Communicable Diseases

Bulletin

Quarterly Summary Report

Quarter – 2018 ( - )
www. .ae Volume ; Issue Number 4; 201
Quarterly Summary Report - 2018

Table of Contents

Section Content Page

Distribution of Notified Cases in Abu Dhabi Emirate, by Region

I 3
(Quarter 4, 2018)

II Distribution of Notified Cases in Abu Dhabi Emirate, by Age Group

4
and Gender (Quarter 4, 2018)

Distribution of Gastrointestinal Infections in Abu Dhabi Emirate, by

III 5
Region (Quarter 4, 2018)

Distribution of Gastrointestinal Infections in Abu Dhabi Emirate, by

IV 5
Age Group and Gender (Quarter 4, 2018)

Monthly Trends for Selected Notified Diseases, Abu Dhabi Emirate

V 6
(Q1-Q4/2018 vs. Q1-Q4/2017 and 2016)

Selected Annual Trends for Antimicrobial Resistance in Abu Dhabi

VI 7-9
Emirate

VII Visa Screening Applicants, Abu Dhabi Emirate (Quarter 4, 2018) 10

VIII Influenza Quarterly Report, Abu Dhabi Emirate (Quarter 4, 2018) 11

IX Topic of the Volume: Influenza Vaccination in Pregnancy 12 -14

X Sharing Reports: Brucellosis Epidemiology in the Emirate of Abu 15-17

Dhabi (2013-2018)

XI Activities 18-19

XII Flash News 20

XIII Flash- on-an-Illness: Nipah Virus 21-23

XIV Applied Researches in Communicable Diseases 24

2 www.doh.gov.ae
 Communicable Diseases Bulletin

Table 1: Distribution of Notified Cases in Abu Dhabi Emirate,

by Region (Quarter 4, 2018)
Abu Al
Dhabi
Al Ain
Dhafra
Cumulative, Abu Dhabi Emirate
Year Total
Cases 2018
Quarter 4, 2018
Q1 Q2 Q3 Q4 2018 2017 2016

AFP/ Poliomyelitis * 0 1 1 2 3 1 2 8 9 8
Brucellosis 2 0 1 2 2 12 30 29 34 1 0 5 91 118
Chickenpox 76 1 1 1 8 6 8 1336 1171 836 94 7 4 2 90 5254 4819
Cholera 0 0 0 0 2 11 0 1 3 8 8
Haemophilus influenzae (Invasive) 0 0 0 0 0 0 0 0 2 1
Hepatitis B 2 5 4 1 0 5 9 311 264 301 36 8 1 2 4 4 1085 1139
Hepatitis C 1 6 7 6 1 8 178 183 194 2 36 791 829 851
Influenza (A, B, H1N1, &
1 0 1 4 7 2 5 0 1 30 0 5890 1667 1942 1 2 94 8 2 2 4 4 7 15993 6774
Unspecified)
Malaria * ¶ 1 5 4 71 1 8 177 399 610 2 4 3 1 4 2 9 1907 1848
Measles * 5 2 0 20 21 9 7 5 7 38 63
Meningitis Bacterial 1 5 3 1 10 7 11 1 9 4 7 45 49
Meningitis Viral 1 5 0 0 13 19 12 1 5 5 9 64 133
Mumps 4 9 32 2 45 58 41 8 3 2 2 7 217 296
Pertussis (Whooping Cough) 2 3 9 0 9 13 11 32 6 5 50 51
Rubella * 2 1 0 2 1 1 3 7 23 73
Scabies 4 97 74 2 2 835 616 428 5 93 2 4 72 2111 1907
Tetanus 0 1 0 1 2 0 1 4 1 5
Tuberculosis (Extra - Pulmonary( 6 4 1 6 1 78 71 85 8 0 314 275 261
Tuberculosis (Pulmonary) * 95 2 1 10 139 112 148 1 2 6 5 2 5 525 405
Typhoid /Paratyphoid Fever 2 9 2 2 2 34 34 57 5 3 1 78 188 251
Other Diseases 1 1 2 0 5 2 6 6 2 1677 1734 1814 1 70 8 6 933 6056 5209
Total $ 13417 3576 505 10769 6407 6541 17498 41215 34769 24269
Grand Total including ruled
14754 3697 712 12214 7661 7806 19163 46844 41239 28357
out notifications
*Illnesses covered by national control programs (only confirmed cases and cases that cannot be ruled out are included in the table).
¶ All notified malaria cases are “imported”.
$ Total number of notifications including gastrointestinal infections. For more details about gastrointestinal infections, refer to table 3.
↑↓Indicates increase or decrease in number of notified cases during the 4th quarter of 2018 compared to previous quarters.
↑↓Indicates increase or decrease in numbers of notified cases over Q1-Q4 2018 as compared to the previous two years.

Volume 9 / Issue 4; 2018 3

Quarterly Summary Report - 2018

Table 2: Distribution of Notified Cases in Abu Dhabi Emirate,

by Age Group and Gender (Quarter 4, 2018)
<1y 1-4y 5 - 14 y 15 -24 y 25 -34 y 35 -44 y 45 -54 y 55-64y 65+ y Total
Cases Total
M F M F M F M F M F M F M F M F M F M F

AFP/ 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 2
Poliomyelitis
Brucellosis 0 0 0 0 2 1 5 0 1 0 4 2 3 3 0 2 1 1 0 2 5 9 34
Chickenpox 1 3 5 36 2 9 5 8 5 8 1 6 9 1 0 333 6 4 1 1 5 1 9 30 2 5 1 0 0 75 9 1 8 8 94 7
Cholera 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Haemophilus
influenzae 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
(Invasive)
Hepatitis B 1 0 0 0 0 0 1 9 7 1 1 1 37 8 0 1 7 4 7 1 5 1 1 1 5 4 4 2 73 95 36 8
Hepatitis C 0 0 0 0 1 0 1 6 4 5 3 1 3 5 7 8 4 7 9 1 7 4 3 4 1 94 4 2 2 36
Influenza (A,
B H1N1 & 2 99 2 2 9 2 0 4 3 1 776 1 8 2 0 1 6 0 3 4 76 35 3 1 2 31 8 6 1 8 5 2 4 6 5 38 9 1 6 6 1 5 3 1 0 6 6 1 6 5 732 4 5 6 2 4 1 2 94 8
unspecified)
Malaria 0 0 2 1 2 0 5 3 2 8 5 5 4 1 4 34 0 1 1 2 1 0 2 2 9 1 4 2 4 3
Measles 0 1 0 1 0 0 0 1 0 2 0 2 0 0 0 0 0 0 0 7 7
Meningitis
6 3 0 2 1 1 1 0 2 0 2 0 0 0 0 0 1 0 1 3 9 1 9
Bacterial
Meningitis
3 2 0 2 0 0 0 2 4 1 0 1 0 0 0 0 0 0 7 8 1 5
Viral
Mumps 0 0 1 3 5 1 8 2 2 3 2 9 3 5 0 1 1 1 0 0 0 5 0 33 8 3
Pertussis 3 2 1 1 3 4 0 2 2 4 4 4 2 0 0 0 0 0 1 5 1 7 32
Rubella 0 0 0 2 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 2 3
Scabies 3 2 6 1 4 37 1 3 99 1 2 1 8 4 2 1 1 1 0 2 2 4 5 9 9 2 2 3 4 95 98 5 93
Tetanus 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 1
Tuberculosis
(Extra- 0 0 1 0 0 0 5 4 2 5 1 0 1 4 6 1 0 0 4 0 1 0 6 0 2 0 8 0
Pulmonary)
Tuberculosis
0 0 0 0 0 0 1 8 4 39 1 5 2 0 7 1 4 3 4 2 0 0 95 31 1 2 6
(Pulmonary)
Typhoid
/Paratyphoid 0 1 1 1 3 2 5 4 1 6 6 4 0 6 1 2 0 0 1 37 1 6 5 3
Fever
Other
72 71 1 92 1 5 7 1 1 6 1 1 3 1 0 2 5 5 2 1 8 2 0 6 1 4 3 1 2 2 4 7 37 2 6 9 1 3 9 92 9 779 1 70 8
Diseases
TO TAL $ 4 0 0 31 6 2 2 95 1 991 2 0 6 3 1 8 1 7 971 4 6 2 2 32 2 1 2 5 2 1 4 5 0 6 8 0 6 76 2 4 3 2 4 5 1 4 2 8 7 8 6 1 0 5 0 9 6 98 9 1 74 98

Grand Total 19163

Highlighted cells (with red numbers) indicate the top three incident counts within the age/gender groups for the given illness.
$ Total number of notifications including gastrointestinal infections. For more details about gastrointestinal infections, refer to table 4.
Σ The grand total for Q4 2018 after including all ruled out notifications is 19163.

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 Communicable Diseases Bulletin

Table 3: Distribution of Gastrointestinal Infections in Abu Dhabi Emirate,

by Region (Quarter 4, 2018)
Abu Al
Al Ain Cumulative, Abu Dhabi Emirate
Dhabi Dhafra Y ear Total
Cases* 2018
Abu
Quarter 4 Al Q1 Q2 Q3 Q4 2018 2017 2016
Al Ain Cumulative, Abu Dhabi Emirate
Adenovirus 0 Dhabi
Dhafra0
0 0 0 0 0 0 Y ear Total
0 0
Cases* 2018
Campylobacter -Enteritis 4 Quarter 0 4 0 Q1
4 Q2
5 Q3
9 Q4
4 2018
2 2 2017
2 1 2016
2 4
Escherichia Coli (Enterohemorrhagic)
Adenovirus 00 00 00 0 0 0 0 0 1 0 0 0 1 0 2 0 2
G iardiasis
Campylobacter -Enteritis 42 1 01 4 0 0 44 4 5 4 0 95 7 4 35 2 2 1 76 2 11 2 8 2 41 8 4
Hepatitis A Coli (Enterohemorrhagic)
Escherichia 0 76 0 36 0 3 0 35 0 4 9 1 6 0 10 1 5 21 5 9 2 1 8 9 2 31 8
G Norovirus
iardiasis 2 10 1 40 0 0 4 4 0 4 0 0 5 70 35 0 1 76 0 1 2 8 0 1 8 4 0
RotavirusA
Hepatitis 761 1 7 361 0 1 31 4 3536 5 4 309 1 6 0 2 4 6 1 1 2 5 32 2 5 1 91 4 4 1 8 98 4 4 31 8 6 73
Salmonellosis (non -typhoidal)
Norovirus 04 5 01 3 0 4 05 0 0 90 0 94 06 2 0 2 96 0 32 4 0 2 0 8
Shigellosis 2 1 1 1 7 5 1 0 2 3 4 5 2 3 2 0
Rotavirus 1 1 7 1 0 1 1 4 36 5 30 1 2 4 6 2 32 1 1 4 4 8 4 4 6 73
Foodborne illness (Not tested) 2 1 1 8 0 2 3 4 1 1 2 2 39 2 2 5 1 92 1 32
Salmonellosis (non -typhoidal) $ 4 5 1 3 4 5 0 90 94 6 2 2 96 32 4 2 0 8
Foodborne illness (Tested - grow th) 1 9 9 1 1 2 2 4 6 3 2 9 1 2 8 1 4 5 35 5
Shigellosis 2 1 1 1 7 5 1 0 2 3 4 5 2 3 2 0
TOTAL 32 4 1 92 2 3 5 4 0 5 5 5 6 6 2 5 39 2 2 96 1 8 6 8 1 91 6
Foodborne illness (Not tested) 2 1 1 8 0 2 3 4 1 1 2 2 39 2 2 5 1 92 1 32
*Foodborne
All cases are reported
illness through
(Tested - electronic notification system of DoH.
1 9
$ Specimens$ were screened for the most common 9
bacterial 1
pathogens. 1 2 2 4 6 3 2 9 1 2 8 1 4 5 35 5
grow th)
↑↓Indicates increase or decrease in number of notified cases during the 4th quarter of 2018 compared to previous quarters.
TOTAL increase or decrease in numbers
↑↓ndicates 32 4 of notified
1 92 cases over
2 3 Q1-Q4
5 4 0 20185 as5 5 compared
6 6 2 to the
5 39previous
2 2 two
96 years.1 8 6 8 1 91 6

Table 4: Distribution of Gastrointestinal Infections in Abu Dhabi Emirate,

by Age
Casesgroup< 1 and
y 1 Gender
-4 y 5 - 1 4 (Quarter
y 1 5 -2 4 y 4,2 5 -342018)
y 35 -4 4 y 4 5 -5 4 y 5 5 -6 4 y 6 5 + y Total
T o t al
M F M F M F M F M F M F M F M F M F M F
Cases < 1 y 1 -4 y 5 -1 4 y 1 5 -2 4 y 2 5 -34 y 35 -4 4 y 4 5 -5 4 y 5 5 -6 4 y 6 5 + y Total
Adenovirus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 T o t al 0
Campylobacter- M F M F M F M F M F M F M F M F M F M F
Enteritis
0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 0 0 0 2 2 4
Adenovirus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Escherichia Coli
Campylobacter-
(Enterohemorrhagic)
Enteritis
00 00 00 00 1 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 2 0 4 0
Escherichia
G iardiasis Coli
(Enterohemorrhagic)
00 00 03 03 0 0 0 0 0 8 0 1 0 9 0 1 0 3 0 5 0 1 0 0 0 1 0 0 0 0 0 0 0 2 5 0 1 0 0 35
Hepatitis A 1 0 1 1 1 0 37 30 7 2 6 4 3 2 1 0 1 0 0 0 6 7 4 8 1 1 5
G iardiasis 0 0 3 3 0 0 8 1 9 1 3 5 1 0 1 0 0 0 2 5 1 0 35
Norovirus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Hepatitis A 1 0 1 1 1 0 37 30 7 2 6 4 3 2 1 0 1 0 0 0 6 7 4 8 1 1 5
Rota Virus G E 31 2 3 6 5 4 1 2 4 9 2 0 1 0 9 5 5 3 2 2 1 0 0 1 4 2 90 2 32
Norovirus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Salmonellosis (non-
Rota Virus G E
typhoidal) 315 2 32 6 5 8 4 1 1 1 2 4 0 93 2 1 0 2 1 07 98 5 6 5 5 3 0 2 1 2 1 1 0 0 1 0 1 1 4 2 2 990 332 32 6 2
Salmonellosis
Shigellosis (non-
typhoidal)
51 20 8 3 1 11 0 1 33 1 2 2 3 70 8 3 6 4 5 0 0 1 1 0 1 1 0 0 1 0 1 0 2 9 1 333 1 0 6 2 2 3
Foodborne illness
Shigellosis
(Not tested) 10 00 32 16 1 3 37 2 3 33 0 5 34 4 2 0 3 1 1 0 0 1 0 0 0 0 0 0 0 1 3 1 6 1 0 2 3 2 3 39
Foodborne
Foodborne illness
illness
(Not tested) no
0 0 2 6 3 7 3 3 5 4 2 3 1 0 0 0 0 0 1 6 2 3 39
(Tested-but 0 0 2 2 2 2 2 0 8 4 0 2 2 2 0 0 1 0 1 7 1 2 2 9
Foodborne
grow th) illness
(Tested-but no 0 0 2 2 2 2 2 0 8 4 0 2 2 2 0 0 1 0 1 7 1 2 2 9
TO TAL
grow th) 38 2 5 94 74 6 8 5 5 2 5 1 1 4 6 33 2 3 2 3 9 5 6 1 2 1 31 1 2 2 8 5 39
TO TAL 38 2 5 94 74 6 8 5 5 2 5 1 1 4 6 33 2 3 2 3 9 5 6 1 2 1 31 1 2 2 8 5 39
Highlighted cells (with red numbers) indicate the top three incident counts within the age/gender groups for the given illness.

Volume 9 / Issue 4; 2018 5

Quarterly Summary Report - 2018
Monthly Trends for Selected Notified Diseases, Abu Dhabi Emirate
(Q1-4/2018 vs. Q1-4 /2017 and 2016)
Figure 1: Number of reported chickenpox cases in Q4/2018 is around
the number of reported cases in the previous 2 years with similar
seasonality pattern. 59% of reported cases in 2018 were in the age
group 25-44 years, and 9% in the age group 5-14 years
Figure 3: Number of reported cases in Q4/2018 is less compared to
Q3 2018 but still higher than number of reported cases in Q4 of the
previous 2 years. 67% of cases had recent travel history to endemic
countries while 15% of the cases were secondary cases.
Figure 5: Malaria cases followed same trend as in previous two years
with obviously less numbers.
6 www.doh.gov.ae
Figure 2: Number of reported cases in Q4/2018 is close to number of
reported cases in Q4 of the previous 2 years. Most common detected
organism in stool culture of reported cases is salmonella species with
few campylobacter species. 8 small clusters were detected in Q4/2018.
Figure 4: In Q4/2018, around 23% of reported cases were linked to
consumption of raw milk or animal contact outside UAE while around
50% of them provided history of raw milk consumption or occupational
exposure to animals in Abu Dhabi Emirate.
Figure 6: Number of reported measles cases in Q4/2018 is higher
compared to Q3/2018. Five out of seven reported cases were adults
with unknown vaccination history.
 Communicable Diseases Bulletin

Selected Annual Trends for Antimicrobial Resistance in

Abu Dhabi Emirate
Antimicrobial resistance (AMR) has become a serious threat to public health, leading to increased length of
stay at hospital, increased costs, treatment failures, and death. Global and UAE commitments have led to
the strengthening of AMR surveillance systems. In this section, selected AMR levels and trends are reported
from Abu Dhabi Emirate AMR surveillance system.
Figure 7 Table 5
% of resistant isolates (%R), by year Trend
Escherichia coli Antibiotic
2010 2012 2014 2016 2018 2010-2018

CT CIP FOS NIT CT and CIP AMP 6 7. 4 6 3. 2 6 5 .3 6 5 .7 6 5 .2 N o t r en d

4 0 AMC 1 3. 6 8 .8 1 2 .6 1 1 .8 1 2 .6 N o t r en d
CAZ 1 4 .0 1 1 .4 1 5 .7 1 6 .4 1 8 .0 ↑
CTX 2 3. 3 2 0 .6 2 6 .8 30 . 0 31 . 7 ↑↑
% of resistant isolates

30 FEP 5 .0 8 .3 7. 7 7. 8 1 0 .1 ↑
ETP – 0 0 .6 0 .7 1 .0 N o t r en d
2 0
IPM 0 .3 0 .2 0 .2 0 .7 0 .5 ↑
MEM 0 .1 0 0 .2 1 .9 0 .5 ↑
CIP 2 7. 1 2 8 .6 30 . 2 31 . 5 31 . 7 ↑
1 0 SXT 4 6 .2 4 2 .7 4 2 .6 4 2 .6 4 2 .0 ↓
FOS – – 0 .5 0 .8 0 .3 N o t r en d
NIT 1 .8 2 .3 2 .7 2 .0 1 .8 N o t r en d
0
2 0 1 0 2 0 1 1 2 0 1 2 2 0 1 3 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 CTX+CIP 1 6 .5 1 4 .1 1 7. 2 1 9. 1 1 9. 8 ↑
Y ear ESBL – 38 . 0 2 8 .9 2 9. 7 2 8 .3 N o t r en d
N 2 , 35 4 5 ,8 6 9 6 , 30 0 6 , 1 30 5 , 1 92 5 1 , 74 2
E. coli: In c r eas i n g t r en d s o f r es i s t an c e f o r 3r d - an d 4 t h -generation cephalosporins (CA ↑, CT ↑↑, FEP↑), carbapenems (IPM ↑,
MEM ↑), and fluoroquinolones (CIP ↑). Slightly decreasing trend for trimethoprim/sulfamethoxazole (S T, ↓).

Figure 8 Table 6
% of resistant isolates (%R), by year Trend
Klebsiella pneumoniae Antibiotic
2010 2012 2014 2016 2018 2010-2018
CT FEP MEM CIP
AMC 8 .3 7. 7 1 3. 7 1 4 .9 1 5 .5 ↑↑
30
CAZ 9. 5 1 0 .0 1 6 .4 1 9. 8 1 8 .4 ↑↑
% of resistant isolates

CTX 1 2 .0 1 5 .8 2 0 .7 2 6 .8 2 5 .1 ↑↑
2 0 FEP 2 .0 5 .4 7. 0 1 0 .2 1 0 .5 ↑↑
ETP – 0 3. 9 5 .2 3. 7 N o t r en d
IPM 0 .4 1 .6 3. 0 3. 7 2 .6 ↑
1 0 MEM 0 .6 1 .0 3. 6 5 .4 3. 2 ↑
CIP 6 .1 8 .5 1 1 .7 1 3. 6 1 2 .4 ↑
0 SXT 1 8 .2 2 0 .3 2 1 .9 2 5 .0 2 4 .6 ↑
2 0 1 0 2 0 1 1 2 0 1 2 2 0 1 3 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 NIT 2 1 .7 35 . 3 32 . 3 2 0 .7 2 3. 0 N o t r en d
Y ear ESBL – 2 4 .4 2 1 .8 2 5 .0 2 1 .9 N o t r en d
N 8 1 6 2 , 1 70 2 ,2 5 5 2 ,4 5 4 2 , 96 9 2 0 ,1 5 6
K. pneumoniae: Increasing trends of resistance for all beta-lactams (↑↑), including 3r d - an d 4 t h -generation cephalosporins (CA , CT ,
FEP: ↑↑) and carbapenems (IPM/MEM ↑), as well as for fluoroquinolones (CIP ↑), and trimethoprim/sulfamethoxazole (S T, ↑).

Figure 9 Table 7
% of resistant isolates (%R), by year Trend
Pseudomonas aeruginosa Antibiotic
2010-2018
2010 2012 2014 2016 2018
IPM or MEM
30 TZP 9. 6 1 0 .9 9. 9 1 0 .0 2 .7 ↓
% of resistant isolates

2 0 .2 CAZ 7. 9 6 .9 8 .1 8 .3 8 .7 ↑
1 6 .7 1 8 .1 FEP 6 .1 5 .4 5 .6 5 .8 6 .1 N o t r en d
2 0
IPM 1 3. 0 1 0 .1 1 6 .2 1 8 .0 1 7. 4 ↑↑
1 0
MEM 1 4 .0 9. 3 1 2 .0 1 3. 6 1 2 .8 ↑
1 1 .6 GEN 8 .0 6 .3 5 .4 5 .8 5 .0 N o t r en d
CIP 7. 0 6 .6 8 .0 8 .9 8 .8 ↑
0
2 0 1 0 2 0 1 1 2 0 1 2 2 0 1 3 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 IPM or
1 6 .7 1 1 .6 1 6 .8 1 8 .8 1 9. 5 ↑
MEM
ear
N 75 7 1 ,8 8 1 1 ,8 1 5 1 , 96 2 2 , 31 0 1 6 ,5 0 4
P. aeruginosa: In c r eas i n g t r en d s o f r es i s t an c e f o r 3r d -generation cephalosporins (CA ↑), carbapenems (IPM ↑↑, MEM ↑), and
fluoroquinolones (ciprofloxacin, CIP ↑). Decreasing trend for resistance for piperacillin/tazobactam (T P ↓).

Figure 10 Table 8 Volume 9 / Issue 4; 2018 7

% of resistant isolates (%R), by year Trend
Acinetobacter baumannii Antibiotic
2010-2018
2010 2012 2014 2016 2018
IPM or MEM
IPM 39. 3 4 7. 0 4 0 .5 33. 7 2 8 .7 ↓↓
ates

8 0
 1 0
MEM 1 4 .0 9. 3 1 2 .0 1 3. 6 1 2 .8 ↑

% of res
1 1 .6 GEN 8 .0 6 .3 5 .4 5 .8 5 .0 N o t r en d
CIP 7. 0 6 .6 8 .0 8 .9 8 .8 ↑
0
2 0 1 0 2 0 1 1 2 0 1 2 2 0 1 3 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 IPM or
1 6 .7 1 1 .6 1 6 .8 1 8 .8 1 9. 5 ↑
MEM
Quarterly Summary Report - 2018 ear
N 75 7 1 ,8 8 1 1 ,8 1 5 1 , 96 2 2 , 31 0 1 6 ,5 0 4
P. aeruginosa: In c r eas i n g t r en d s o f r es i s t an c e f o r -generation cephalosporins (CA ↑), carbapenems (IPM ↑↑, MEM ↑), and 3r d
fluoroquinolones (ciprofloxacin, CIP ↑). Decreasing trend for resistance for piperacillin/tazobactam (T P ↓).

Figure 10 Table 8
% of resistant isolates (%R), by year Trend
Acinetobacter baumannii Antibiotic
2010-2018
2010 2012 2014 2016 2018
IPM or MEM
IPM 39. 3 4 7. 0 4 0 .5 33. 7 2 8 .7 ↓↓
% of resistant isolates

8 0
5 6 .2 MEM 4 6 .3 5 4 .3 4 1 .8 34 . 6 2 9. 1 ↓↓
6 0 4 6 .3 AMK 1 3. 5 2 1 .4 1 3. 0 6 .1 5 .6 ↓↓
GEN 33. 0 37. 5 2 8 .6 2 8 .5 2 4 .9 ↓↓
4 0 2 9. 1
CIP 4 1 .2 4 6 .6 4 1 .4 33. 7 30 . 0 ↓↓
2 0 MNO – 1 9. 5 1 4 .1 1 2 .1 6 .1 ↓↓
TCY 36 . 2 4 2 .8 4 3. 6 34 . 3 2 0 .6 ↓↓
0
2 0 1 0 2 0 1 1 2 0 1 2 2 0 1 3 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 IPM or
4 6 .3 5 3. 7 4 1 .7 34 . 5 2 9. 1 ↓↓
MEM
ear
N 1 8 9 5 2 3 4 32 4 2 0 5 0 6 4 ,1 2 2
A. baumannii: Overall decreasing trends of resistance across all classes of antibiotics, however, resistance to carbapenems remains
high (IPM, MEM, IPM or MEM: 30 %R).

Figure 11 Table 9
% of resistant isolates (%R), by year Trend
Staphylococcus aureus Antibiotic
2010 2012 2014 2016 2018 2010-2018
O A (MRSA)
% of resistant isolates

5 0 39. 7 OXA (MRSA) 2 5 .7 2 7. 5 33. 0 37. 7 39. 3 ↑↑

4 0 2 5 .7 GEN 4 .9 3. 5 4 .5 5 .8 5 .0 ↑
30
CIP 1 0 .6 2 7. 4 2 6 .2 30 . 3 32 . 8 ↑↑
2 0
1 0 SXT 1 6 .6 1 9. 5 1 8 .9 1 9. 5 2 2 .4 ↑
0 CLI 1 .5 2 .9 1 1 .3 1 1 .1 1 3. 1 ↑↑
2 0 1 0 2 0 1 1 2 0 1 2 2 0 1 3 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8
ERY 1 6 .2 1 8 .6 2 2 .1 2 4 .2 2 6 .4 ↑↑
ear
N 1 , 38 4 3, 32 3 3, 2 77 3, 6 78 3, 376 2 9, 1 6 5
S. aureus: Increasing trends of resistance across all antibiotic classes, including beta-lactam antibiotics (O A ↑↑), aminoglycosides
(GEN ↑), fluoroquinolones (CIP ↑↑), trimethoprim/sulfamethoxazole (S T ↑), lincosamides (CLI ↑↑), and macrolides (ER ↑↑).

Figure 12 Table 10
% of resistant isolates (%R), by year Trend
Streptococcus pneumoniae Antibiotic
2010-2018
2010 2012 2014 2016 2018
PEN-G (oral BP) PEN-G ER
6 0 PEN- oral P 1 9. 8 1 2 .9 1 0 .3 7. 2 8 .5 ↓↓
% o f r es i s t an t i s o l at es

PEN-G NM 0 0 0 0 .4 0 .5 N o t r en d
4 0 PEN-G M 6 1 .7 6 0 .4 5 9. 5 6 0 .5 5 8 .7 N o t r en d
RO NM 1 .2 1 .4 0 .4 0 .9 0 .7 N o t r en d
2 0
CTX NM 2 .4 1 .6 0 0 0 .7 N o t r en d
SXT 2 2 .2 1 7. 3 2 1 .0 2 2 .8 2 3. 8 N o t r en d
0
2 0 1 0 2 0 1 1 2 0 1 2 2 0 1 3 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 ERY 4 3. 5 4 1 .9 4 5 .2 4 9. 8 4 7. 3 N o t r en d
ear PEN- ERY 35 . 9 33. 9 33. 6 39. 0 37. 1 N o t r en d
N 2 0 4 4 38 38 3 4 71 6 0 4 4 ,0 2 7
S. pneumoniae: D ec r eas i n g t r en d of resistance for penicillin G (oral breakpoints), ↓↓). High level of resistance for macrolides (ER ),
and for penicillin G and macrolides combined (PEN-G ER ).

Figure 13 Table 11
% of resistant isolates (%R), by year Trend
N eisseria gonorrhoeae Antibiotic
2010 2012 2014 2016 2018 2010-2018
CIP
1 0 0 76 . 9
% o f r es i s t an t i s o l at es

6 9. 2 PEN 5 0 .0 4 5 .5 6 2 .1 4 2 .9 4 3. 5 N o t r en d
75
RO 0 0 0 0 0 N o t r en d
5 0
2 5
CTX 0 0 0 0 0 N o t r en d

0 CIP 6 9. 2 6 6 .7 77. 1 78 . 0 76 . 9 N o t r en d
2 0 1 0 2 0 1 1 2 0 1 2 2 0 1 3 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 T Y 92 . 9 71 . 9 6 7. 3 71 . 9 6 2 .5 N o t r en d
ear
N 1 4 33 5 0 71 74 4 4 2
N . gonorrhoeae: High level of resistance for penicillin, fluoroquinolones (ciprofloxacin) and tetracycline. No trend observed. No data
available for cefixime, azithromycin, spectinomycin, and gentamicin. Note: small sample size, potential selection bias.

Figure 14 Table 12
8 www.doh.gov.ae
% of resistant isolates (%R), by year Trend
M ycobacterium tuberculosis Antibiotic
2010-2018
2010 2012 2014 2016 2018
RIF INH (MDR-TB)
1 0 STR 0 5 .1 3. 3 – – N o t r en d
i s o l at es

8 RI 2 .3 1 .1 1 .5 4 .0 1 .6 N o t r en d
 CTX 0 0 0 0 0 N o t r en d

% o f r es i s t
2 5
0 CIP 6 9. 2 6 6 .7 77. 1 78 . 0 76 . 9 N o t r en d
2 0 1 0 2 0 1 1 2 0 1 2 2 0 1 3 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 T Y 92 . 9 71 . 9 6 7. 3 71 . 9 6 2 .5 N o t r en d
ear
N 1 4
Communicable Diseases Bulletin
33 5 0 4 4 2 71 74
N . gonorrhoeae: High level of resistance for penicillin, fluoroquinolones (ciprofloxacin) and tetracycline. No trend observed. No data
available for cefixime, azithromycin, spectinomycin, and gentamicin. Note: small sample size, potential selection bias.

Figure 14 Table 12
% of resistant isolates (%R), by year Trend
M ycobacterium tuberculosis Antibiotic
2010-2018
2010 2012 2014 2016 2018
RIF INH (MDR-TB)
1 0 STR 0 5 .1 3. 3 – – N o t r en d
% o f r es i s t an t i s o l at es

8 RI 2 .3 1 .1 1 .5 4 .0 1 .6 N o t r en d
6 EM 0 0 0 .4 1 .9 0 .5 N o t r en d
4 2 .3 1 .6 INH 4 .7 6 .5 6 .4 7. 7 6 .5 N o t r en d
2 PZA 9. 5 9. 4 6 .5 8 .9 1 0 .9 N o t r en d
0 RI I
2 0 1 0 2 0 1 1 2 0 1 2 2 0 1 3 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 .3 0 .9 1 .3 3. 4 1 .6 N o t r en d
(M R)
ear
N 91 36 0 4 5 6 4 73 2 32 3, 1 6 2
M . tuberculosis: Low level of resistance to first-line antimicrobials, and low rate of multidrug-resistant TB (MDR-TB). No data available
f o r s ec o n d -l i n e antibiotics.

• Results shown represent a selection of key trends relevant for surveillance of antimicrobial resistance. Antibiotics in this
report are important for antimicrobial resistance surveillance purposes. They may not be first-line options for testing or
treatment, and should not be interpreted as such. Trend figures and data in tables represent the percentage of isolates
tested resistant (%R), by year and antimicrobial agent. AMR data represents average rates across all patients/location
types (inpatient and outpatient), and all specimen types. First isolate per patient only (non-duplicate isolates).
• Data was generated by routine clinical antimicrobial susceptibility testing (AST), conducted on VITEK®-2 platform
(BioMérieux), (minimal inhibitory concentrations data only, MIC, except for M. tuberculosis data which represents
growth interpretation data, generated on BD BACTEC™ MGIT™ (BD Diagnostics). Data represents average resistance
rates for all specimen/all patient types.
• AMC=Amoxicillin/clavulanic acid, AMK=Amikacin, AMP=Ampicillin, CAZ=Ceftazidime, CIP=Ciprofloxacin, CLI=Clindamycin,
CRO=Ceftriaxone, CTX=Cefotaxime, CXM=Cefuroxime, EMB=Ethambutol, ERY=Erythromycin, ESBL=extended-spectrum
β-lactamase-producing Enterobacteriaceae, ETP=Ertapenem, FEP=Cefepime, GEN=Gentamicin, INH=Isoniazid,
IPM=Imipenem, MEM=Meropenem, MNO=Minocycline, NIT=Nitrofurantoin, OXA=Oxacillin, PEN V=Penicillin V
(oral), PEN G M/NM=Penicillin G (i.v., meningitis/non-meningitis breakpoints), PZA=Pyrazinamide, RIF=Rifampin,
STR=Streptomycin, SXT=Trimethoprim/sulfamethoxazole, TCY=Tetracycline, TZP=Piperacillin/tazobactam.
• ABX = Antibiotic,
• %R = percentage resistant.
• N = Number of non-duplicate isolates tested for antimicrobial susceptibility by MIC (minimal inhibitory concentration).
• – : no data available.
• No trend: means no statistically significant trend was identified (p>0.05).
• The symbols ↑ and ↓ indicate significant increasing and decreasing trends, respectively. The symbols ↑↑ and ↓↓
indicate significant increasing and decreasing trends, with resistance increasing or decreasing by ≥ 1.0 percentage-points
per year (on average), respectively. Trends are long-term trends (2010-2018).
Data source: Abu Dhabi Antimicrobial Resistance Surveillance System. Data shown is from Abu Dhabi public healthcare
facilities (SEHA) only, 2010-2018.

Volume 9 / Issue 4; 2018 9

Quarterly Summary Report - 2018

Visa Screening Applicants, Abu Dhabi Emirate (Quarter 4, 2018)

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 (TB),
and leprosy. Screening for Hepatitis B and syphilis is limited to a few specified occupational categories.

The Department of Health (DoH) Visa Screening Standard is available online at:
http://www.haad.ae/HAAD/LinkClick.aspx?fileticket=rPUOPzw3_Gw%3D&tabid=820

Average of 250,000 people or more apply for visa medical screening every quarter in Abu Dhabi Emirate.
During the fourth quarter of 2018, a total of 355,357 applicants were screened at all DoH-licensed Screening
Centers (there are 14 centers in the three regions of Abu Dhabi Emirate) and mobile clinics.

Figure 15: Visa screening applicants during the fourth quarter of Figure 16: Active TB cases detected by visa screening in
2018. Abu Dhabi Emirate (Q4 2018).

Table 13: Number and rate of positive cases among new and renewal visa applicants during the fourth quarter of 2018.

* Rate: the number of positive cases per 100,000 visa screened applicants.
** Applied to certain occupational categories only (New= 37104; Renew= 19095).
*** This refers to active TB cases confirmed by PCR and culture.

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 Communicable Diseases Bulletin

Influenza Quarterly Report, Abu Dhabi Emirate (Quarter 4, 2018)

Monitoring influenza trends through the surveillance systems enable the decision makers to evaluate the
current situation of influenza epidemiology in Abu Dhabi Emirate. Influenza surveillance reports and activity
updates are derived from a number of data sources that include passive infectious disease surveillance
through DoH electronic notification system; sentinel influenza-like illness (ILI) reporting and Severe Acute
Respiratory Illness (SARI) reporting from the selected healthcare facilities.

A total of 12,948 influenza cases were reported to DoH in Q4/2018 through the electronic infectious disease
notification system. In figure 17, influenza cases are presented in monthly distribution compared to the
previous two years. Distribution of influenza cases by weeks during quarter 4, in addition to virus types are
shown in figure 18.

Figure 17: Influenza cases showed sharp peak in November similar Figure 18:Distribution of influenza types by week. Increasing activity
to 2017 peak. Cases decrease in December reaching almost same of influenza A is noted in Q4/2018.
number at the beginning of Q4. Number of reported cases decreased
in December.

A total of 334 ILI cases in Q4/2018 were reported through the active surveillance system. 106 (32%) of
the cases were influenza positive distributed by percentage of virus serotypes as shown in figure 19. Third
source of influenza surveillance is SARI in which 852 cases were reported from two selected health care
facilities (762 cases from Mafraq and 90 cases from Al Ain Hospital). Out of 782 tested SARI cases, 310 cases
(40%) were found to be positive for respiratory organisms as shown in figure 20.

Figure 19: Distribution of influenza viruses in ILI cases by percentage. Figure 20: Distribution of respiratory organisms among SARI cases
Influenza A (H3N2) is the most common type of detected influenza by percentage. RSV was the most common organism (n = 310).
viruses followed by Influenza A (H1N1) specially toward the end of
the quarter (n = 106).

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Quarterly Summary Report - 2018

Topic of the Volume

Influenza Vaccination in Pregnancy

Seasonal in en a
Seasonal influenza is an infectious disease caused by four influenza viruses; types A, B, C and D. Different
strains from influenza A and influenza B are usually circulating and in some cases it is associated with severe
illness and seasonal epidemics. Typical incubation period is 1 – 2 days; this period can range from 1 – 4
days. The communicability period is 1 day before symptoms appearance, and up to 5 -7 days after having
the symptoms.
Influenza infection is usually characterized by sudden onset of fever, cough (usually dry), headache, muscle
and joint pain, severe malaise, sore throat and a runny nose. Most healthy people will have a self-limiting
infection that will last for about 1 – 2 weeks. However, certain groups are particularly vulnerable to develop
complications including severe respiratory tract infections, worsening of the chronic conditions and even
deaths. These include younger children, older adults, pregnant women, immunocompromised individuals
and people with chronic diseases.

In en a in re nancy
Influenza infection can lead to severe complications during pregnancy, prenatal and postpartum period. It
can lead to pneumonia, hospitalization and sometimes death. In addition, pregnant women with influenza
are at higher risk of intensive care unit admission and severe perinatal and neonatal outcomes like premature
birth or stillbirth. Pregnant women are at increased risk of influenza complications, due to physiologic
changes that occur during pregnancy, such as the increase in heartbeat and oxygen consumption, increase
in lung capacity and changes in immunity.

Pre ention of in en a
Annual influenza vaccination is recommended, ideally as soon as the vaccine is available and before the
beginning of influenza season which usually occurs between October to May. However, vaccination during
the season is still recommended to get the benefit of the vaccine by giving protection throughout the
season.
The composition of flu vaccine is being reviewed annually and updated to match the expected circulating
flu viruses. Available flu vaccines usually protect against three or four strains.
The Department of Health – Abu Dhabi is providing two types of seasonal influenza vaccine; Influenza
Inactivated Trivalent (IIV3) Vaccine and Influenza Inactivated Quadrivalent (IIV4) Vaccine. The Influenza
Trivalent (IIV3) Vaccine for 2018 - 2019 influenza season contains the following three strains of influenza
viruses.
• an A/Michigan/45/2015 (H1N1) pdm09-like virus;
• an A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus;
• a B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage).

However, Influenza Inactivated Quadrivalent (IIV4) vaccine contains the following four strains:

• an A/Michigan/45/2015 (H1N1) pdm09-like virus;

• an A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus;
• a B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage);
• a B/Phuket/3073/2013-like virus (B/Yamagata/16/88 lineage).

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 Communicable Diseases Bulletin

Licensed inactivated influenza vaccines can be given safely to pregnant women at any stage of pregnancy.
Influenza vaccine can also be administered safely at same session with reduced tetanus, reduced diphtheria
and a cellular pertussis (Tdap) vaccine. Influenza vaccination is also safe for breastfeeding mothers, if the
vaccine was not received previously during the same season.
It is worth mentioning that protective immunity against influenza usually develops between 1 – 2 weeks
after vaccination.

Safety
Millions of pregnant women around the world received flu vaccination with a good safety records. Many
studies were conducted to proof vaccine safety in pregnant women and their infants, further studies are
ongoing to obtain more data.
Influenza vaccine is like any other medications, can cause mild side effects. Pregnant women might experience
similar side effects that might be experienced by other general population. Side effects following influenza
vaccination may include:
Soreness, redness, and/or swelling from the vaccine
• Headache
• Fever
• Nausea
• Muscle aches
These side effects usually start soon after vaccination and last for 1 – 2 days. Influenza vaccination cannot
cause influenza infection as the vaccine contains inactivated parts of the viruses. In rare cases, flu vaccine
can cause severe adverse events. People with a history of severe, life-threatening allergic reaction to any of
the vaccine components should not get vaccinated.
Recent data showed that even people with severe allergy to eggs can still get vaccinated against flu. However,
vaccine administration should be supervised by healthcare providers who are able to recognize and manage
“Adverse Events following Immunization).

E cacy an ene ts
Influenza vaccination efficacy among pregnant women is similar to the efficacy in general adults. It is evident
that influenza vaccination effectiveness is less if compared with the effectiveness of other adult vaccines.
On the other hand, influenza vaccination can provide significant protection toward severe infection, taking
into consideration that pregnant women are at greater risk of influenza complications compared to non-
pregnant women. During 2012-2013, a cohort study was conducted to analyze the hospitalized cases of
acute respiratory illness among pregnant women. The results have shown that hospitalizations were lower
among vaccinated pregnant women compared to non-vaccinated (Trushakova et. al., 2019).

eonatal bene ts of aternal i ni ation

Influenza vaccination during pregnancy can also benefit infants. Due to the functional immaturity of their
immune systems, infants below 6 months of age are at higher risk of hospitalization due to influenza. In
fact, newborns are 5 times more likely to be admitted when compared with those aged 6 – 23 months.
Currently, no influenza vaccine is licensed to be used for children under 6 months of age; therefore, the best
protection method against influenza is through the mothers receiving the vaccine during pregnancy. Passive
immunization of newborns can occur in two ways:
• Before birth: protective IgG antibodies are transferred to the fetus through placenta.
• After birth: anti-influenza IgG and IgA-antibodies are transferred to the newborns through breast milk.
Therefore, maternal influenza vaccination is essential to protect both mothers and their infants. Influenza
antibody titers in mothers and placental transfer efficacy play major roles in the degree and duration of
neonatal protection. This could be maximized through having adequate time between vaccination and
delivery.

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Quarterly Summary Report - 2018

ealt care Professional s Role

Lack of knowledge about influenza infection and importance of vaccination are some of the major barriers
toward vaccination acceptance. Therefore, it is essential that healthcare professionals discuss this subject
with their pregnant patients. Educational materials like booklets and posters can increase level of awareness
as well as increase frequency of discussion. It is more likely that pregnant women will get vaccinated when
she is advised by their obstetrician–gynecologists and the vaccine is being provided at their clinics.
Therefore, healthcare professionals and especially obstetrician–gynecologists should take major roles in
advocating for influenza vaccination among pregnant women. Obstetrician–gynecologists are advised to
keep the vaccine at their clinics, or otherwise direct their patients to nearest accessible clinic, where they
can take the vaccine. Healthcare professionals should also be vaccinated every season to protect their
vulnerable patients.
It is also important for obstetrician–gynecologists to follow-up with the vaccination status of the pregnant
women, ask for proof vaccine documentation if the vaccine was taken in another healthcare facility, in order
to update the patient’s record. All these efforts will have a positive impact on pregnant women concerning
importance of vaccination to protect themselves and their fetus.

oncl sion
The severity of influenza infection during pregnancy for both mothers and their fetus has been recognized
long time back. Therefore, influenza vaccination is a critical intervention for prenatal and postpartum care. In
addition, good safety profile and immunogenicity of seasonal influenza vaccine, proven the recommendation
that all pregnant women should receive influenza vaccine, regardless of pregnancy stage. Healthcare
professionals play major role in increasing influenza vaccination coverage among pregnant women.

Provide the
Antibodies are
pregnant women Antibodies pass Mother & infant
developed against
flu vaccine at any to fetus are protected
influenza
trimester

Figure 21: Infographic about influenza vaccination and pregnancy.

Reference
1- Trushakova, S., Kisteneva L., Guglieri-López B., Mukasheva E., Kruzhkova I., Mira-Iglesias A.,
Krasnoslobodtsev K., Morozova E., Kolobukhina L., Puig-Barberà J. and Burtseva E. 2019. Epidemiology
of influenza in pregnant women hospitalized with respiratory illness in Moscow, 2012/2013–
2015/2016: a hospital-based active surveillance study. BMC Pregnancy and Childbirth. 19:72.
2- http://www.immunizeca.org/vaccine-info/pregnant-women

14 www.doh.gov.ae
 Communicable Diseases Bulletin

Sharing Reports
Brucellosis Epidemiology in the Emirate of Abu Dhabi (2013-2018)
Brucellosis is a zoonotic disease caused by bacteria of the genus Brucella spp., found in different regions
of the world. It is considered as re-emerging disease and causes serious health problems and economic
losses.
Brucellosis is mainly transmitted from cattle, sheep, goats, pigs and camels through direct contact with
blood, placenta, fetuses or uterine secretions, or through consumption of contaminated raw animal
products (especially unpasteurized milk and soft cheese).

linical escri tion

An illness characterized by acute or insidious onset of fever and one or more of the following:
night sweats, arthralgia, headache, fatigue, anorexia, myalgia, weight loss, arthritis/spondylitis, meningitis,
or focal organ involvement (endocarditis, orchitis/epididymitis, hepatomegaly, splenomegaly).

aboratory con r ation

Different procedures are used to confirm brucellosis:

e niti e
• Culture and identification of Brucella spp. from clinical specimens.
• Evidence of a fourfold or greater rise in Brucella antibody titer between acute- and convalescent-
phase serum specimens obtained greater than or equal to 2 weeks apart.
Pres ti e
• Brucella total antibody titer of greater than or equal to 160 by standard tube agglutination test (SAT)
or Brucella micro-agglutination test (BMAT) in one or more serum specimens obtained after onset of
symptoms.
• Detection of Brucella DNA in a clinical specimen by PCR assay.

ase e nition
Probable
A clinically compatible illness with at least one of the followings:
• Epidemiologically linked to a confirmed human or animal brucellosis case.
• Presumptive laboratory evidence, but without definitive laboratory evidence of Brucella infection.

on r e
A clinically compatible case with definitive laboratory evidence of Brucella infection.

lobal e i e iolo y
Brucellosis occurs worldwide and remains endemic among Mediterranean countries of Europe, Northern
and Eastern Africa, Near East countries, India, Central Asia, Mexico and Central and South America. According
to World Health Organization (WHO), Brucella melitensis have the highest zoonotic potential, followed by
Brucella abortus, and Brucella suis in the endemic regions.

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Quarterly Summary Report - 2018

Figure 22: The Global Incidence of Human Brucellosis (Ariza et. al. 2006)

Brucellosis considered as a reemerging disease in many countries such as Kuwait, Saudi Arabia, Brazil and
Colombia, where there is an increasing incidence of Brucella melitensis or Brucella suis biovar infection in
cattle.
In many of European countries, such as Greece, it has been found that human brucellosis incidence is
related directly to occupational risk factors.

E i e iolo y in Ab abi E irate

Brucellosis is a notifiable disease according to DoH standard and UAE federal law no. 14 of 2014 concerning
the control of communicable diseases. Communicable Diseases Department conducts case investigation by
obtaining travel history of the case, occupation, contact to domestic cattle or history of raw milk /dairy product
consumption. Abu Dhabi Food Control Authority (ADFCA) is notified whenever food, animals or animal products
are suspected.
There was a total of 537 cases reported between 2013 to 2018 (Table 14). Brucellosis rate has increased during
the last two years in Abu Dhabi Emirate. In 2016, brucellosis rate was the highest as shown in table 14. Identified
risk factors include direct exposure to animals in farms and consumption of unpasteurized milk.

Table 14: Notified Brucellosis cases and rate, Abu Dhabi Emirate (2013-2018)

* Rate = (number of brucellosis cases/Abu Dhabi Emirate population) *100,000

@ Estimated rate.

Brucellosis cases occurred in different age groups with highest number in 25 to 34 years old group. Males
are affected more than females with brucellosis probably because of occupation risk as shown in figure 23.

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 Communicable Diseases Bulletin

Figure 23: Notified brucellosis cases by age and gender in Abu Dhabi Emirate (2013 - 2018).

Monthly distribution of brucellosis shows no seasonality pattern (Figure 24).

Figure 24: Monthly distribution of brucellosis cases in Abu Dhabi Emirate (2013 - 2018).

oncl sion
The worldwide trend towards more animal commerce and larger populations, along with limited resources,
have made the control of brucellosis very difficult in many countries. Evaluation of the procedures used for
the prevention and control of animal brucellosis should be performed. This should include surveillance of
animals and humans and investigations of outbreaks.
Nowadays, trials directed toward using brucellosis vaccination for animals in order to control the disease,
are expected to prevent the disease in human.
Meanwhile, efforts should focus on educating farmers, workers at slaughter houses, meat processing plants
and butcher shops about the the disease and the risk in handling carcasses and products from potentially
infected animals without using proper personal protective equipments (PPE).
Public health education should work on raising awareness on the importance of pasteurizing fresh milk
before consuming it.
References
Ariza J.; Bosilkovski M.; Cascio A.; Colmenero J. D.; Corbel M. J.; Falagas M. E.; Memish Z. A.; Roushan M. R.;
Rubinstein E; Sipsas N. V.; Solera J. and Young E. J. (2006) Perspectives for the Treatment of Brucellosis in the
21st Century: The Ioannina Recommendations. PLoS Med. 4(12): e317.
Volume 9 / Issue 4; 2018 17
Quarterly Summary Report - 2018

Activities
I Infectio s iseases oti cation (I ) trainin sessions
• In continuity to the series of the IDN training sessions, 16 sessions were conducted covering
several public and private Healthcare facilities (HCFs). Eight sessions were conducted at the
Department of Health (DoH)-Al Ain office, 8 sessions were conducted in Al Dhafra region and
one session was conducted in Abu Dhabi region.
• The sessions aimed at increasing the knowledge among the healthcare practitioners (HCPs)
on procedures and requirements for reporting communicable diseases through the electronic
notification system and the importance of epidemiological investigation process and infectious
disease control and prevention.
• The total number of attendees to these sessions was 251 HCPs in Al Ain and 94 in Al Dhafra
region from different facilities.
II Trainin or s o on ri ean on o e orr a ic e er ( ) Mana e ent
• A training workshop on CCHF management was conducted in Al Dhafra region, Madenat Zayed
in October -2018, targeting HCPs working at public and private HCFs. HCPs are mainly from
emergency and isolation departments, staff working in the infectious diseases management field
in addition to representatives from Abu Dhabi Food Control Authority/ animal health department.
CCHF workshop aimed to:
i. Update the attendees on CCHF epidemiology,
ii. Discuss global practices toward CCHF management and how HCPs can handle cases
with the required infection control precautions,
iii. Emphasize on the importance of applying preventive measures for veterinarians and
other workers who are working in the slaughterhouses of Al Dhafra region.
• The workshop was attended by 82 HCPs.
III A areness session to Me ical st ents on I an o res onse to Mi le East Res iratory
orona ir s (MERS o )
• An awareness session was provided to UAE university medical students. The objectives were to
present an overview on the Electronic IDN system and importance of reporting infectious diseases
in specific timeframe to provide data required for the control and preventive intervention with
highlights on DoH response to MERS CoV infection.
• The session was attended by 25 medical students.
I Stren t enin t e artners i it t e strate ic sta e ol ers in Ab abi in controllin infectio s
isease
• Communicable Diseases Department (CDD) at DoH participated in the outbreak management
workshop conducted by the Military Medical Services. DoH shared the experience in outbreak
management and the aim was to strengthen the partnership in controlling outbreaks and
improving the community health. This lecture was attended by 15 participants from Military
Medical Services.
• CDD participated in the school health services annual training for school nurses. CDD officers
presented a lecture on the importance of infectious disease notification and the required control
measures to prevent the spread of infectious diseases in school community. 220 school nurses
attended the training workshop.
A areness sessions for t e blic on sto t e s rea
• Awareness sessions on “stop the spread” were conducted in four different entities including
the Ministry of Interior, Abu Dhabi Chamber and Strata in Al Ain region. The fourth session was

18 www.doh.gov.ae
 Communicable Diseases Bulletin

provided to New York University employees and students in Abu Dhabi region. The objectives of
these sessions were to raise the awareness of the attendees about the healthy habits, their roles
in stopping the spread of infectious diseases and the preventive measures for the commonly
reported infectious diseases.
• 53 employees from the mentioned entities attended the lectures in Al Ain region, and 15
employees and students attended from New York University.
I A areness sessions on Polio era ication an Measles r bella eli ination ro ra s
• Two awareness sessions on Polio eradication and measles/rubella elimination programs were
conducted targeting the HCPs from Medeor 24x7 international hospital at Al Ain region and
Health point hospital in Abu Dhabi region. These sessions aimed at increasing the awareness of
the focal points on Polio eradication and measles/rubella elimination programs requirements.
The attendees were trained on preparing weekly Acute Flaccid Paralysis (AFP) reports and the
requirements for AFP and measles/rubella surveillance.
• 7 healthcare professionals attended these awareness sessions.

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Quarterly Summary Report - 2018

Flash News

I Ty oi fe er Isla ic Re blic of Pa istan

WHO- Disease outbreak news 27 December 2018.
Pakistan Health Authorities have reported an ongoing outbreak of extensively drug resistant (XDR) typhoid
fever that began in the Hyderabad district of Sindh province in November 2016. An increasing trend of
typhoid fever cases caused by antimicrobial resistant (AMR) strains of Salmonella enterica serovar Typhi (or
S. Typhi) poses a notable public health concern. From 1 November 2016 through 9 December 2018, 5274
cases of XDR typhoid out of 8188 typhoid fever cases were reported by the Provincial Disease Surveillance
and Response Unit (PDSRU) in Sindh province, Pakistan.
This outbreak highlights the importance of public health measures to prevent the spread of resistant and
non-resistant pathogens. While the emerging resistance in S. Typhi complicates treatment, typhoid fever
remains common in places with poor sanitation and a lack of safe drinking water. Access to safe water
and adequate sanitation, hygiene among food handlers, and typhoid vaccination are the main and most
important WHO recommendations.
https://www.who.int/csr/don/27-december-2018-typhoid-pakistan/en/

II Ac te Ence alitis it Aty ical Presentation of R bella in a ily l ster, In ia

CDC- EID journal 10 October 2018.
A family from a village in India where the father worked as a ward attendant at a hospital, had 7-year-
old girl, recovered from a mild febrile illness with no rashes. The 2 other siblings, an 8-year-old girl and a
2-year-old boy, died of acute encephalitis within 4 days of onset of disease. No history of similar illness in
the neighbourhood, travel history, or visitors were reported. There was also no history of consumption of
fruits or accidental ingestion of any toxic drugs or pesticides before symptom onset. Nutritional status for all
children was normal for height, weight, and body mass index. Both other siblings developed fever with no
rashes and with convulsions few days following their sister, admitted to ICU and were ventilated, both died
due to cardiorespiratory failure with meningoencephalitis due to intractable seizures.
After so many lab investigations, most of common febrile illness were excluded. The index case (7-year-old
girl) and the 3rd case (2-year-old boy) were found to be Rubella IgM positive. The expected source were
their father who works in a hospital.
In conclusion, rubella encephalitis can present without rash. Rubella virus infection should be considered in
the differential diagnosis of Acute encephalitis syndrome (AES) in unvaccinated children.
https://wwwnc.cdc.gov/eid/article/24/10/18-0053_article

III e atitis T ree ne strains fo n in Africa

Outbreak News Today Journal- December 17, 2018.
A new study from the Wellcome Sanger Institute, the MRC-University of Glasgow Centre for Virus Research
and collaborators and published in the Journal Hepatology of the discovery of three new hepatitis C virus
(HCV) strains circulating in the general population in sub-Saharan Africa. Researchers say that the new
strains could impact hepatitis C treatment and vaccine development worldwide. To investigate HCV in sub-
Saharan Africa, researchers carefully screened the blood of 7751 people from the general population in
Uganda and, using molecular methods, found undiagnosed HCV in 20 of these patients. They sequenced
the HCV genomes from these and two further blood samples from people born in the Democratic Republic
of Congo (DRC) and discovered three completely new strains of the virus, in addition to some strains seen
in the west.
The researchers found that many of the strains present carry mutations in genes known to be associated
with resistance to some commonly used antiviral drugs, proving that careful approaches are needed to
diagnose and treat HCV effectively in Africa.
http://outbreaknewstoday.com/hepatitis-c-three-new-strains-found-africa-83669/

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 Communicable Diseases Bulletin

Flash-on-an-Illness
Nipah Virus
i a ir s infection
Nipah virus (NiV) is a paramyxovirus that causes severe disease in both animals and humans. From
September 1998 to April 1999, human cases of febrile encephalitis with high mortality were reported by the
Malaysian Ministry of Health. Initially Japanese encephalitis (JE) was suspected; however, serological tests
and the disease epidemiology suggested a different disease. Tissue culture isolation from cases identified
an unrecognized paramyxovirus closely related to Hendra virus. Nipah virus was named after the village
(Sungai Nipah) where the first cases were reported.

Si ns an Sy to s
Human infections range from asymptomatic infection to acute respiratory infection, and fatal encephalitis.
Infected people initially develop symptoms including:
• Fever
• Headaches
• Myalgia
• Vomiting
• Sore throat

This can be followed by dizziness, drowsiness, altered consciousness, and neurological signs that indicate
acute encephalitis. Some people can also experience atypical pneumonia and severe respiratory problems,
including acute respiratory distress. Encephalitis and seizures occur in severe cases, progressing to coma
within 24 to 48 hours.

Inc bation erio

The incubation period ranges from 4 to 14 days. However, an incubation period as long as 45 days has been
reported.

Diagnosis
Laboratory diagnosis of a patient with a clinical history depends on the stage of the disease. Virus isolation
from throat and nasal swabs, cerebrospinal fluid, urine, and blood should be performed in the early stages
of disease. Antibody detection (IgG and IgM) by enzyme-linked immunosorbent assay (ELISA) can be used
later on.

Although Nipah virus has caused only a few known outbreaks in Asia, it infects a wide range of
animals and causes severe disease and death in people, making it a public health concern.

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Quarterly Summary Report - 2018

Trans ission

• The primary reservoir for Nipah virus are fruit bats

of the genus Pteropus.

• Transmission of Nipah virus from bats to swine

has not been shown conclusively; however,
there are various biologically plausible means for
infected secretions of primary hosts to enter pigs,
including direct contact with infected secretions,
contaminated fruit or dead bats.

• It is suspected that fruit trees close to pig

confinement areas are foraged by the bats and
the virus is spread by urine or saliva-contaminated
partially-eaten fruit on which the pigs feed.

• Human cases have been related to close contact

with sick pigs and their contaminated tissues, body
fluids, urine, or feces. Some human cases acquired
infection by consumption of fruits or fruit products
(such as raw date palm juice) contaminated with
urine or saliva from infected fruit bats

• Human-to-human transmission of Nipah virus has

also been reported among family and care-givers
including healthcare providers of infected patients.

Treat ent
There are currently no medications or vaccines specific for Nipah virus infection but intensive supportive
care is recommended to treat severe respiratory and neurologic complications.

The case fatality rate is estimated at 40% to 75%. This rate can vary by outbreak, depending
on local capabilities for epidemiological surveillance and clinical management.

22 www.doh.gov.ae
 Communicable Diseases Bulletin

i a ir s e i e iolo y an O tbrea s

i a ir s in ani als
Outbreaks of the Nipah virus in pigs and other domestic animals such as horses, goats, sheep, cats and dogs
were first reported during the initial Malaysian outbreak in 1999. The infection can be asymptomatic in
some pigs, but some develop acute febrile illness, difficulty in breathing, and neurological symptoms.
ontrol of infection in far s
• Routine and thorough cleaning and disinfection of farms with appropriate detergents may be
effective in preventing infection.
• If an outbreak is suspected, the animal premises should be quarantined immediately.
• Culling of infected animals with close supervision of burial or incineration of remains may be
necessary to reduce the risk of transmission to people.
• Restricting or banning the movement of animals from infected farms to other areas can reduce
the spread of the disease.
Re cin t e ris of infection in eo le
Raising awareness of the risk factors and educating people about the measures they can take to reduce
exposure to the Nipah virus is the cornerstone of prevention.
Public health educational messages should focus on:
• Re cin t e ris of bat to an trans ission
Freshly collected date palm juice should be boiled, and fruits should be thoroughly washed and
peeled before consumption. Fruits with sign of bat bites should be discarded.
• Re cin t e ris of ani al to an trans ission
Gloves and other protective clothing should be worn while handling sick animals or their tissues,
and during slaughtering and culling procedures. As much as possible, people should avoid being
in contact with infected pigs.
• Re cin t e ris of an to an trans ission
Close unprotected physical contact with Nipah virus-infected people should be avoided. Regular
hand washing should be carried out after caring for or visiting sick people.
ontrollin infection in ealt care se n s
• Healthcare workers caring for patients with suspected or confirmed infection of Nipah virus, or
handling specimens from them, should implement standard infection control precautions at all times,
• As human-to-human transmission has been reported, particularly in healthcare settings, contact
and droplet precautions should be used in addition to standard precautions. Airborne
precautions may be required in certain circumstances.
• Samples taken from people and animals with suspected Nipah virus infection should be handled
by trained staff working in suitably equipped laboratories.
Volume 9 / Issue 4; 2018 23
Quarterly Summary Report - 2018

Applied Researches in Communicable Diseases

Human brucellosis in the Emirate of Abu Dhabi, United Arab Emirates,
2010–2015
Nawal Al Shehhi, Faisal Aziz, Farida Al Hosani, Bashir Aden and Iain Blair

Abstract
Background: Worldwide, human brucellosis remains an important and widespread infection. In the past,
there were limited data on the occurrence of human brucellosis in the United Arab Emirates and the
reported incidence appeared to be low compared with similar areas. In 2009, a new web-based infectious
disease surveillance system was introduced in the Emirate of Abu Dhabi. This paper reports data from this
new system on human brucellosis for the 6 years 2010 to 2015.
Methods: A dataset was extracted for each case of human brucellosis reported to the notification system
for the 6 year period January 2010 to December 2015. Annual brucellosis rates by age-group, gender,
nationality and, geographical region were calculated and compared.
Results: A total of 480 cases of brucellosis were reported. The overall crude notification rate was 3 · 3 per
100,000 population but higher rates were seen in certain population subgroups notably expatriate males of
working age in the Eastern Region (approximately 10 per 100,000) and UAE nationals of all ages and both
genders in Abu Dhabi (between 4 – 24 per 100,000).
Conclusions: These findings reflect environmental and behavioral factors linked to occupation and leisure
time activities associated with the large number of small non-commercial livestock farms in Abu Dhabi.
Controlling human brucellosis in these circumstances will be challenging.

Keywords: Human brucellosis, Brucella, Incidence, United Arab Emirates, Abu Dhabi, Emirati

To read full article, please refer to:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5059989/

24 www.doh.gov.ae
 Communicable Diseases Bulletin

Editorial Board
- Dr. Farida Al Hosani (Manager / Communicable Diseases Department, DoH)
- Dr. Mariam Al Mulla (Section Head, Communicable Diseases Department, DoH)
- Dr. Badreyya Al Shehhi (Section Head, Communicable Diseases Department, DoH)
- Dr. Ahmed Khudhair (Senior Officer, Communicable Diseases Department, DoH)
- Dr. Tahera Al Ameri (Senior Officer, Communicable Diseases Department, DoH)
- Mrs. Wafa Aldhaheri (Senior Officer, Communicable Diseases Department, DoH)
- Dr. Salwa Mohammed (Officer, Communicable Diseases Department, DoH)
- Mrs. Feda El Saleh (Officer, Communicable Diseases Department, DoH)
- Dr. Bashir Aden (Advisor, Healthcare Quality, DoH)
- Dr. Faiza Ahmed (Senior Analyst, Healthcare Quality, DoH)
- Dr. Jens Thomsen (Section Head, Environmental Health, DoH)
- Dr. Budoor Al Shehhi (Senior Officer, Non-Communicable Diseases Department, DoH)

Scientific Board
- Dr. Farida Al Hosani, Chair of the committee (Manager / Communicable Diseases Department, DoH)
- Prof. Tibor Pal (Professor, Department of Medical Microbiology, UAEU)
- Dr. Agnes Sonnevend (Associate Professor, Department of Medical Microbiology, UAEU)
- Dr. Ahmed Al Suwaidi (Consultant Pediatric Infectious Diseases, Assistant Professor, UAEU)
- Dr. Rayhan Hashmey (Consultant Infectious Diseases, Tawam Hospital)
- Dr. Bashir Aden (Advisor, Healthcare Quality, DoH)
- Dr. Jamal Al Mutawa (Manager, Community Health and Surveillance Department, DoH)
- Dr. Stefan Weber (Consultant Microbiologist / SKMC)
- Dr. Zahir Babiker (Consultant Infectious Diseases Physician and Assistant Professor in UAEU)
- Dr. Huda Imam (Consultant Physician / Al Ain Hospital)
- Mrs. Wafa Aldhaheri, Secretary (Senior Officer, Communicable Diseases Department, DoH)

We are glad to invite you to participate in this bulletin. Please contact:

Mrs. Wafa Aldhaheri
Communicable Diseases Department
Department of Health
Tel: +971 (3) 7165020
E-Mail: waldhaheri@doh.gov.ae

Volume 9 / Issue 4; 2018 25

 LIST OF INFECTIOUS DISEASES TO BE NOTIFIED
1 1
Viral Unspecified
Anthrax Bacterial Fungal
Botulism
Brucellosis 1 Pertussis (Whooping Cough) 1
Plague
Chikungunya 1 Rabies
Cholera Relapsing Fever 1
Corona virus (MERS COV)
Dengue Fever Rubella (German Measles) 1
Diphtheria Rubella Syndrome, Congenital 1
1
Viral Unspecified
Bacterial
Escherichia coli (Enterohemorrhagic): 1
Foodborne Illness Specify: ..............

Haemophilus influenza invasive disease 1

1

Shigellosis 1
1 Smallpox (Variola)
Human Immunodeficiency Virus
(HIV)/AIDS Tuberculosis (Pulmonary)

Influenza - Avian (Human) Typhoid/Paratyphoid Fever 1

Influenza – H1N1 Typhus Fever 1
Viral Hemorrhagic Fever
Legionellosis 1 Yellow Fever
Leprosy (Hansen Disease) 1 Zika Virus 1
Occurrence of any unusual diseases
Malaria 1 specify ...........................................
Measles (Rubeola) 1

All notifications (suspected and confirmed) should be submitted via:

https://bpmweb.haad.ae/UserManagement/Login.aspx