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 ofthe 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.

Novel coronavirus infection in the eastern mediterranean region: time to act.

The Eastern Mediterranean Region of World Health Organization has been an emerging focus for global health after the discovery of a novel coronavirus infection in some countries in the Region. The Region has already witnessed a number of emerging zoonoses with epidemic potential. In view of this new virus, there is now an urgent need for strong public health vigilance and monitoring of the evolution of the virus in the Region. The situation will challenge and test the national health authorities' resilience and ability to respond in a timely manner. This review summarizes the evidence related to the emergence in the Region of new epidemic diseases of predominantly zoonotic origin and the challenges posed by the discovery of the novel coronavirus infection, and outlines recommendations for the countries for early detection, prevention threats from this novel coronavirus infection. and control of public health

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

Novel coronavirus infection in the Eastern Mediterranean Region: time to act

The Eastern Mediterranean Region of World Health Organization has been an emerging focus for global health after the discovery of a novel coronavirus infection in some countries in the Region. The Region has already witnessed a number of emerging zoonoses with epidemic potential. In view of this new virus, there is now an urgent need for strong public health vigilance and monitoring of the evolution of the virus in the Region. The situation will challenge and test the national health authorities' resilience and ability to respond in a timely manner. This review summarizes the evidence related to the emergence in the Region of new epidemic diseases of predominantly zoonotic origin and the challenges posed by the discovery of the novel coronavirus infection, and outlines recommendations for the countries for early detection, prevention and control of public health threats from this novel coronavirus infection

Management of the use of public health pesticides in the face of the increasing burden of vector-borne diseases in the Eastern Mediterranean region.

The Eastern Mediterranean Region of the World Health Organization is facing an increasing burden of vector-borne diseases. Progress in controlling these diseases is compromised by the limited number of vector control interventions, most of which rely on the use of pesticides. Seventeen countries of the Region participated in a global survey that aimed to map and document registration and management practices for public health pesticides. This paper aims to draw the attention of policy- and decision-makers to the challenges the Region is facing in managing public health pesticides properly to control disease vectors and, based on the outcome of the survey, recommends a set of actions to guide national policy and to strengthen national capacity for the sound management and judicious use of public health pesticides.

Management of the use of public health pesticides in the face of the increasing burden of vector-borne diseases in the Eastern Mediterranean Region

The Eastern Mediterranean Region of the World Health Organization is facing an increasing burden of vector-borne diseases. Progress in controlling these diseases is compromised by the limited number of vector control interventions, most of which rely on the use of pesticides. Seventeen countries of the Region participated in a global survey that aimed to map and document registration and management practices for public health pesticides. This paper aims to draw the attention of policy- and decision-makers to the challenges the Region is facing in managing public health pesticides properly to control disease vectors and, based on the outcome of the survey, recommends a set of actions to guide national policy and to strengthen national capacity for the sound management and judicious use of public health pesticides

Establishment of public health security in Saudi Arabia for the 2009 Hajj in response to pandemic influenza A H1N1.

Mass gatherings of people challenge public health capacities at host locations and the visitors' places of origin. Hajj--the yearly pilgrimage by Muslims to Saudi Arabia--is one of the largest, most culturally and geographically diverse mass gatherings in the world. With the 2009 pandemic influenza A H1N1 and upcoming Hajj, the Saudi Arabian Ministry of Health (MoH) convened a preparedness consultation in June, 2009. Consultants from global public health agencies met in their official capacities with their Saudi Arabian counterparts. The MoH aimed to pool and share public health knowledge about mass gatherings, and review the country's preparedness plans, focusing on the prevention and control of pandemic influenza. This process resulted in several practical recommendations, many to be put into practice before the start of Hajj and the rest during Hajj. These preparedness plans should ensure the optimum provision of health services for pilgrims to Saudi Arabia, and minimum disease transmission on their return home. Review of the implementation of these recommendations and their effect will not only inform future mass gatherings in Saudi Arabia, but will also strengthen preparedness efforts in other settings.

TB contact investigations: 12 years of experience in the National TB Programme, Morocco 1993-2004.

We reviewed data collected from 1993 to 2004 as part of the routine activities of the national tuberculosis (TB) control programme (NTP) in Morocco. More than 1 million household TB contacts were identified in approximately 200,000 investigations. On average, 77% of identified contacts were screened every year; overall prevalence was 2.5%. The proportion of TB cases identified in household contacts of registered cases was 5.6%. This was significantly higher in children under 10 years and in patients registered and diagnosed with symptomatic primary complex. Performing TB contact investigations as part of the routine activities of NTP services is feasible in low-middle-income countries.

TB contact investigations: 12 years of experience in the National TB Programme, Morocco 1993-2004

We reviewed data collected from 1993 to 2004 as part of the routine activities of the national tuberculosis [TB] control programme [NTP] in Morocco. More than 1 million household TB contacts were identified in approximately 200 000 investigations. On average, 77% of identified contacts were screened every year; overall prevalence was 2.5%. The proportion of TB cases identified in household contacts of registered cases was 5.6%. This was significantly higher in children under 10 years and in patients registered and diagnosed with symptomatic primary complex. Performing TB contact investigations as part of the routine activities of NTP services is feasible in low-middle-income countries

Knowledge, attitudes and beliefs about tuberculosis in urban Morocco.

We sought to characterize conceptions of tuberculosis (TB) in an urban population in Morocco. Thus 301 subjects, some being treated for TB (patients) and some attending health facilities for other conditions (non-patients), in 2 Moroccan cities were surveyed. Most patients did not identify their illness as TB referring instead to a body region or symptom. Non-patients tended to cite causative factors related to living conditions, home and family. There was considerable stigma associated with TB. Most non-patients knew that TB was treatable, but few were aware that diagnosis and treatment were free. Popular understandings of TB etiology and transmission in this population differ from the biomedical view, highlighting the need for better communication about the disease.

Knowledge, attitudes and beliefs about tuberculosis in urban Morocco

We sought to characterize conceptions of tuberculosis [TB] in an urban population in Morocco. Thus 301 subjects, some being treated for TB [patients] and some attending health facilities for other conditions [non-patients], in 2 Moroccan cities were surveyed. Most patients did not identify their illness as TB referring instead to a body region or symptom. Non-patients tended to cite causative factors related to living conditions, home and family. There was considerable stigma associated with TB. Most non-patients knew that TB was treatable, but few were aware that diagnosis and treatment were free. Popular understandings of TB etiology and transmission in this population differ from the biomedical view, highlighting the need for better communication about the disease

Improving the quality of cohort analysis by incorporating treatment outcomes of 'transferred in' TB cases.

Treatment outcomes of patients with tuberculosis (TB) who move between TB units ('transferred out') are often not incorporated in the annual cohort analysis. Experience from Morocco shows that using a simple method, the outcomes of these patients, notified as 'transferred in' cases, can be easily taken into account when compiling the annual report on treatment outcomes. With this method the treatment success rate increased in Morocco by a median of 5.8% (range 5.0-6.7), indicating that the country reached the global target of curing at least 85% of the new smear-positive TB cases detected during the period 1995-2003.

Results of cohort analysis by category of tuberculosis retreatment cases in Morocco from 1996 to 2003.

OBJECTIVE: To analyse treatment outcomes by subcategory of tuberculosis (TB) retreatment cases. METHODS: All TB patients treated with the Category II regimen from 1996 to 2003 in Morocco were enrolled in this retrospective study. For each cohort, the retreatment outcome data were analysed as a whole and by the following sub-categories: 1) cases who relapsed after one course of anti-tuberculosis treatment; 2) cases who failed the Category I regimen; and 3) cases who interrupted one course of anti-tuberculosis treatment. RESULTS: The study population included 14 635 retreatment patients, among whom 81.7% were TB relapse cases, 5.2% had failed the Category I regimen and 13.1% were defaulters. The average treatment success rates were respectively 74.8% (range 71.8-76.6), 58.0% (range 52.4-74.0) and 51.4% (range 46.4-55.6) among relapse, failure and default cases. Failure and default rates were significantly higher (P < 0.001) among patients who failed Category I treatment and among those who defaulted, respectively. CONCLUSIONS: TB cases who fail the Category I regimen should systematically receive drug susceptibility testing, while defaulters should be given support to improve treatment adherence. Stratified cohort analysis by subcategory of retreatment has been shown to be useful for evaluating the performance of TB control programmes.

Pharyngeal carriage of serogroup W135 Neisseria meningitidis in Hajjees and their family contacts in Morocco, Oman and Sudan.

In 2000 the global outbreak that began in Saudi Arabia was caused by a W135:2a:P1.5,2 strain of Neisseria meningitidis belonging to the ET-37 complex and to ST-11. There was concern that introduction of this epidemic clone (EC) might lead to a wave of outbreaks in the African meningitis belt. The WHO therefore initiated studies of meningococcal carriage among pilgrims and their family contacts in Morocco, Oman and Sudan, 3 to 12 months after the Hajj 2000. In Morocco, 1186 persons were swabbed 3 times. Ninety-five meningococcal strains were isolated from 2.7% of the specimens. Pulsed-field gel electrophoresis showed that 32 (33.6%) were identical with the EC. In Sudan, 5 strains identical with the EC were obtained after sampling 285 persons. In Oman, among 18 meningococcal strains isolated from 399 subjects, 11 (61.1%) belonged to the EC. The important pharyngeal carriage of W135 (EC) and its role in the 2001-2002 outbreaks in Burkina Faso argues for the necessity of reinforcing surveillance, and adapting and planning responses in Africa and the Middle East using the most appropriate vaccine.

Cataract in the Kingdom of Morocco: indications for surgery and functional results.

AIM: To investigate the results of cataract surgery in different settings in the Kingdom of Morocco. METHOD: At four separate health facilities, 100 consecutive patients undergoing ECCE cataract extraction for age-related cataract were examined pre-operatively and 6-8 weeks post-operative for changes in visual acuity. RESULTS: Thirty-four percent of patients (better eye acuity) and 95.5% of operated eyes had a visual acuity of less than 3/60 pre-operatively. Six to eight weeks post-operatively 84.0% of patients (better eye acuity) and 74.7% of operated eyes achieved a visual acuity of 6/18 or better. Of 198 eyes having an intraocular lens (IOL) implanted, 87.9% achieved 6/18 and 3.0% were less than 6/60 post-operatively. Of 202 eyes having cataract surgery without an IOL, 61.7% achieved 6/18 and 4.5% were less than 3/60. The proportion of eyes receiving an IOL in the 4 centres ranged from 29% to 74%. CONCLUSION: Monitoring the pre and post-operative acuity of cataract patients can give useful information on the indications for surgery in different settings, the use of IOLs and the visual outcome. Implantation of an IOL should be encouraged in all people having cataract surgery unless contra-indicated.

[Urethral discharge in Morocco: prevalence of microorganisms and susceptibility of gonococcos]. / Les ecoulements urétraux au Maroc: prévalence des germes et sensibilité du gonocoque.

We studied 422 patients with urethral discharge recruited from 4 sentinel sites in Morocco to determine sociodemographic characteristics, history of STI infection, infecting organism and antibiotic susceptibility of Neisseria gonorrhoeae. The mean age of the sample was 28 years (range 16-67 years), and most were single, had multiple sex partners without taking protective measures and came from all social backgrounds; 59.9% had a history of a previous STI. The majority (87%) of the infections were the acute form. By polymerase chain reaction of urine samples of 399 patients, 41.6% had N. gonorrhoeae infection, 6.3% Chlamidia trachomatis and 10.8% both organisms; in 41.4% no organism was identified. N. gonorrhoeae was strongly susceptible to ciprofloxacin.

[Urethral discharge in Morocco: prevalence of microorganisms and susceptibility of gonococcos]

We studied 422 patients with urethral discharge recruited from 4 sentinel sites in Morocco to determine sociodemographic characteristics, history of STI infection, infecting organism and antibiotic susceptibility of Neisseria gonorrhoeae. The mean age of the sample was 28 years [range 16-67 years], and most were single, had multiple sex partners without taking protective measures and came from all social backgrounds; 59.9% had a history of a previous STI. The majority [87%] of the infections were the acute form. By polymerase chain reaction of urine samples of 399 patients, 41.6% had N. gonorrhoeae infection, 6.3% Chlamidia trachomatis and 10.8% both organisms; in 41.4% no organism was identified. N. gonorrhoeae was strongly susceptible to ciprofloxacin

[Study of tuberculosis in health care workers in the public sector of Morocco]. / Etude de la tuberculose chez les professionnels de santé du secteur public au Maroc.

SETTING: Tuberculosis is one of the most important causes of disease in Morocco, with an annual incidence of 100 cases per 100,000 population. There is a permanent risk of tuberculosis for health care workers in contact with bacillary positive tuberculosis patients. OBJECTIVE: To evaluate the risk and incidence of tuberculosis in health care workers and to study its distribution by cohort analysis. METHODS: A questionnaire was sent to all of the provinces and prefectures of the kingdom to gather information on tuberculosis cases notified between 1994 and 1997 in health care workers. RESULTS: Over the 4-year period, 130 new cases of tuberculosis were notified among health care workers in 30 provinces and prefectures: 73 men (56%) and 57 women (44%), with a mean age of 41.3 +/- 8.9 and 38.6 +/- 8.4 years, respectively (P = 0.093). The mean cumulative incidence was 85.3/100 000 health care workers; for doctors in specialist diagnostic centres for tuberculosis it was 1,094.8/100,000. The survey showed no significant difference between the mean annual cumulative incidences for doctors (83.4), nurses (78.5) and administrative staff (94.3). The cohort analysis indicated a mean annual success rate of 89.2%, failure rate of 0.9%, lost to follow-up 0.8%, death 3.8% and transfer out 3.1%. Several studies have shown weaknesses in the conditions of hygiene and security in the health centres (such as lack of gloves and masks, and meals taken within the workplace). CONCLUSION: The risk of tuberculosis is not much higher in health care workers in general than in the general population; however, it is significantly higher in the specialist diagnostic centres for tuberculosis. The recent creation of health units for personnel working in the health centres should result in improvements in working conditions if the recommended preventive measures are respected.

New challenges in schistosomiasis control in Morocco.

Cases of schistosomiasis were first detected in 1914. However, there is strong evidence that it was prevailing in the southern part of Morocco long before then. As reported from different African countries, over the last three decades, the development of irrigation has led to the spread of the disease to the north and centre of the country. Thereafter, a national programme of schistosomiasis control was launched by the Ministry of Health in 1983. The programme was based on case detection and treatment, snail control using chemicals, and health education. It has succeeded in reducing the prevalence and intensity of infection to a level low enough to allow an elimination programme to be launched in 1994. The aim is to reach a complete elimination of the disease by the year 2004 in all provinces affected. Though substantial progress was made since the programme started, there is a potential risk of outbreaks in many affected provinces. Therefore, an integrated approach including measures against the intermediate host is needed to reach the goal of elimination. The present paper sheds some light on the features of schistosomiasis in Morocco and presents an evaluation of environmental methods of control of Bulinus truncatus in Tessaout Amont and Akka oasis irrigation schemes. The role of community involvement in planning and implementing environmental measures against the snail intermediate host in modern and traditional irrigation schemes is also discussed.

[The quality of trichiasis surgery in the kingdom of Morocco]. / Qualité de la chirurgie du trichiasis au royaume du Maroc.

In December 1998, a survey was carried out on the quality of trichiasis surgery, based on a random sample of 750 people chosen from the surgical records of 13 health centres of the provinces of Zagora and Errachidia (Kingdom of Morocco). Among those, 740 people were examined (participation ratio: 98.6%). The study population was mainly composed of women (63.8%) and people > 40 years (83.5%). The average age was 51.8 (48.5 for women and 57.4 for men). The most common surgical technique was the bilamellar tarsal rotation procedure. In 98.7% of cases, the operation concerned one of the upper eyelids, and in 58.5% of cases the right eye. At the time of the interviewers' visit, 11.1% of the people examined were blind (vision < 1/20 for the best eye) and 28.9% were visually impaired (vision > 1/20 but < 3/10). In addition, 17.6% of the eyes whose eyelids had been operated on rated as blind and 29% of them as visually impaired. The definition of recurrence was the presence of at least one or more eyelashes in contact with the eyeball. The recurrence rate is estimated to be 15.8%, divided into 2 categories: (1) Severe or total recurrence (2.4%) - At least one eyelash from the median part of the lid margin is in contact with the cornea - and, (2) Partial recurrence "One or more eyelashes affect the corners of the eyelids but never rub against the cornea" (13.4%). 14. 3% of the patients operated on were removing their eyelashes regularly which is a clear indicator of the failure of the operation. The following constitute risk factors for recurrence: being aged over 40, having been operated on in Errachidia province, having been operated on by a general practitioner or by an ophthalmologist. However, "time elapsed since the operation" does not appear to influence the recurrence rate in each of the three cohorts which were subsequently formed using the date of the operation (retrospectively). Most recurrences seem to develop during the first twelve months after the operation. The post-operational complications/sequelae detected were rarely sight-threatening, except in four cases, i.e., three ptoses and one case of tegumental necrosis with permanent exposure of the cornea. The most common complications were excessive rotation of the lid margin (over-correction) (2.3%) and cutaneous necroses with no exposure of the cornea (3.6%). In this series, 15.7% of the eyes examined presented central corneal opacity and 2.1% xerosis. In 1.6% of cases the eyeball was either destroyed (phthisis bulbi) or absent. A majority of patients (51.8%) was affected by persistent lacrimation or secretions.