Communicable Diseases

Bulletin

Quarterly Summary Report

First Quarter– 2019 (Jan-Mar)
www.doh.gov.ae Volume 10; Issue Number 1; 2019
Quarterly Summary Report - 2019

Table of Contents
Section Content Page

Distribution of Notified Cases in Abu Dhabi Emirate, by Region

I 3
(Quarter 1, 2019)

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

4
and Gender (Quarter 1, 2019)

Distribution of Gastrointestinal Infections in Abu Dhabi Emirate, by

III 5
Region (Quarter 1, 2019)

Distribution of Gastrointestinal Infections in Abu Dhabi Emirate, by

IV 5
Age Group and Gender (Quarter 1, 2019)

Monthly Trends for Selected Notified Diseases, Abu Dhabi Emirate

V 6
(Q1, 2019 vs. Q1, 2018 and 2017)

Selected Annual Trends for Antimicrobial Resistance in Abu Dhabi

VI 7-9
Emirate

VII Visa Screening Applicants, Abu Dhabi Emirate (Quarter 1, 2019) 10

VIII Influenza Quarterly Report, Abu Dhabi Emirate (Quarter 1, 2019) 11

IX Topic of the Volume: Measles, Re-emerging Challenges to Public Health 12 -16

X Sharing Reports: New TB-DOT Regulating Rules 17-19

XI Activities 20

XII Flash News 21

XIII Flash-on-an-Illness: Dengue Fever 22-25

XIV Applied Research in Communicable Diseases 26

2 www.doh.gov.ae
 Communicable Diseases Bulletin

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

by Region (Quarter 1, 2019)
Abu Al
Al Ain Dhafra TOTAL
Dhabi Year Total
Cases 2019 2018 2017
Quarter 1, 2019
Q1 Q1 Q1 2018 2017
AFP/Poliomyelitis * 3 0 0 3 2 1 8 9
Brucellosis 9 6 2 17 12 21 105 91
Chickenpox 1007 158 134 1299 1336 1475 4290 5254
Cholera 1 0 0 1 0 1 13 8
Haemophilus influenzae (Invasive) 0 0 0 0 0 1 0 2
Hepatitis B 251 67 8 326 211 230 1244 1085
Hepatitis C 200 43 18 261 178 246 791 829
Influenza (A, B, H1N1 & Unspecified) 5625 1477 303 7405 5890 2870 22447 15993
Malaria * ¶ 84 36 15 135 177 149 1429 1907
Measles * 16 4 1 21 20 13 57 38
Meningitis (Bacterial) 12 0 0 12 10 13 47 45
Meningitis (Viral ) 30 0 0 30 13 24 59 64
Mumps 47 19 3 69 45 59 227 217
Pertussis 9 1 0 10 9 17 65 50
Rubella * 13 1 0 14 2 5 7 23
Scabies 568 71 27 666 835 616 2472 2111
Tetanus 1 0 0 1 1 0 4 1
Tuberculosis (Extra-Pulmonary) 67 28 3 98 78 81 314 275
Tuberculosis (Pulmonary)* 107 19 17 143 139 122 525 523
Typhoid /Paratyphoid Fever 25 11 1 37 34 41 178 188
Other Diseases 1191 408 85 1684 1677 1243 6933 6056
TOTAL @
9266 2349 617 12232 10769 7228 41215 34769
Grand total including ruled out 10473 2470 740 13683 12214 8741 46844 41239
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.
Increase or decrease in numbers of notified cases in Q1, 2019 compared to the same period in previous two years.
Abu Al TOTAL
Al Ain Dhafra
Dhabi Year Total
Cases* 2019 2018 2017
Quarter 1, 2019 Q1 Q1 Q1 2018 2017
Campylobacter Enteritis 8 1 0 9 4 7 18 21
Escherichia coli (Enterohemorrhagic) 0 0 0 0 0 0 1 2
Giardiasis 26 16 4 46 44 22 141 128
Hepatitis A 46 12 5 63 35 36 144 189
Rotavirus 200 123 16 339 365 252 912 844
Salmonellosis (non-typhoidal) 44 8 1 53 50 54 234 324
Shigellosis 8 0 0 8 7 4 22 23
Foodborne illness (Not tested) 37 15 0 52 23 55 186 192
Foodborne illness 36
(Tested-but no growth) @ 8 0 44 12 29 99 145
Volume 10 / Issue 1; 2019 3
TOTAL 405 183 26 614 540 459 1757 1868
Grand Total (including ruled out
448 187 30 665 577 511 1930 2027
notifications)
Quarterly Summary Report - 2019

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

by Age Group and Gender (Quarter 1, 2019)
<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/
Poliomyelitis 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 2 1 3
Brucellosis 0 0 1 0 1 0 2 0 6 2 2 1 1 0 1 0 1 0 15 3 18
Chickenpox 15 7 33 38 90 64 218 31 447 93 183 25 39 4 9 1 2 0 1036 263 1299
Cholera 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1
Haemophilus
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
influenzae (Invasive)
Hepatitis B 0 0 0 0 0 0 25 5 97 27 65 19 41 9 18 9 6 5 252 74 326
Hepatitis C 0 0 0 0 0 0 11 1 64 2 72 11 43 6 23 8 8 12 221 40 261
Influenza (A,
B H1N1 & 131 124 993 851 1015 803 429 198 951 537 574 269 238 101 75 42 34 40 4440 2965 7405
unspecified)
Malaria 0 0 1 0 2 0 39 1 33 3 26 4 12 0 11 0 3 0 127 8 135
Measles 1 0 2 0 0 1 5 3 3 3 2 1 0 0 0 0 0 0 13 8 21
Meningitis
1 1 0 0 1 0 0 0 2 0 4 1 0 1 0 0 1 0 9 3 12
Bacterial
Meningitis
6 2 3 2 8 1 2 0 2 2 1 0 1 0 0 0 0 0 23 7 30
Viral
Mumps 1 0 12 8 16 7 1 1 9 2 7 2 3 0 0 0 0 0 49 20 69
Pertussis 1 1 0 1 0 1 1 0 0 1 0 3 1 0 0 0 0 0 3 7 10
Rubella 0 0 2 1 0 0 1 1 2 1 5 0 0 0 1 0 0 0 11 3 14
Scabies 3 3 7 8 25 12 121 8 217 26 150 16 44 3 17 2 2 2 586 80 666
Tetanus 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1
Tuberculosis
0 0 0 0 0 0 9 2 24 16 22 6 5 2 5 2 3 2 68 30 98
(Extra–Pulmonary)
Tuberculosis
0 0 0 0 0 0 14 3 38 16 27 10 19 4 9 1 4 2 111 36 147
(Pulmonary)
Typhoid/
1 0 5 3 1 1 2 3 8 2 6 2 0 0 3 0 0 0 26 11 37
Paratyphoid Fever
Other
45 42 171 135 118 102 95 78 229 247 124 137 60 42 22 15 13 9 877 807 1684
Diseases
TOTAL@ 205 180 1231 1048 1278 992 976 335 2132 978 1269 507 506 172 195 80 76 72 7868 4364 12232
Grand Total 13683
∑

Cells with red numbers are indicative of the highest 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 Q1-2019 after including all ruled out notifications is 13683.

<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
Campylobacter -
1 0 1 0 1 0 1 0 0 1 0 0 2 0 0 0 0 2 6 3 9
Enteritis
Escherichia coli
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
(Enterohemorrhagic)
Giardiasis 0 0 0 0 1 0 11 2 18 2 6 1 4 0 0 0 0 1 40 6 46
Hepatitis A 0 0 4 2 14 10 7 9 6 4 4 1 1 0 1 0 0 0 37 26 63
Rotavirus 28 22 85 77 40 30 3 2 9 16 9 7 4 0 3 2 2 0 183 156 339
Salmonellosis (non-
3 6 11 12 4 3 1 0 2 4 3 1 0 0 1 1 1 0 26 27 53
typhoidal)
Shigellosis 0 0 0 1 2 0 0 1 1 1 0 1 0 0 0 0 0 1 3 5 8
Foodborne illness
0 0 3 2 6 6 3 6 8 7 3 3 2 2 1 0 0 0 26 26 52
(Not tested)
www.doh.gov.ae
4Foodborne illness
(Tested but no 0 0 2 2 2 2 4 2 7 8 2 4 3 0 1 2 3 0 24 20 44
growth)
TOTAL 32 28 106 96 70 51 30 22 51 43 27 18 16 2 7 5 6 4 345 269 614
Brucellosis
Tuberculosis (Extra-Pulmonary)
0 0 1 0 167 0 228 0 6 3 2 2 981 1 78
0 1 081 1 031415 3 27518
Chickenpox 15 7 33 38 90 64 218 31 447 93 183 25 39 4 9 1 2 0 1036 263 1299
Tuberculosis (Pulmonary)* 107 19 17 143 139 122 525 523
Cholera 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1
Typhoid /Paratyphoid Fever
Haemophilus 25 11 1 37 34 41 178 188
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
influenzae (Invasive)
Other Diseases
Hepatitis B 0 0 0 0
1191
0 0
408
25 5
85
97 27
1684
65 19
Communicable
1677
41 9
1243 Diseases
18 9 6
6933 Bulletin
6056
5 252 74 326
TOTAL@C
Hepatitis 0 0 0 0 9266
0 0 2349 1 646172
11 7212232
11 43 10769
6 23 7228
8 8 41215 34769
12 221 40 261
Influenza (A, including ruled out
Grand total 10473 2470 740 13683 12214 8741 46844 41239
Bnotifications
H1N1 & 131 124 993 851 1015 803 429 198 951 537 574 269 238 101 75 42 34 40 4440 2965 7405
Table 3: Distribution of Gastrointestinal Infections in Abu Dhabi Emirate,
unspecified)
Malaria 0 0 1 0 2 26 0
4 39
12 0 1
11 0 33
3 3
0 127 8 135
by Region (Quarter 1, 2019)
Measles 1 0 2 0 0 2 1
1 050 3
0 0 3
0 0 3
13 8 21
Meningitis
1 1 0 0 1
Abu 0 0 0 2 Al 0 4 1 0 1 0 0 1 0 9 3 12
Bacterial Al Ain TOTAL
Meningitis Dhabi Dhafra Year Total
Viral Cases* 6 2 3 2 8 1 2 0 2 2 1
2019
0
2018
1
2017
0 0 0 0 0 23 7 30
Mumps 1 0 12 8 16 Quarter
7 1 1,
1 2019
9 2 7 Q1 2 3 Q10 0 0Q1 0 02018
49 20201769
Pertussis 1 1 0 1 08 1 1 0 0 1 0 3 1 0 0 07 0 0 18 3 7
Campylobacter Enteritis 1 0 9 4 21 10
Rubella 0 0 2 1 0 0 1 1 2 1 5 0 0 0 1 0 0 0 11 3 14
Escherichia coli (Enterohemorrhagic)
Scabies 3 3 7 8 250 12 1210 8 217 0 26 150 016 44 03 17 20 2 2 1 586 80 2 666
Giardiasis
Tetanus 0 0 0 0 026 0 116 0 0 4 0 0 460 0 0
44 0 022 0 0141 1 0 128 1
Tuberculosis
Hepatitis A 0 0 0 0 046 0 912 2 24 5 16 22 636 5 35
2 5 236 3 214468 3018998
(Extra–Pulmonary)
Tuberculosis
Rotavirus 0 0 0 0 200
0 0 123 3 381616
14 27 339
10 19 365
4 9 252
1 4 2912111 36844147
(Pulmonary)
Salmonellosis (non-typhoidal)
Typhoid/ 44 8 1 53 50 54 234 324
1 0 5 3 1 1 2 3 8 2 6 2 0 0 3 0 0 0 26 11 37
Paratyphoid Fever
Shigellosis
Other 8 0 0 8 7 4 22 23
45 42 171 135 118 102 95 78 229 247 124 137 60 42 22 15 13 9 877 807 1684
Foodborne illness (Not tested)
Diseases 37 15 0 52 23 55 186 192
Foodborne illness 205 180 1231 1048 1278 992 976 335 2132 978
TOTAL @
1269 507 506 172 195 80 76 72 7868 4364 12232
@ 36 8 0 44 12 29 99 145
(Tested-but
Grand Total no growth) 13683
∑

TOTAL 405 183 26 614 540 459 1757 1868

* All cases are reported through electronic notification system of DoH.
@
Specimens were screened for the most common bacterial pathogens.
Indicates increase or decrease in numbers of notified cases during the 1st quarter of 2019 compared to the same period of the
previous two years.

Table 4: Distribution of Gastrointestinal Infections in Abu Dhabi

Emirate, by Age Group and Gender (Quarter 1, 2019)
<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
Campylobacter -
1 0 1 0 1 0 1 0 0 1 0 0 2 0 0 0 0 2 6 3 9
Enteritis
Escherichia coli
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
(Enterohemorrhagic)
Giardiasis 0 0 0 0 1 0 11 2 18 2 6 1 4 0 0 0 0 1 40 6 46
Hepatitis A 0 0 4 2 14 10 7 9 6 4 4 1 1 0 1 0 0 0 37 26 63
Rotavirus 28 22 85 77 40 30 3 2 9 16 9 7 4 0 3 2 2 0 183 156 339
Salmonellosis (non-
3 6 11 12 4 3 1 0 2 4 3 1 0 0 1 1 1 0 26 27 53
typhoidal)
Shigellosis 0 0 0 1 2 0 0 1 1 1 0 1 0 0 0 0 0 1 3 5 8
Foodborne illness
0 0 3 2 6 6 3 6 8 7 3 3 2 2 1 0 0 0 26 26 52
(Not tested)
Foodborne illness
(Tested but no 0 0 2 2 2 2 4 2 7 8 2 4 3 0 1 2 3 0 24 20 44
growth)
TOTAL 32 28 106 96 70 51 30 22 51 43 27 18 16 2 7 5 6 4 345 269 614

Cells with red numbers are indicative of the highest counts within the age/gender groups for the given illness.

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Quarterly Summary Report - 2019

Monthly Trends for Selected Notified Diseases, Abu Dhabi Emirate

(Q1, 2019 vs. Q1, 2018 and Q1, 2017)
Number of reported FBI cases significantly increased compared to cases reported
Chickenpox reported cases follow similar trend of the previous two years with
in Q1, 2018, with 6 detected clusters. Salmonella was detected in 33% of the
almost similar number of reported cases in Q1, 2018.
reported FBI cases in this quarter.

Figure 1: Chickenpox cases reported from 2017 to Q1, 2019. Figure 2: Foodborne illness cases reported from 2017 to Q1, 2019.

Number of reported hepatitis A cases increased compared to cases reported in No difference is noted in the number of reported brucellosis cases in Q1, 2019
Q1 of the previous two years with similar trend. 39% of reported cases had recent compared to same period of the previous two years. Main risk factors in the
travel history while 14% of the reported cases were secondary cases. reported cases of Q1, 2019 were occupational exposure (35%) and consumption
of unpasteurized milk (35%).

Figure 3: Hepatitis A cases reported from 2017 to Q1, 2019. Figure 4: Brucellosis cases reported from 2017 to Q1, 2019.

In Q1, 2019 there was a marked increase in number of reported rubella cases Number of reported measles cases in Q1, 2019 is almost equal to cases reported
compared to the same period of time in the previous two years. None of the in Q1, 2018 with two clusters (one cluster in a healthcare facility). 33% were
reported cases were related, 71% of them were adults with unknown MMR epidemiologically linked to confirmed cases, 81% of cases were adults with
vaccination history. unknown MMR vaccination history and 24% of the cases had recent travel history.

Figure 5: Rubella cases reported from 2017 to Q1, 2019. Figure 6: Measles cases reported from 2017 to Q1, 2019.

6 www.doh.gov.ae
 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
Antibiotic
Escherichia coli 2010 2012 2014 2016 2018 2019 Q1 2010-2019 Q1

CTX CIP SXT AMP 67.4 63.2 65.3 65.7 65.2 67.3 No trend
FOS NIT CTX and CIP AMC 13.6 8.8 12.6 11.8 12.6 13.7 No trend
50 CAZ 14.0 11.4 15.7 16.4 18.0 19.0
CTX 23.3 20.6 26.8 30.0 31.7 34.3
% of resistant isolates

40 FEP 5.0 8.3 7.7 7.8 10.1 11.3

ETP – 0 0.6 0.7 1.0 0.9 No trend
30 IPM 0.3 0.2 0.2 0.7 0.5 0.5
MEM 0.1 0 0.2 1.9 0.5 0.6
20
CIP 29.8 33.4 32.9 34.8 37.9 38.0
SXT 46.2 42.7 42.6 42.6 42.0 45.2
10
FOS – – 0.5 0.8 0.3 0.8 No trend
0 NIT 1.8 2.3 2.7 2.0 1.6 1.5 No trend
CTX+CIP 16.5 14.1 17.2 19.1 19.0 23.4
ESBL – 38.0 28.9 29.7 27.9 28.0 No trend
Year N 2,354 5,869 6,300 6,130 5,192 1,089 53,731
E. coli: Increasing trends of resistance for 3rd-generation (CAZ ↑, CTX ↑↑) and 4th-generation (FEP↑) cephalosporins, carbapenems
(IPM ↑, MEM ↑), and fluoroquinolones (CIP ↑). High resistance to trimethoprim/sulfamethoxazole (SXT).

Figure 8 Table 6
% of resistant isolates (%R), by year Trend
Klebsiella pneumoniae Antibiotic
2010 2012 2014 2016 2018 2019 Q1 2010-2019 Q1
CTX FEP MEM CIP
AMC 8.3 7.7 13.7 14.9 15.5 15.4
30
CAZ 9.5 10.0 16.4 19.8 18.4 18.5
% of resistant isolates

CTX 12.0 15.8 20.7 26.8 25.1 26.3

20 FEP 2.0 5.4 7.0 10.2 10.5 11.5
ETP – 0 3.9 5.2 3.7 5.3 No trend
IPM 0.4 1.6 3.0 3.7 2.6 3.6
10 MEM 0.6 1.0 3.6 5.4 3.2 4.5
CIP 11.1 16.5 18.9 21.3 25.6 26.6
SXT 18.2 20.3 21.9 25.0 24.6 24.4
0
NIT 21.7 35.3 32.3 20.7 23.0 21.2 No trend
ESBL – 24.4 21.8 25.0 21.9 20.4 No trend
Year N 816 2,170 2,255 2,454 2,969 904 21,069
K. pneumoniae: Increasing trends of resistance for all beta-lactams (↑↑), including 3rd- and 4th-generation cephalosporins (CAZ, CTX,
FEP: ↑↑) and carbapenems (IPM↑, MEM ↑), as well as for fluoroquinolones (CIP ↑), and trimethoprim/sulfamethoxazole (SXT, ↑).
Figure 9 Table 7
% of resistant isolates (%R), by year Trend
Pseudomonas aeruginosa Antibiotic
2010 2012 2014 2016 2018 2019 Q1 2010-2019 Q1
30 IPM or MEM 25.3 TZP 9.6 10.9 9.9 10.0 2.7 5.3
% of resistant isolates

CAZ 7.9 6.9 8.1 8.3 8.7 13.2

16.7
20 FEP 6.1 5.4 5.6 5.8 6.1 8.7 No trend
IPM 13.0 10.1 16.2 18.0 17.4 24.3
10
MEM 14.0 9.3 12.0 13.6 12.8 17.9
GEN 8.0 6.3 5.4 5.8 5.0 5.7 No trend
0
CIP 10.0 9.8 11.7 12.2 12.2 14.9
IPM/MEM 16.7 11.6 16.8 18.8 18.1 25.3
Year N 757 1,881 1,815 1,962 2,310 843 17,338
P. aeruginosa: Increasing trends of resistance for 3rd-generation cephalosporins (CAZ ↑), carbapenems (IPM ↑↑, MEM ↑), and
fluoroquinolones (CIP ↑). Decreasing trend for resistance for piperacillin/tazobactam (TZP ↓).

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Quarterly Summary Report - 2019

P. aeruginosa: Increasing trends of resistance for 3rd-generation cephalosporins (CAZ ↑), carbapenems (IPM ↑↑, MEM ↑), and
fluoroquinolones (CIP ↑). Decreasing trend for resistance for piperacillin/tazobactam (TZP ↓).

Figure 10 Table 8
% of resistant isolates (%R), by year Trend
Acinetobacter baumannii Antibiotic
2010-2019 Q1
2010 2012 2014 2016 2018 2019 Q1
IPM or MEM
IPM 39.3 46.6 40.5 33.7 28.7 48.2
% of resistant isolates

80
MEM 46.3 53.7 41.8 34.6 29.1 47.1
60
AMK 13.5 21.8 13.0 6.1 5.6 7.1
40
GEN 33.0 37.2 28.6 28.5 24.9 36.6
20 CIP 41.2 45.9 41.4 33.7 30.0 49.3
0 MNO – 19.1 14.1 12.1 6.1 10.7
TCY 36.2 42.9 43.6 34.3 20.6 30.3
IPM/MEM 46.3 53.7 41.7 34.5 29.1 48.2
Year N 189 523 432 420 506 144 4,266

A. baumannii: Overall decreasing trends of resistance across all classes of antibiotics, however, resistance to carbapenems (IPM,
MEM, IPM or MEM) remains high.

Figure 11 Table 9
% of resistant isolates (%R), by year Trend
Staphylococcus aureus Antibiotic
2010 2012 2014 2016 2018 2019 Q1 2010-2019 Q1
OXA (% MRSA) OXA (MRSA) 25.7 27.5 33.0 37.7 39.3 44.0
% of resistant isolates

50
40 GEN 4.9 3.5 4.5 5.8 5.0 5.2
30
CIP 10.6 27.4 26.2 30.3 32.8 29.7
20
10 SXT 16.6 19.5 18.9 19.5 22.4 19.5
0 CLI 1.5 2.9 11.3 11.1 13.1 14.2
ERY 16.2 18.6 22.1 24.2 26.4 29.1
Year N 1,384 3,323 3,277 3,678 3,376 1277 31,569

S. aureus: Increasing trends of resistance across all antibiotic classes, including beta-lactam antibiotics (OXA ↑↑), aminoglycosides
(GEN ↑), fluoroquinolones (CIP ↑↑), trimethoprim/sulfamethoxazole (SXT ↑), lincosamides (CLI ↑↑), and macrolides (ERY ↑↑).

Figure 12 Table 10
% of resistant isolates (%R), by year Trend
Streptococcus pneumoniae Antibiotic
2010-2019 Q1
2010 2012 2014 2016 2018 2019 Q1
PEN-G (oral BP) PEN-G + ERY
50 PEN-G (oral BP) 19.8 12.8 10.3 7.2 8.5 11.0
% of resistant isolates

40 PEN-G (NM BP) 0 0 0 0.4 0.4 0.7 No trend

PEN-G (M BP) 61.7 61.0 59.5 60.5 58.0 54.5 No trend
30
CRO NM 1.2 1.4 0.4 0.9 0.7 0.6 No trend
20
CTX NM 2.4 1.5 0 0 0.7 0 No trend
10
SXT 22.2 17.7 21.0 22.8 23.8 30.2 No trend
0
ERY 43.5 41.0 45.2 49.8 47.3 48.3 No trend
PEN-G + ERY 35.9 33.9 33.6 39.0 37.1 31.0 No trend
Year N 204 438 384 471 604 176 4,027

S. pneumoniae: Decreasing trend of resistance for penicillin G (oral breakpoints), ↓↓). High level of resistance for macrolides (ERY),
and for penicillin G and macrolides, combined (PEN-G + ERY).

8 www.doh.gov.ae
 Communicable Diseases Bulletin

Figure 13 Table 11
% of resistant isolates (%R), by year
Neisseria gonorrhoeae Antibiotic
Trend
2010 2012 2014 2016 2018 2019 Q1 2010-2019 Q1
CIP
% of resistant isolates

100
PEN 50.0 45.5 62.1 42.9 43.5 40.0 No trend
75
CRO 0 0 0 0 0 0 No trend
50
25
CTX 0 0 0 0 0 0 No trend

0 CIP 69.2 66.7 77.1 78.0 76.9 90.0 No trend

TCY 92.9 71.9 67.3 71.9 62.5 73.7 No trend
Year N 14 33 50 71 74 25 450
N. gonorrhoeae: High level of resistance for penicillin, fluoroquinolone (CIP) 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
Mycobacterium tuberculosis Antibiotic
2010 2012 2014 2016 2018 2019 Q1 2010-2019 Q1
10
RIF+INH (MDR-TB)
% of resistant isolates

STR 0 5.1 3.3 – – – No trend

8
6 RIF 2.3 1.1 1.5 4.0 1.6 3.9 No trend
4 EMB 0 0 0.4 1.9 0.5 1.0 No trend
2 INH 4.7 6.5 6.4 7.7 6.5 4.9 No trend
0 2.9
PZA 9.5 9.4 6.5 8.9 10.9 No trend
RIF+INH (MDR) 2.3 0.9 1.3 3.4 1.6 2.9 No trend
Year N 91 360 456 473 434 103 3,467
M. tuberculosis: Low level of resistance to first-line antimicrobials, and low rate of multidrug-resistant TB (MDR-TB).

• 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-lac-
tamase-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/sulfa-
methoxazole, 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).
• Trend indicators / : Trend for percent of resistant isolates (%R) is increasing ( ) or decreasing ( ), statistically
significant, (p≤0.05). / : Trend for percent of resistant isolates (%R) is increasing ( ) or decreasing ( ) by
≥1.0 percentage points per year (on average) (p≤0.05). Trends are long-term trends (2010-2019 Q1).
Data source: Abu Dhabi Antimicrobial Resistance Surveillance System. Data shown is from Abu Dhabi public healthcare
facilities (SEHA), 2010-2019 Q1.

Volume 10 / Issue 1; 2019 9

Quarterly Summary Report - 2019

Visa Screening Applicants, Abu Dhabi Emirate (Quarter 1, 2019)

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 occupational categories.

The Department of Health (DoH) Visa Screening Standard is available online at:
https://www.haad.ae/HAAD/LinkClick.aspx?fileticket=taXl6j6Q6I4%3d&tabid=820

Average of 250,000 applicants or more apply for visa medical screening every quarter in Abu Dhabi Emirate.
During the First quarter of 2019, a total of 374,143 applicants were screened at all DOH-licensed Screening
Centers.

400000
400000 374145
374145 60 60
New
New
350000
350000 48 48 Renewal
Renewal
50 50
290562
290562
300000
300000 41 41
40 40
No. of Applicants
No. of Applicants

250000
250000 34 34
207629
207629
No. of Cases
No. of Cases

200000
200000 166516
166516 30 30
22 22
150000
150000
20 20
100000
100000 83583
83583
10 10
50000
50000

0 0 0 0
MM F F New
New Renew Renew TOTAL
TOTAL PCR+ve
PCR+ve PCR-ve
PCR-ve
& Culture+ve
& Culture+ve
Gender
Gender Visa Status
Visa Status LabLab
result
result

Figure 15: Visa screening applicants during the First quarter of 2019. Figure 16: Active TB cases detected by visa screening in Abu Dhabi
Emirate (Q1, 2019).

Table 13: Number and rate of positive cases among new and renewal visa applicants during the First quarter of 2019.

* Rate: the number of positive cases per 100,000 visa screened applicants.
** Applied to certain occupational categories only (New= 31180; Renew= 19829).
*** This refers to active TB cases only confirmed by PCR or culture.

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 Communicable Diseases Bulletin

Influenza Quarterly Report, Abu Dhabi Emirate (Quarter 1, 2019)

Monitoring influenza trends through the surveillance systems enables 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; and active influenza surveillance that includes both sentinel
influenza-like illness (ILI) and severe acute respiratory Illness (SARI) reporting from the selected healthcare
facilities.

A total of 7,405 influenza cases were reported to DoH in Q1, 2019 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 1, in addition to virus types are
shown in figure 18.
6000
6000 600
600 Influenza
InfluenzaAA Influenza
InfluenzaBB
2017
2017
2018
2018 Influenza
InfluenzaH1N1
H1N1 Influenza
InfluenzaA/B
A/B
5000
5000 500
500
Unspecified
Unspecified
Notified Cases
Cases

2019
2019
4000
4000 400
400
of Notified

of Cases
Cases
3000
3000 300
300
No. of

2000
2000
No. of

200
200
No.
No.

1000
1000 100
100

00
00
Jan
Jan Feb
Feb Mar
Mar Apr
Apr May
May Jun
Jun Jul
Jul Aug
Aug Sep
Sep Oct
Oct Nov
Nov Dec
Dec

Months
Months
WEEK
WEEK
Figure 17: In Q1, 2019, higher number of influenza cases were Figure 18: Distribution of influenza types by weeks. Increasing activity
reported compared to the same period in the previous two years of influenza B is noted in Q1, 2019.
(Percentage of influenza increase = 158% and 26% compared to 2017
and 2018, respectively).

485 ILI cases in Q1, 2019 were reported through the active surveillance system. 124 (25%) of the cases were
influenza positive distributed by percentage of virus types (Figure 19). Third source of influenza surveillance
is SARI in which 652 cases were reported from two selected health care facilities (548 cases from Mafraq
and 104 cases from Al Ain Hospital). Out of 598 tested SARI cases, 152 cases (25%) were found to be
positive for respiratory organisms as shown in figure 20.

6060 Influenza
InfluenzaAA(H1N1)
(H1N1) 5656 Influenza
InfluenzaAA(H1N1)
(H1N1) Influenza
InfluenzaAA(H3N2)
(H3N2)
Influenza
InfluenzaAA(H3N2)
(H3N2) Influenza
InfluenzaBB Respiratory
RespiratorySyncytial
SyncytialVirus
Virus(RSV)
(RSV)
5050 Others
Others
of Cases
Cases

Influenza
InfluenzaBB 3737
3838 4040 3636
4040 3535 3535 3232
of Cases
Cases

3232 3232 3535 2929

3131
Percentage of

2626 3030 2525 2626

3030
Percentage

2525 2222 2121 2121

Percentage of

2020 1717
Percentage

2020 1414 1313

1515
77 88
1010 1010 44 33
55
00 00
Months Jan
Jan Feb
Feb
Months viruses in ILI cases by percentage. Mar
Mar
Figure 19: Distribution of influenza Jan
Figure 20: DistributionJan of Month
Month Feb
respiratory Feb
organisms amongMar Mar cases
SARI
The three common influenza types were almost distributed equally in by percentage. RSV was still the most common organism in January
the first two months of the quarter. Influenza B is the most common same as the previous two quarters (Q3 and Q4 of 2018). Gradual
type in March. (n = 124). reduction in percentage of Flu A (H3N2) through the quarter and
increase in Flu A (H1N1) in March were noted (n = 152).

Volume 10 / Issue 1; 2019 11

Quarterly Summary Report - 2019

Topic of the Volume

Measles, Re-emerging Challenges to Public Health

Introduction
Measles is a highly contagious disease worldwide caused by morbillivirus virus and it continues to cause
significant deaths among children although the effective and safe vaccine is available since decades.
Measles, Mumps, Rubella (MMR) vaccine is an effective safe vaccine. Measles is eliminated in some parts
of the world; however, other developing countries in Asia and Africa are still struggling. Measles is targeted
to be eliminated in WHO 5 years Global Vaccine Action Plan in 2020.
Around 7 million persons were affected by measles in 2016. According to WHO, measles’s death globally
decreased from 550,100 deaths in 2000 to 89,780 in 2016.

Signs and Symptoms

The incubation period of measles varies from 7 to 21 days from exposure to an infected person, with average
of 10 days. Measles symptoms include high fever, cough, runny nose, red watery eyes and rash. Measles is
a highly contagious disease in which the communicability period varies from 4 days before to 4 days after
rash appearance. Rash usually starts as flat red spots distributed at the hairline on face, then spread down
to neck, arms, trunk and legs.

Transmission of Measles
Measles is one of the most contagious of all infectious diseases; up to 9 out of 10 susceptible persons with
close contact to a measles patient will develop measles. The virus is transmitted by direct contact with
infectious droplets or by airborne spread when an infected person breathes, coughs, or sneezes. Measles
virus can remain infectious in the air and surfaces for up to two hours after an infected person leaves an
area.

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 Communicable Diseases Bulletin

Complications of Measles
Patients with measles can suffer from various complications especially children younger than 5 years, adults
over 20 years old, pregnant women and people with compromised immune systems, such as leukemia or
HIV infection. Complications vary in severity from common & less severe complications, severe to longterm/
fatal but rare complications (Figure 21).

Common Ear infections is reported in less than one

Diarrhea is reported in less than one out
Complications out of 10 cases, can result in permanent
of 10 cases.
hearing loss.

Severe 1 out of every 20 infected children could

Complications Hospitalization due to sever complication develop pneumonia, the most common
of measles infection. cause of death from measles in young
children.

About 1 child out of every 1,000 who

get measles will develop encephalitis
(swelling of the brain) that can lead to
convulsions and can leave the child
deaf or with intellectual disability.
Nearly 1 to 3 of every 1,000 children
Pregnant woman will give birth
who become infected with measles
prematurely, or have a low-birth-
will die from respiratory and
weight baby
neurologic complications.

Long-term Subacute sclerosing panencephalitis (SSPE) is a very rare, but fatal

Complications disease of the central nervous system that results from a measles virus
infection acquired earlier in life.

Figure 21: Complications of measles.

Reporting measles cases in UAE and Abu Dhabi Emirate

UAE
WHO published annual reports of measles cases in UAE from 2007 to 2018 (figure 22). There was an
increase in number of reported cases from 2011-2015. Cases decreased after conducting MMR vaccination
campaign in 2015/2016.

Abu Dhabi Emirate

Measles is one of the notifiable communicable diseases in Abu Dhabi and UAE. Therefore, any suspected
or confirmed case of measles must be reported through DoH electronic notification (e-notification) system
within one calendar day. As UAE is progressing towards measles elimination, it is required to report any
case with fever and rash as suspected measles.
In 2018, there were 57 reported cases through DoH e-notification system, compared to 38 cases in 2017.

Volume 10 / Issue 1; 2019 13

Quarterly Summary Report - 2019

Number of Cases 100

80
60
40
20
0
2017-02

2017-03

2017-04

2017-05

2017-06

2017-07

2017-08

2017-09

2017-10

2017-11

2017-12

2018-01

2018-02

2018-03

2018-04

2018-05

2018-06

2018-07

2018-08

2018-09

2018-10

2018-11

2018-12

2019-01

2019-02

2019-03
Discarded
Clinical
Epi
Lab Month of onset

Confirmed
United Arab Emirates age distribution, vaccination status, and incidence, 2018-02 to 2019-01 Year
Cases

Incidence rate per 1,000,000

70 2007 63
300
60 255.8 2008 40
Number of Cases

250 2009 84
50
200 2010 77
40
150 2011 143
30 91.5 100 2012 107
20 2013 310
23.2 50
10 14.2 13.8 14.5 2.1 2014 344
0 0
2015 826
<1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 2016 215
Age at onset 2017 118
0 doses 1 dose 2+ doses Unknown 2018 173

Figure 22: UAE reported cases of measles between 2007 to 2018 with age distribution and vaccination status (WHO).

Prevention of Measles
Measles is a vaccine preventable disease. Measles vaccine is usually combined with other vaccines; mumps &
rubella (MMR) or with extra-combination of varicella (MMRV). MMR is an attenuated live virus vaccine, that
protects against the three diseases. One dose of MMR vaccine is 93% effective, while two doses are about 97%
effective in preventing measles. Measles vaccination resulted in 80% drop in measles deaths between 2000
and 2017 worldwide according to WHO. Table 14 summarizes the DoH recommendations of MMR vaccine in
different groups.
Table 14: DoH recommendations of MMR vaccine in different groups.
Who Should Get MMR Vaccine?
Children:
• The first dose of MMR vaccine is given at the end of 12 months of age.
• The second dose of MMR vaccine is given at 18 months of age.

Healthcare Professionals:
• The recommendation by DoH is 2 doses of MMR vaccine to healthcare professionals without serologic
evidence of immunity or document of prior vaccination.
Contacts of measles cases:
• Regardless of previous MMR immunization history, one dose of MMR vaccine is recommended for con-
tacts in accommodation, schools/nursery or work place.
Women of Childbearing age:
• MMR vaccine is indicated in premarital screening program for applicants with no evidence of immunity.
• Pregnant women with no evidence of immunity during antenatal care screening, should receive at least
one dose of MMR vaccine before their coming pregnancy.

MMR vaccine contraindications

Persons with the below conditions should not receive MMR vaccine:
• History of severe allergic reaction after previous dose or to a vaccine component.
• Severe immunodeficiency
• Pregnancy

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 Communicable Diseases Bulletin

Treatment
There is no specific treatment for measles. Complications can be prevented through supportive care such
as adequate fluid replacement and nutrition to treat the dehydration caused by diarrhea. For ear and chest
infections, antibiotics can be prescribed. Two doses of vitamin A, 24 hours apart, must be given to infected
children which can help in reducing risk of blindness.

Re-emerging Measles
Measles cases started to spike in the last few years in some parts of the world. In 2017, the most common
regions that experienced the increase in measles cases were Eastern Mediterranean Region, the Americas
and Europe, although Western Pacific experienced a decrease in measles incidence.
For example, there is misconception about the measles vaccine in Europe, while in Venezuela there is
general collapse in the health system, while Africa is facing problems with low immunization coverage.
Reported measles cases have increased worldwide by 300% according to WHO in the first quarter of 2019
(Figure 23). Measles outbreaks were reported by some countries including Democratic Republic of the
Congo, Ethiopia, Georgia, Kyrgyzstan, Madagascar, Myanmar, Philippines, Sudan and Ukraine. On the other
hand, the United States, Tunisia and Thailand experienced serious outbreaks in the last few months despite
high immunization coverage.

Pacific

Figure 23: Measles increasing rates worldwide in different world’s regions in Q1, 2019 compared to Q1, 2018.

Volume 10 / Issue 1; 2019 15

Quarterly Summary Report - 2019

International Efforts toward Measles Elimination

Incidence of vaccine - preventable diseases usually subsequently decreases when immunization coverage
increases.

Global efforts should focus on reaching poor people, those who live in marginalized communities, especially
places that face conflicts and wars; as well as ensuring the accessibility of the high quality and affordable
services in the primary health care centers to everybody.

Other forms of advocacy to strengthen the vaccination coverage may include:

• Vaccine quality improvement,
• Advocacy activities between decision makers,
• Awareness activities and campaigns for public about the importance of the vaccine.
To control measles, a good timely surveillance system has to be developed. Any suspected case should be
investigated thoroughly in order to assist in early detection of any outbreak. WHO member states report
their suspected and confirmed measles cases, which are shared through their national disease surveillance
system.
WHO outlines various options to be used as vaccination strategies in several settings comprising the planning,
organizing, implementation and monitoring steps. Vaccination strategies include routine immunization,
mass immunization campaigns and high quality supplementary immunization activities (SIAs).

Take Home Messages

• Measles is a highly contagious disease.
• Routine measles vaccination for children, combined with mass immunization campaigns in countries with low
routine coverage, are key public health strategies to reduce global measles incidence and deaths.
• The MMR vaccine is safe, Two doses are required to prevent the infection.

16 www.doh.gov.ae
 Communicable Diseases Bulletin

Sharing Reports
New TB-DOT Regulating Rules
Tuberculosis (TB) is caused by bacteria called Mycobacterium tuberculosis that most often affect the lungs.
Tuberculosis is curable and preventable disease. TB is spread from one person to another through air. When
people with pulmonary TB cough, sneeze or spit, they propel the TB germs into the air. A person needs to
inhale only a few of these germs to become infected.
TB mostly affects adults in their most productive years. However, all age groups are at risk. Over 95% of
cases and deaths are in developing countries.
TB occurs in every part of the world. In 2017, the largest number of new TB cases were reported in the
South-East Asia and Western Pacific regions with 62% of new cases, followed by the African region with 25%
of new cases. 87% of new TB cases occurred in the 30 high TB burden countries. Eight countries accounted
for two thirds of the new TB cases: India, China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh
and South Africa (figure 24).
.

Figure 24: Estimated TB incidence rates, 2017.

TB reporting in Abu Dhabi Emirate

TB (pulmonary and extra-pulmonary) disease is a reportable disease as per the Federal law No.14 for 2014
and the Department of Health (DoH) policy for reporting the infectious diseases. Any suspected case
that meets TB case definition should be reported to DoH and investigated as per the DoH standard for TB
management; Directly Observed Therapy (DOT).
Pulmonary Tuberculosis (PTB) cases can be detected also through screening programs mainly visa screening
of expatriates (both new and renew). Confirmed PTB cases are isolated in SEHA hospitals, managed as
per the DOT standard, and monitored clinically and bacteriologically until they become non-infectious. For
more information about DOT program, refer to the below link:
https://www.haad.ae/HAAD/LinkClick.aspx?fileticket=2Nvz3dlk6KU%3d&tabid=819

DOT course is divided into 2 phases; Initial phase includes treatment with a four-drug regimen, isoniazid
(INH), Rifampicin (Rif), Pyrazinamide (PZA) and Ethambutol (EMB) for 2-3 months followed by a continuation
phase with 2 drugs regimen for 4-6 months.

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Quarterly Summary Report - 2019

All PTB cases whether detected in visa screening or through the electronic infectious diseases notification
(e-IDN) system will be followed during the treatment course through the electronic system which is designed
to have 6 stages sub-forms in the TB notification:
• First stage for the demographic data and history.
• Second stage for the lab investigations.
• Third stage for the diagnosis and treatment categories.
• Fourth stage for the respiratory sample culture and sputum conversion date.
• Fifth stage for the follow up progress in DOT clinic.
• Sixth stage for the date of treatment completion and treatment outcome.

New changes in the laws and decisions regulating TB management in visa screening
The Cabinet decree No. 5 for 2016 amending the ministerial decree No. 7 for 2008, allows all residents
found to have active PTB disease during visa renewal screening to be treated under DOT program and
offered fitness certificate for one year.

TB cases enrolled in DOT program will be referred to one of the DOT clinics in the three regions of Abu Dhabi
Emirate. The program is currently running in the following HCFs:
1- Disease prevention and screening center (DPSC)- Abu Dhabi
2- Baniyas clinic
3- DPSC – Al Ain
4- Al Dhafra hospitals
TB cases will be scheduled for weekly visits -or as indicated. Patient and sponsor consents are mandatory
requirements for any PTB case to be enrolled under DOT program. Patient’s visits will be documented in the
DOT clinic and in the patient treatment card. TB patients under DOT program are educated by the DOT clinic
staff about their disease, course duration, anti-TB medications side effects and importance of compliance
to the treatment course.
The impact of new changes on TB management program
PTB cases eligible for treatment course under DOT program are increasing as shown in figure 25.

Figure 25: Reported, confirmed and DOT enrolled PTB cases in Abu Dhabi Emirate for the period 2015-2018.

18 www.doh.gov.ae
 Communicable Diseases Bulletin

PTB cases detected through visa screening in the period 2015-2018

Confirmed PTB cases by TB- PCR (Genexpert/Rif) or sputum culture for Acid Fast Bacilli (AFB) during renewal
visa screening who were eligible for enrollement under DOT program increased after implementation of the
new regulations (figure 26).

Figure 26: PTB cases detected through visa screening and eligible for treatment under DOT program.

Requirements for completion of treatment under DOT program:

PTB patients should comply with the below requirements to be enrolled in DOT program in Abu Dhabi
Emirate:
1- Consent forms should be signed by the patient and sponsor,
2- Comply with the weekly visits schedule at assigned DOT clinic,
3- Comply with the requested follow up investigations as per DOT standard,
4- If the patient go for vacation, he/she should inform the DOT clinic and should not exceed three weeks
(applied only for patients in the continuation phase of DOT program).

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Quarterly Summary Report - 2019

Activities
I- Community school events:
• Communicable diseases department (CDD) team participated in several community school
events organized in Abu Dhabi Emirate. CDD team presented the importance of applying healthy
habits and their role in preventing infectious diseases.
• A total of 621 participants from community school staff in addition to the parents and their
children attended those events.
II- Awareness sessions on polio eradication and measles/rubella elimination programs:
• An awareness session about polio eradication and measles/rubella elimination programs was
conducted the in first quarter of 2019. This session targeted the healthcare professionals from
Burjeel hospital at Al Ain region. The main aim of this session is to increase the awareness on
polio eradication and measles/rubella elimination programs requirements.
• 18 healthcare professionals attended this session
III- Awareness session to medical students on IDN and DoH response to Middle East Respiratory
Syndrome Corona Virus (MERS CoV):
• An awareness session was provided to UAE University medical students. An overview about the
Electronic IDN system and the 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 30 medical students.
IV- Infectious Diseases Notification (IDN) training sessions:
• Six IDN sessions were conducted –in Abu Dhabi and Al Ain regions- to educate healthcare
professionals (HCPs) on procedures and requirements for reporting communicable diseases
through the electronic notification system and the importance of epidemiological investigation
process. In addition, infectious disease control and prevention was discussed.
• Total of 89 HCPs attended those sessions.
V- Personal Protective Equipment (PPE) training for non-healthcare staff
• Training sessions about the proper use of PPEs was conducted for non-health care staff who are
dealing with the infectious materials.
• The sessions were conducted in Abu Dhabi, Al Ain and Al Dhafra regions and were attended by
92 staff from municipality, mortuary and Tadweer staff.

20 www.doh.gov.ae
 Communicable Diseases Bulletin

Flash News
1- Measles – Madagascar
Disease outbreak news -17 January 2019
From 4 October 2018 to 7 January 2019, 19,539 measles cases and 39 “facility-based” deaths (case fatality
ratio: 0.2%) have been reported by the Ministry of Public Health (MoH) of Madagascar. Cases were reported
from 66 of 114 total districts in all 22 regions of Madagascar. Among the 19,539 measles cases, 375 have
been laboratory confirmed (all are IgM+) and 19,164 were confirmed by epidemiological link. In the current
epidemic, children aged 1 to 14 years account for 64% of the total number of cases.
The national immunization program recommends routine measles immunization for children aged nine
months. More than half of the cases (51%) reported during the current outbreak have not been vaccinated
or have unknown immunization status. MoH started the response to the outbreak by enhancement of
active surveillance (active case finding, community-based surveillance, distribution of specimen collection
kits) in all affected districts and use of the Global Measles Programmatic Risk Assessment Tool to target
priority districts for vaccination.

https://www.who.int/csr/don/17-january-2019-measles-madagascar/en/

2- Exposures to Drug-Resistant Brucellosis (RB51) Linked to Raw Milk

CDC-February 8, 2019
The Centers for Disease Control and Prevention and state health officials are investigating potential
exposures to Brucella strain (RB51) in 19 states, connected to consuming raw (unpasteurized) milk from
Miller’s Biodiversity Farm in Quarryville, Pennsylvania. One case of RB51 brucellosis infection has been
confirmed in New York, and an unknown number of people may have been exposed to RB51 from drinking
the milk from this farm. This type of Brucella is resistant to first-line drugs and can be difficult to diagnose;
because of limited testing options and the fact that early brucellosis, symptoms are similar to those of more
common illnesses like flu.
The New York case is the third known instance of an infection with RB51 associated with consuming raw
milk or raw milk products produced in the United States. The other two human cases occurred in October
2017 in New Jersey and in August 2017 in Texas. Those cases reported drinking raw milk from an online
retailer and a Texas farm, respectively. In addition to these three confirmed cases, hundreds of others were
potentially exposed to RB51 during these three incidents.
https://www.cdc.gov/brucellosis/exposure/drug-resistant-brucellosis-linked-raw-milk.html

3- Middle East Respiratory Syndrome Coronavirus (MERS-CoV) – Oman

Disease outbreak news -4 March 2019
Between 12 and 18 February 2019, the National IHR Focal Point of Oman reported eight additional cases of
Middle East respiratory syndrome coronavirus (MERS-CoV) infection. Four cases were reported from South
Sharquia governorate, and four cases were reported from North Batinah governorate where a MERS-CoV
cluster was recently identified.
Since 27 January 2019, a total of 13 MERS cases were reported from Oman, including nine from North
Batinah (five cases were previously reported in the Disease outbreak News 11 February 2019) and four from
South Sharquia. All five laboratory confirmed cases are females from the same family and range in age from
30-59 years. The source of infection in this cluster is under investigation in Oman and four of the five cases
appear to be secondary cases resulting from human-to-human transmission. While all cases did not report
direct contact with dromedary camels, they resided on a farm where dromedary camels and other animals
were kept.
https://www.who.int/csr/don/04-march-2019-mers-oman/en/

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Quarterly Summary Report - 2019

Flash-on-an-Illness
Dengue Fever
Dengue fever is caused by Dengue virus (DENV), a mosquito-borne flavivirus. DENV is a single stranded RNA
positive-strand virus of the family Flaviviridae, genus Flavivirus. This genus includes also the West Nile virus,
Tick-borne Encephalitis Virus, Yellow Fever Virus, and several other viruses, which may cause encephalitis.
The Dengue virus causes a wide range of diseases in humans, from a self-limited Dengue fever to a life-
threatening syndrome called Dengue haemorrhagic fever or Dengue Shock Syndrome.
Dengue infection is common in tropical and subtropical regions around the world. In recent years,
transmission has increased in urban areas and has become a major international public health concern.

History of dengue fever

• The first record of a case of probable dengue fever was in a Chinese

265–420 AD medical encyclopedia from the Jin Dynasty which referred to a “water
poison” associated with flying insects.

• The first recognized dengue fever epidemics occurred almost simulta-

1780 neously in Asia, Africa, and North America in the 1780s.

• The first confirmed case report was in 1789 by Benjamin Rush who
1789 coined the term "breakbone fever" because of the symptoms of, myalgia
and arthralgia

Transmission
Aedes aegypti mosquito is the primary vector of dengue virus. The dengue virus is transmitted to humans
through the bites of infected female mosquitoes. Infected symptomatic or asymptomatic humans are the
main carriers and multipliers of the virus, serving as a source of the virus for uninfected mosquitoes.
The Aedes aegypti mosquito lives in urban habitats and breeds mostly in man-made containers. Unlike
other mosquitoes Aedes aegypti is a day-time feeder; its peak biting periods are early in the morning and
in the evening.
Aedes albopictus, a secondary dengue vector in Asia, has spread to North America and more than 25
countries in the European Region, largely due to the international trade in used tyres (a breeding habitat)
and other goods (e.g. lucky bamboo). Aedes albopictus is highly adaptive and, therefore, can survive in
cooler temperate regions of Europe. Its spread is due to its tolerance to temperatures below freezing,
hibernation, and ability to shelter in microhabitats.

Incubation period: The incubation period is usually short, it varies from 3 to 14 days (commonly 4-7 days).

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 Communicable Diseases Bulletin

Clinical Features

Vomiting

Fever Bleeding

Joints
pain

Headache

Figure 27: Clinical features of dengue fever.

Diagnosis
Diagnosing dengue fever can be difficult, because its signs and symptoms can be easily confused with those
of other diseases such as malaria, leptospirosis and typhoid fever.

Laboratory criteria for diagnosis: Any one of the following

• Isolation of dengue virus from serum and/or autopsy samples
• Demonstration of a four-fold or greater change in antibody titers to one or more dengue virus antigens
in paired serum samples (Acute serum should be collected within 1-5 days and convalescent serum
from 15-21 days after the 1st serum).
• Detection of dengue virus genomic sequences in autopsy tissue or serum samples by polymerase chain
reaction (PCR).
• Detection of dengue virus antigen NS1 from serum sample.

((For PCR, virus isolation and NS1 tests sample should be collected ideally within 5 days and can extended
up to 7 days of onset of symptoms)).

Other tests that can help in the diagnosis of Dengue fever includes Complete Blood Cell Count (CBC),
coagulation tests, urinalysis, liver function tests. Coagulation abnormalities include:
• Thrombocytopenia (≤ 100,000 platelets/μL)
• A prolonged prothrombin time (PT)
• Prolonged activated partial thromboplastin (PTT)
• Decreased fibrinogen
• Increased amount of fibrin split products

Management and treatment

No antivirals have been shown to improve outcome. Treatment is supportive to relieve the symptoms.
Increased oral fluid intake is recommended to prevent dehydration. Supplementation with intravenous
fluids may be necessary to prevent dehydration and significant concentration of the blood if the patient
is unable to maintain oral intake. A platelet transfusion is indicated in rare cases if the platelet level drops
significantly (below 20,000 platelets/μL) or if there is significant bleeding.

Epidemiology
Dengue fever remained a relatively geographically restricted disease until the middle of the 20th century. The
disruption of the Second World War, in particular the coincidental transport of Aedes mosquitoes around
the world in cargo, thought to have played a crucial role in the dissemination of the viruses.
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Quarterly Summary Report - 2019

Global situation
Today about 2.5 billion people (40% of the world’s population) live in areas where there is a risk of dengue
fever transmission. Dengue fever is endemic in at least 100 countries in Asia, the Pacific, the Americas, Africa,
and the Caribbean. The World Health Organization (WHO) estimates that 50 to 100 million infections occur
yearly, including 500,000 Dengue Hemorrhagic Fever cases and 22,000 deaths, mostly among children.

Figure 28: Distribution of dengue fever cases worldwide (2016).

Dengue fever in the UAE

Dengue fever and dengue hemorrhagic fever cases are reportable diseases in the UAE. Nearly all dengue
fever cases reported in the UAE were acquired elsewhere by travelers coming from endemic countries.
Because of the vigorous vector screening and control measures in the UAE, the secondary transmission of
the dengue infection is unlikely from the imported cases.

Dengue fever in Abu Dhabi

Any suspected or confirmed case of dengue fever and dengue hemorrhagic fever must be reported through
DoH electronic notification system immediately. The communicable diseases department report the cases
to the concerned authority to conduct the vector screening and control measures.
All confirmed dengue infection reported in Abu Dhabi were imported cases. Figure # 29 shows the total
number of reported suspected and confirmed cases of dengue fever from 2016 to 2018.
An increase was noticed in the number of cases in 2017 due to several outbreaks in countries like India,
Pakistan, and Philippines during the same period.

24 www.doh.gov.ae
 Communicable Diseases Bulletin

Figure 29: Reported dengue fever in Abu Dhabi, 2016-2018.

Prevention and control measures

Preventing or reducing dengue virus transmission depends entirely on controlling the mosquito vectors or
interruption of human–vector contact.
Aedes aegypti uses a wide range of confined larval habitats, both man-made and natural. Some man-made
container habitats produce large numbers of adult mosquitoes, whereas others are less productive.

Volume 10 / Issue 1; 2019 25

Quarterly Summary Report - 2019

Applied Researches in Communicable Diseases

Risk Factors for MERS-CoV Seropositivity among Animal Market and Slaughterhouse
Workers, Abu Dhabi, United Arab Emirates, 2014–2017

Ahmed Khudhair, Marie E. Killerby , Mariam Al Mulla, Kheir Abou Elkheir, Wassim Ternanni, Zyad Bandar, Stefan Weber, Mary Khoury,
George Donnelly, Salama Al Muhairi, Abdelmalik I. Khalafalla, Suvang Trivedi, Azaibi Tamin, Natalie J. Thornburg, John T. Watson,
Susan I. Gerber, Farida Al Hosani, and Aron J. Hall

Abstract
Camel contact is a recognized risk factor for Middle East respiratory syndrome coronavirus (MERS-
CoV) infection. Because specific camel exposures associated with MERS-CoV seropositivity are not fully
understood, we investigated worker–camel interactions and MERS-CoV seroprevalence. We assessed
worker seroprevalence in 2 slaughterhouses and 1 live-animal market in Abu Dhabi, United Arab Emirates,
during 2014–2017 and administered an epidemiologic survey in 2016 and 2017. Across 3 sampling rounds
during 2014–2017, we sampled 100–235 workers, and 6%–19% were seropositive for MERS-CoV at
each sampling round. One (1.4%) of 70 seronegative workers tested at multiple rounds seroconverted.
On multivariable analyses, working as a camel salesman, handling live camels or their waste, and having
diabetes were associated with seropositivity among all workers, whereas handling live camels and either
administering medications or cleaning equipment was associated with seropositivity among market workers.
Characterization of high-risk exposures is critical for implementation of preventive measures.

To read full article, please refer to:

https://wwwnc.cdc.gov/eid/article/25/5/18-1728_article

26 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. 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 10 / Issue 1; 2019 27

 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

http://www.haad.ae/haad/