised of experts assessed the status of influenza prevention and control using a structured survey

Methods: A survey questionnaire was used to obtain information from each participating country on surveillance system, the burden of disease, influenza vaccination programs, recommendations, funding and access for vaccine and vaccination, target rate, coverage rate monitoring, and drivers and barriers to influenza vaccination

Results: Out of the 10 countries that participated, nine had an influenza surveillance system and vaccination policy, and seven had World Health Organization [WHO] accredited reference laboratory. Three countries had burden of disease data available and eight had a reimbursement vaccine policy. Influenza vaccine was available in five countries through the Ministry of Health whereas in others, pharmacies also dispensed for the private sector. In all countries, prescribers were physicians, and vaccinators, which could be physicians, nurses, and pharmacists. Eight countries had a set vaccination target rate and only three monitored the influenza coverage rates. Drivers and barriers of vaccination were similar in all countries

Conclusions: Despite existing policies, influenza vaccination coverage remains far below the WHO recommendations. Increased awareness and effective implementation of policies with collaboration of stakeholders can help increase the rates to reach WHO targets

Assessment of hepatitis B immunization programme among school students in Qatar

Background: In 2010, Qatar adopted the target of reducing hepatitis B prevalence to < 1% in children by 2015. The World Health Organization Region for the Eastern Mediterranean is identified with intermediate hepatitis B virus [HBV] endemicity, ranging from 2% to 7%. It is estimated that 4.3 million individuals are living with HBV infection in the Region.

Aims: This study was conducted to assess hepatitis B seroprevalence in children, hepatitis B vaccination coverage, potential exposure to risk factors, and knowledge among parents/guardians about hepatitis B infection.

Methods: We carried out this cross-sectional study in Qatar during the academic year 2015/16. Multistage cluster sampling was used to select a nationally representative sample of 2735 grade 1 school students aged . 5 years. Blood was collected by finger prick and tested using the point-of-care test/rapid test. A self-administered, precoded questionnaire was used to assess parent/guardian knowledge about HBV and collect information on the childfs HBV vaccination coverage.

Results: All blood samples were HBsAg negative. Qataris had a vaccination card and were totally vaccinated but 17.7% of non-Qataris did not hold a vaccination card and most parents/guardians were not aware of the vaccination status of their children. Children were exposed to various hepatitis B risk practices. Knowledge about hepatitis B among parents/ guardians was low.

Conclusions: Qatar has averted the hepatitis B threat and maintained high vaccination coverage for children

Clinical characteristics of childhood Guillain-Barr‚ syndrome

To find the incidence, clinical pattern and outcome of Guillain-Barre syndrome in the Sultanate of Oman in children less than 15 years of age. All children under fifteen years with acute flaccid paralysis were admitted to identify the underlying cause. The diagnosis of Gullain Barre syndrome was made by clinical criteria, cerebrospinal fluid findings and nerve conduction studies. Intravenous immunoglobulins were given to all and two needed plasmapharesis. Sixty-one children were diagnosed as Guillan-Barr‚ syndrome and constituted 20% of cases of acute flaccid paralysis. Males 39 [63.9%] outnumbered females [36.1%].The annual incidence below 15 years was 0.45/100,000. Cranial nerves were involved in 31 [50.8%] children. Albumino-cytological dissociation in cerebrospinal fluid was seen in 42/45[93.3%] cases. Acute relapse was seen in six [9.8%] cases. Eleven children [18.3%] needed ventilation. Complete recovery was seen in 45 to 310 days [mean 69.1 days]. Three children [4.9%] were left with minimal residual deficit. There was no mortality. Guillain Barre syndrome is a serious disease, although recovery is the rule in children. The disease is associated with very low mortality and long term morbidity. Immunoglobulins have reduced the duration of hospital stay and the total time needed for recovery