Volume 3 Issue 2 2012 2nd Quarter Apr Jun

Quarterly Summary Report
Second Quarter – 2012 (Apr – Jun)

Volume 3; Issue Number 2
Communicable
Diseases Bulletin
www.haad.ae
Foreword
As part of HAAD mission to ensure reliable excellence in health care for the
community, prevention is the best approach to healthy community. Vaccination is
one of the most effective strategies to eliminate and control infectious diseases.
The introduction of exuded program of immunization in UAE, helped to eradicate
polio and today UAE is certified as polio free country. In addition, vaccines helped
to decrease the presence of several childhood illnesses such as measles
and rubella, which is clearly seen in our notified list of illnesses with very minimal
numbers reported for these diseases.
The advancements in vaccine programs to target vaccine preventable illnesses

are ongoing and based on the available evidence and best practices. In this
respect, we are proud to introduce the full spectrum adult vaccination program.
This includes adults with high risk groups, and occupational groups at high risk of
exposure to infections like health care workers. In addition, the program is also
reemphasizing on the existing vaccination of close contacts, and travelers to high
risk areas.
Introducing adult vaccines is a new concept in our community that is expected

to be very challenging. Gathering our efforts at different levels is very important to
increase the awareness of the community and ensure success of the program.
Dr. Farida Al Hosani, Manager

Communicable Diseases Department- HAAD
Tel: 02 4193245
Fax: 02 4496966
Email: cdd@haad.ae
Page 2 Quarterly Summary Report: 2nd Quarter - 2012

Table of Contents
Item Content Page
I Foreword 2
II Table of contents 3
III Notified illnesses in Abu Dhabi Emirate by region 4

(Quarter 2, 2012)
IV Notified illnesses in Abu Dhabi Emirate by age & 5

gender (Q2, 2012)
V Monthly trends for selected notified diseases in Abu 6

Dhabi Emirate (Q1-Q2/2012 Vs 2010 and 2011)
VI Visa screening applicants in Abu Dhabi Emirate 7

(Q2 /2012)
VII Topic of the volume: Adult Vaccination Program 8-10
VIII Sharing Reports: Figures from Premarital screening 11
IX Contribution: Judicious use of antibiotics 12
X Activities 13-14
XI Flash news 15-16
XII The volume “Flash- on-an-Illness”: Typhoid/Paraty- 17-18

phoid fever
Quarterly Summary Report: 2nd Quarter - 2012 Page 3

Table 1: Notified Illnesses in
Abu Dhabi Emirate by Region (Quarter 2, 2012)
Abu Eastern Western Total Cumulative in Abu Dhabi Emirate

Dhabi Region Region (Q1-Q2)
Cases
Quarter 2 2012
Q1 Q2 TOTAL
2011 2010
AFP * 4 1 1 7 6 13 8 4
Brucellosis 40 12 6 20 58 78 37 18
Chickenpox 2794 1371 470 2791 4635 7426 8635 5195
Cholera 1 0 0 0 1 1 4 1
Foodborne illnesses ** 172 179 23 253 374 627 420 288
Haemophilus influenzae (invasive) 0 0 0 0 0 0 23 0
Hepatitis A 30 14 7 53 51 104 66 47
Hepatitis B 136 44 14 131 194 325 397 377
Hepatitis C 138 30 1 107 169 276 323 341
Influenza 23 3 5 79 31 110 172 142
Malaria * 383 202 107 265 692 957 967 439

Measles * 1 1 0 14 2 16 31 31
Meningitis (bacterial) 9 1 1 9 11 20 18 25
Meningitis (viral) 11 1 2 6 14 20 24 21
Mumps 46 20 3 37 69 106 123 125
Pertussis 18 9 0 9 27 36 19 38
Rubella * 5 0 1 2 6 8 36 11
Scabies 146 27 3 195 176 371 352 361
Shigellosis 8 1 0 7 9 16 14 33
Tetanus 0 0 0 1 0 1 3 1
Tuberculosis (Pulmonary) * 69 19 5 89 93 182 255 198
Tuberculosis (Extra-Pulmonary) 37 13 5 43 55 98 112 94
Typhoid /Paratyphoid 105 17 7 130 129 259 160 136
Other diseases 258 68 47 327 373 700 749 451
Total 4434 2033 708 4575 7175 11750 12948 8377
Grand total including ruled out notifications 12411 13506 8544
Illnesses covered by national control programs

Foodborne illnesses other than those specified in the list
All notified malaria cases are “imported”
$ None of the reported Haemophilus influenzae cases was found meeting the case definition criteria.
Grand total with all ruled out notifications for Q1-Q2 over the three years
Indicates increase or decrease in number of notified cases during the 2nd quarter of 2012 compared to first quarter
Indicates increase or decrease in numbers of notified cases over Q1-Q2 2012 as compared to the previous two years
The number of whooping cough is increasing elsewhere as well, like in the US.

Table 2: Notified Illnesses in
Abu Dhabi Emirate by Age & Gender (Q2, 2012)
Cases Total
AFP * 1 3 2 4 2 6
Brucellosis 1 3 5 6 3 8 1 7 6 6 3 3 3 1 1 1 23 35 58
Chickenpox 80 110 520 550 886 931 162 276 244 541 49 215 4 51 4 9 3 1949 2686 4635
Cholera 1 1 0 1
Foodborne Illness 31 38 62 76 33 27 10 14 20 32 6 10 4 5 4 1 1 167 207 374
Haemophilus influenzae 0 0 0
Hepatitis A 4 2 7 11 2 7 3 11 2 2 16 35 51
Hepatitis B 16 11 45 38 14 22 3 23 4 13 2 3 84 110 194
Hepatitis C 2 1 14 27 12 37 5 44 4 18 3 2 40 129 169
Influenza 1 2 3 4 1 1 2 2 5 1 5 1 2 1 14 17 31
Malaria 2 2 7 6 11 167 4 261 4 129 65 31 1 2 29 663 692
Measles 1 1 0 2 2
Meningitis bacterial 2 1 1 1 1 2 1 1 1 5 6 11
Meningitis viral 1 1 2 2 2 1 1 2 2 6 8 14
Mumps 8 14 7 15 1 4 11 1 4 1 3 18 51 69
Pertussis 10 12 2 3 13 14 27
Rubella 1 4 1 1 5 6
Scabies 4 1 5 4 6 2 33 5 56 4 36 1 14 4 1 17 159 176
Shigellosis 3 2 1 1 1 1 2 7 9
Tetanus 0 0 0
Tuberculosis (Pulmonary) 1 6 14 10 29 1 15 1 8 1 4 3 22 71 93
Tuberculosis 1 2 2 6 10 16 2 7 7 2 17 38 55
(Extra-Pulmonary)
Typhoid /Paratyphoid 1 1 1 1 4 5 21 5 54 4 16 3 8 1 4 20 109 129
Fever
Other Diseases 7 8 43 61 17 25 16 27 38 48 18 31 5 14 4 9 0 2 148 225 373
Total 132 177 648 724 978 1039 240 595 407 1139 125 537 30 249 24 103 12 16 2596 4579 7175
* The highlighted cells (with red numbers) indicate the age/gender categories that had the largest numbers of reported cases for the given illness.
The grand total after including all ruled out notifications will be 7522

Monthly Trends for Selected Notified Diseases
in Abu Dhabi Emirate
(Q1-Q2/2012 Vs 2010 and 2011)
The decrease in reported chickenpox during The peak in April and May was Salmonella
Rotavirus
31
215
Q2 2012 is largely attributed to the introduc- largely due to Rotavirus infections Unspecified 126
tion of varicella vaccine in Oct 2010. Especially that dropped during June, and this Other 2
that the vaccinated cohort is now at the age goes with Rotavirus seasonality.
Total 374
group 1-4 years, which used to be among the However, acquisition of rotavirus
most reported cases in previous years. is not always foodborne, and this
should be considered when inter-
Chickenpox preting the apparent trend.
2500
2010
2011 Foodborne Illnesses

Number of notified cases
160
2000
2012
140 2010

120 2011
1500
2012
100
80
1000
60
40
500
20
0
0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec MONTH
MONTH
The number of reported cases started to decrease
Close to half the cases reported travel history, in May, as reporters were informed to refer to the
and only five had epidemiologic link to another case definition for reporting (which requires posi-
case. As appear in table 2 (page 5), close to tive culture or epidemiologic link in addition to the
half aged less than 14 y, and more than two clinical picture).
thirds were males.
Typhoid/Paratyphoid
Hepatitis A
2010
80
50 2010
2011
70
45 2011 2012
60
40 2012
50
35
40
30
30
25
20
20
10
15
0
10 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
5 MONTH
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec All reported malaria cases are imported, and the
MONTH majority of them diagnosed after returning from
their holidays in malaria endemic countries.
Influenza
Malaria
60
500
2010
50 2010 450
2011
2011 400
40 2012
2012 350
30 300
250
20 200
150
10
100
0 50
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
MONTH
MONTH
Note: HAAD surveillance officers investigate individual cases, assess for outbreaks, and take action whenever indicated.

Visa Screening in Abu Dhabi Emirate
(Q2-2012)
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), pul-
monary tuberculosis, and leprosy. Screening for Hepatitis B and syphilis are limited to a few
occupational categories. HAAD Visa Screening Standard is available at: http://www.haad.
ae/HAAD/LinkClick.aspx?fileticket=DDCVCmde9R0%3d&tabid=819
Around quarter a million people or more apply for visa medical screening every three months
in Abu Dhabi Emirate. During the second quarter of 2012, a total of 279,720 applicants were
screened in all HAAD-licensed Screening Centers (a total of nine centers in the three regions
of Abu Dhabi).
. Visa screening applicants during first quarter 2012

300000
279720
250000
217114
200000
No. of Applicants
153704
150000
126016
100000
62606
50000
Male Female New Renew Total

Gender Visa Status
The table below shows the number and prevalence of positive cases among new and renew-
al visa applicants during the second quarter of 2012.
HIV Hepatitis B*** Tuberculosis** Leprosy Syphilis***

New Renew New Renew New Renew New Renew New Renew
Number
30 4 287 10 86 44 0 0 289 0
Prevalence 19.5 3.2 834.8 54.4 55.95 34.9 0 0 840.6 0
Overall Prevalence 12.2 563.1 46.5 0 547.9
* Prevalence: the number of positive cases per 100,000 visa screened applicant
** This refers to active TB cases only
*** Applies to tested occupational categories

TOPIC OF THE VOLUME
Adult Vaccination Program

Official launch of Adult Vaccination Campaign
The Health Authority of Abu Dhabi (HAAD) officially an-

nounced on 30 July, 2012 through its Communicable
Diseases Department the launch of Adult Vaccination
Campaign. This campaign is a part of HAAD Vaccination
Campaign that was previously announced on May 2012 under the theme “Protect Your Health
with Vaccination”.
The announcement event took place in HAAD building in the presence of a diverse group of
attendees from the media, healthcare facilities in Abu Dhabi, and HAAD employees. The event
addressed the importance of adult vaccines in preventing morbidity, especially among adults
who are at high risk of contracting infections and developing related complications.
Inspite of the wide success achieved by HAAD Immunization Programs, the announcement
pointed out to the challenges that “Adults Vaccination” might face as a new concept to the com-
munity. However, given the importance of adults’ vaccinations, and to ensure good compliance
and acceptability, HAAD adjoined the announcement with issuing a circular to all health facili-
ties in the Emirate of Abu Dhabi, and produced brochures and video for the public on adults’
vaccines. This would be followed by training workshops and forums for health providers, and a
number of media messages for the public over the coming months.
Why to vaccinate adults?
Given the large burden of some infectious diseases among certain high risk groups of adults (like
old people, people with debilitating medical conditions, travelers, and people in close contact
with or have frequent exposure to infections), the Health Authority of Abu Dhabi identified vac-
cines to be given to those high risk groups of adults as per best international practices and
WHO recommendations. The aim is to reduce preventable infections and related morbidity and
mortality and to enhance human’s health.
Based on the developed regulations:
“Adult high risk groups” to be vaccinated

People aged > 65 years Adults < 65 years at high risk include:
• immunocompromising conditions
Adults with certain health conditions • Diabetes
• Chronic cardiovascular disease(except
Adults with certain non healthy practices hypertension)
• Chronic lung disease(including Asthma)
Travelers to high risk areas • Chronic alcoholism
• Asplenia
Contacts of cases with certain infections • Chronic liver disease
• Kidney failure, end stage renal diseases,
High risk occupational groups hemodialysis
Other special conditions
The whole list is shown in page 10!

What vaccines you would need?
To make it easy for adults to decide what vaccines they need to take, the Communicable
Diseases Department at HAAD developed a simple questionnaire/quiz of 16 questions that
can be simply completed by ticking on the correct statements that pertain to your case.
Once completing all answers, you would click on “My Results” button to get what kind of
vaccines you need to have.
Fill a short quiz to know what vaccines you need to have!

The survey is available at HAAD website on:
http://emqubeweb.com/haad/survey.php
Are you a healthcare professional?
Below is an example of the survey rsult you might get if your answers indicated that you are
working in any healthcare setting (Healthcare Professional).
Vaccine Suggested if Number of doses

Tdap Vaccine and Td You are a healthcare worker and you may not have immunity Tdap single dose
booster to diphtheria, tetanus, or pertussis. Td booster, once every 10 years after
receiving Tdap vaccine
You are a healthcare worker and you may not have immunity
Varicella Vaccine 2 doses, 4 to 8 weeks apart
to chickenpox.
You are a healthcare worker and may not have

Hepatitis B Vaccine 3 doses at 0, 1 and 6 months
immunity against Hepatitis B.
If a microbiologist and routinely exposed to isolates of N. Single dose every 3 years

Meningococcal Vaccine
meningitides.
MMR Vaccine You are a healthcare worker and if you may not have immunity 2 doses, 4 weeks apart
to measles, mumps or rubella.
Seasonal Influenza You are a healthcare worker and need to be vaccinated against Single dose every year
Vaccine seasonal influenza once every year.
Travelers to certain places shall receive the recommended adults vaccines!
Travelers
Meningococcal vaccine ACWY135 for travelers to
countries in meningitis belt.
Yellow Fever vaccine for travelers to countries
in the endemic zone.
Rabies vaccine to travelers to high risk areas who
are likely to get in contact with rabies
The following page shows required adults vaccines and indicated groups (the list with de-
tailed scheduled doses is included in HAAD circular to all facilities, available at HAAD website
(Healthcare Facilities - Circulars): http://www.haad.ae/haad/tabid/183/Default.aspx

Adults Vaccinations indicated for All vaccines will be given through Primary
Health Care Centers in Abu Dhabi, while
contacts of cases will be vaccinated at
High Risk Groups

Disease Prevention and Screening Centers.
Places for Haj and Umra vaccines are
announced annually.
Vaccine Indication Vaccine Indication

• People with following conditions (if
• Hajj and Umrah pilgrims
did not receive Hib vaccine
• All healthcare professionals
• All Adults ≥ 65years Haemophilus influenzae previously)
sickle cell disease
• < 65 years Adults at high risk which type b (Hib)
leukemia
include the following :
HIV infection
immunocompromising conditions Splenectomy
Diabetes • Contacts of a case
Seasonal Influenza Chronic cardiovascular disease(except
• Patients with Chronic liver disease
(Flu) hypertension)
• Persons who receive clotting factor
Chronic lung disease(including Asthma)
Hepatitis A concentrates
Chronic alcoholism
• Outbreak control
Asplenia (including elective splenectomy
• Contacts of a case.
and persistent complement component
deficiencies) • All unvaccinated healthcare
Chronic liver disease professionals who have no serologic
Kidney failure ,end stage renal disease, proof of immunity, prior vaccination, or
recipients of hemodialysis Varicella
history of varicella disease or herpes
zoster
• Contacts of a case
• All Adults ≥ 65years without a history of • All unvaccinated healthcare

Pneumococcal polysaccharide 23 Valent professionals
vaccination • IV Drug user
• Adults < 65 years at high risk which include • Household contacts of Hepatitis
the following : B cases/chronic carries
immunocompromising conditions • Post exposure immunoprophy-
Diabetes laxis
Chronic Cardiovascular disease(except • Patients with chronic liver disease
Pneumococcal hypertension) • Person beginning hemodialysis
Hepatitis B • Diabetes Mellitus type 1 and 2 up
polysaccharide Sickle cell anemia
23 Valent Cochlear implants to age of 59Years
Chronic lung disease include asthma • Contacts of a case include:
Chronic alcoholism
Household members
Asplenia (including elective splenectomy
Sexual contacts
and persistent complement component
Medical staff exposed to
deficiencies)
oral or respiratory secretions
Chronic liver disease
Kidney failure ,end stage renal disease,
recipients of hemodialysis
• Persons with rabies-prone animal bite • Hajj and Umrah pilgrims

• Persons in high-risk occupational groups, such • Travelers to countries in meningitis
as veterinarians and their staff, animal handlers, belt
Meningococcal
rabies researchers, and certain laboratory workers • Asplenia (including elective
ACWY135
Rabies • Travelers to high risk area (traveler who likely to splenectomy and persistent
get in contact with domestic animals particularly complement component deficiencies)
dogs and other rabies vectors) • Microbiologists who are routinely
exposed to isolates of N. meningitidis.
• Close contacts
• All unvaccinated healthcare professionals • Unvaccinated postpartum

Measles, mumps, • Premarital Program in case of unavailability of mothers
Rubella • Premarital screening program for
rubella (MMR) Rubella vaccine
Contacts of a case unvaccinated female applicant
• Contacts of a case
Tetanus, diphtheria, • All unvaccinated healthcare professionals Tetanus Toxoid (TT) • Post tetanus-prone wound
pertussis (Tdap)
• Travelers to countries in the
Typhoid Contacts of a case Yellow Fever Yellow Fever endemic zone

Sharing Reports
Figures from HAAD Premarital Screening Report, 2011
Marriage Consanguinity Rate by Nationality, Abu Dhabi, 2011 Consanguinity

(Premarital Screening Applicants n=2341)
50.0%
Premarital screening applicants during
Nationals Expatriates 2011 revealed that 1130 (20%) of UAE
45.0%
nationals married their 1st cousin, 294 (5%)
40.0% second cousins, and 494 (7%) married
35.0% distance cousins. The overall consanguin-
32.3%
30.0%
ity was higher among UAE nationals 1838
(32.3%) when compared to expatriates 503
25.0%
(13.3%).
Rate
19.9%
20.0%
15.0% 13.3%
10.0% 8.2% 7.3%

5.2%
5.0% 2.6% 2.5%
0.0%
1st Degree 2nd Degree 3rd Degree Total
Consanguinity
Smoking and types

• Close to one quarter of premarital screen-
ing applicants during 2011 were current
Adult Smoking Prevalence by Type, Abu Dhabi 2011
(Premarital Screening Program applicants n=2309) smokers, with men were more than
women to be current cigarette smokers
40.0% (19.2% Vs 3.5%).
• Women were much less likely to smoke
35.0%
medwakh than men ((0.1% Vs 11.5%),
30.0% with male UAE Nationals had the highest
24.7% prevalence (16.1%).
25.0%
• The prevalence of waterpipe smoking
was 6.8% among men and 2.8% among
Rate
20.0%
women, with the highest prevalence was
15.0% 11.5%
among Arab expatriate men (10.2%)
10.0%
5.9% 4.8% • Such variations in prevalence reflect
5.0% preferences for different modes of to-
0.0% bacco consumption by nationality, age
Cigarette Medwakh Waterpipe Overall Smoking group, and gender.
• Enforcement of tobacco control laws
and targeted health education pro-
grams are required to reduce tobacco
consumption and related morbidity and
mortality.

Contributions!
Judicious use of antibiotics
By: Kholoud Jamal, Infectious Diseases Clinical Pharmacist, Tawam Hospital; Aqeel Saleem, Infec-
tious Diseases Consultant, Tawam Hospital.
Since their introduction in 1940s, antimicrobial agents have significantly reduced morbidity and
mortality associated with infectious diseases. Antibiotics are relatively so effective, non-toxic, gener-
ally inexpensive, and so easy to use; that they are prone to abuse. Studies suggest that overall, up
to 50% of antibiotic usage is inappropriate. The widespread use of antibiotics in hospitalized and
non-hospitalized patients has been associated with increase in bacterial strains and species that no
longer respond to treatment with most antibiotics. The world is facing a major public health threat
with the spread of antibiotic-resistant bacteria running ahead of production of new antibiotics to fight
them, leading to increased mortality due to multi-drug resistant microorganisms, increased length of
hospital stay, increased C. difficile & other ecological consequences and increased healthcare costs.
Achieving more judicious prescribing of antibiotics requires an understanding of the factors that
promote overuse and the barriers to change, and implementation of effective strategies for chang-
ing behavior. Among providers, most physicians are aware that antibiotics misuse/overuse is a major
risk factor for the development of antibiotic resistance; despite this recognition, unnecessary antibi-
otic prescriptions remain common. The majority of this abuse occurs in treatment of upper respira-
tory infections, for example, pharyngitis, acute otitis media, and acute bronchitis, for which antibiotic
use is not proven to be beneficial. Particularly worrisome is the overuse of fluoroquinolones and
cephalosporins as first-line agents for the treatment of respiratory tract infections. On the other
hand, patients’ lack of knowledge and past experience contribute to increased misuse of antibiot-
ics. Many patients have received antibiotics for viral respiratory illness, and these treatments were
perceived as effective because the infections were generally self-limiting.
Overcoming barriers to more judicious prescribing needs the development of materials to support
change, implementation of effective strategies, and development of supportive structures in health-
care organizations. Those efforts should take into consideration the two sides of this issue, the
patients and prescribers.
Implementation of an antimicrobial stewardship program is the recommended strategy to help

improving the proper use of antibiotics. These antimicrobial stewardship programs are interventions
designed to ensure that patients receive the right antibiotic, at the right dose, at the right time, and
for the right duration. Hospitals are adopting various stewardship strategies to minimize the misuse
of antimicrobials and decreasing the burden of resistance, an example is the formulary restriction
and preauthorization requirements for certain classes of antibiotics. From a provider’s perspective,
education at an individual level or small group level is one effective strategy. Another effective strat-
egy is the adoption of clinical practice guidelines, which has to be accompanied by other educa-
tional activities. Patients should also be involved in this educational process, in order to increase the
awareness of common infections and diseases among patients.

Activities
The Communicable Diseases Department conducted several activities during the second quarter of
2012. Below are briefs on the main activities took place during that period.
1) Meetings and Workshops with Po-

lice Social Support Centers
HAAD communicable diseases team arranged three work-
shops in coordination with Abu Dhabi Social Support Cent-
ers in the three regions of Abu Dhabi Emirate (Abu Dhabi
city, Al Ain, and the Western Region). During the meetings
HAAD team discussed the importance of collaboration
Abu Dhabi workshop for Police Social Support between the two authorities; mainly in follow up of defaulters
from disease control programs. The workshops targeted all
staff working in those centers, to increase their awareness
about communicable diseases and their burdens, and the
different programs run by HAAD Communicable Diseases
Department to prevent and control the spread of those ill-
nesses in the community. The workshop focused mainly on
illnesses like tuberculosis and HIV infections, and how social
support can help combating the stigma surrounding those
illnesses and encourage infected people to seek medical
Western Region workshop for Police Social Support care and abide by recommended treatment protocols. A
total of 70 participants attended the three workshops in the
three regions of Abu Dhabi.
Al Ain workshop for Police Social Support
2) CME on Malaria Prevention in Travelers from UAE

An educational session on malaria prevention among travelers from UAE was conducted on 30th of
June 2012. The CME activity targeted physicians working in primary health care and Disease Preven-
tion and Screening Centers. The importance of this CME activity comes from the fact that the majority
of imported malaria cases are diagnosed in patients returning from their holidays in malaria endemic
countries. Taking malaria prophylaxis medication, in addition to mosquitoe bite prevention, will mini-
mize the possibility of being infected by malaria.
The CME covered the epidemiology of malaria and malaria endemic countries, products used to pre-
vent mosquito bite, medications used for malaria prophylaxis, and prophylaxis in special groups mainly
children and pregnant women.

3) Training Workshop on Malaria
Laboratory Diagnosis with Ministry of
Health Oman
The Communicable Diseases Department at HAAD organ-
ized through its Malaria Control Program a training workshop
on Malaria Laboratory Diagnosis during the period from 25
to 27 June, 2012.The workshop was arranged in collabora-
tion between HAAD and the Ministry of Health in Sultanate
of Oman. It targeted laboratory technicians from the main
public and private hospitals diagnosing malaria in UAE. The
aim was to enable laboratory technicians to acquire up to
date technical knowledge on malaria microscopic diagno-
sis, so they can confidently diagnose the different types of
malaria parasites, which is the corner stone for physicians
to treat malaria appropriately and as per the internationally
recommended guidelines.
Malaria has been eliminated from UAE and reintroduction is
a threat that should be prevented through effective labora-
tory diagnosis, treatment, epidemiological investigation, and
vector control.
4) Continuation of e-Infectious
Diseases Notifications Workshops
HAAD communicable diseases team conducted two addi-
tional workshops on e-notification of infectious diseases dur-
ing April 2012, targeting Zayed Military and Al Rahba Hos-
pitals in Abu Dhabi. The workshops introduced attendees
to the benefits of the electronic notification system for both
HAAD and the reporting facility in terms of confidentiality,
record keeping, search options, and timeliness of reporting.
It included an enhanced training on the different parts of the
notification process; stressed on the importance of filling the
investigation subforms; and openly discussed noticed gaps.

Flash News
Measles and rubella eradication-Meetings and new resolutions

The GCC Committee of infectious diseases conducted a meeting in Dubai during the period 1-2
April 2012, to discuss the regional and international efforts in the eradication of measles and ru-
bella. The meeting was attended by representatives from all member states of the GCC for health
affairs, in additions to representatives from the Executive Council of the GCC Ministers of Health
and the WHO. After discussing the updated reports presented by countries, a set of recommen-
dations were raised to allow achieving the goals of eradication in the GCC region. Consequently,
the GCC Ministers of Health released on May 2012 the Resolution No. 8 for Conference (73), with
the following main points:
• Circulation to all GCC approved Home Screening Centers to assess the vaccination status of applicants for
measles and rubella, and to give additional dose of measles and rubella vaccine before issuing a Fitness
Certificate.
• Asking for vaccination records certificates from all newcomers less than 18 years old (especially to assess for
measles, German measles, and polio vaccines), and to give children necessary doses in case of non comple-
tion of the required schedules.
• Assess the possibility of giving the second dose of MMR during the second year of age, and ensure comple-
tion of the second dose before school entry.
Acceptance of the UAE report by the certification committee of polio eradication!
The UAE hosted the 26th meeting of the Regional Commission of Certification (RCC) of polio
eradication for countries of the Eastern Mediterranean Region of the WHO (EMRO). This is an
annual meeting to discuss the abridged annual update reports on the performance of polio eradi-
cation programs and polio situation in all member states of EMRO. The UAE Abridged Annual Up-
date Report for 2011 , which is a national documentation submitted annually by the UAE National
Certification Committee, was among the accepted reports that were considered adequate by the
WHO/EMRO, and hence UAE maintained the WHO certification of polio eradication.
Expansion of “Home Screening “ to include Ethiopia
The Home Screening Program has been expanded to include Ethiopia as the third country after
Indonesia and Sri Lanka. This came by a ministerial decree that is to be effective starting from July
2012. Hence, similar to previous two countries, all applicants coming from Ethiopia for residency
or work in UAE have to do medical screening in their home country, and this should only be done
in any of the GCC approved centers there. Medically fit newcomers from all three countries will be
subjected to re-testing once arriving UAE, and therefore must show the original and copy of the
home-issued fitness certificates at any of the designated screening centers in UAE.
HAAD and Dubai Health Authority share experiences!
The two health authorities of Abu Dhabi and Dubai met early in April 2012 to discuss all possible
collaborations especially with respect to reporting of infectious diseases. HAAD and DHA shared
their experiences in e-notifications and all documentations and standards related to communica-
ble diseases surveillance. Such kind of collaboration is expected to grow given the sincere inten-
tions of both authorities to make better investment for resources available at their institutes.

Complicated hand, foot and mouth disease claimed dozens of Cambodian children
The World Health Organization helped the Cambodian Ministry of health investigating an illness that
was initially considered mysterious. The unknown illness was described as a severe respiratory dis-
ease with neurologic symptoms affecting children, mostly under 3 years of age, and generally starts
with high fever. Initially it was announced that 61 of the 62 children admitted in hospitals have died from
the disease, but further investigation showed that 57 out of the 78 cases meeting the case definition
died of the illness.
The investigations into the cases and deaths have lastly concluded that a severe form of hand, foot
and mouth disease (HFMD) was the cause in the majority of cases, where most of the tested samples
were positive for Enterovirus 71 (EV-71) that causes HFMD. It was found that a significant number
of cases had been treated with steroids at some point during their illness, which has been shown to
worsen the condition of patients with EV-71.
Enhanced surveillance for neuro-respiratory syndrome was established, and it is therefore expected
to identify occasional new cases in the coming months. Additionally, the authorities trained the staff on
proper management, and raised public awareness on prevention, identification, and care.
Bone marrow transplants and hopes for HIV cure!
Infection with the human immunodeficiency virus type 1 (HIV-1) requires the presence of a CD4
receptor and a chemokine receptor, principally chemokine receptor 5 (CCR5). Homozygosity for a
32-bp deletion in the CCR5 allele provides resistance against HIV-1 infection. So far, only one per-
son who was infected with HIV-1 and had bone marrow transplant to treat acute myeloid leukemia
has been considered cured of HIV. In his case, the bone marrow donor was not only HIV-negative,
but was homozygous for CCR5 delta32 (i.e. had a rare genetic mutation that blocks HIV from
entering cells).
Recently, researchers at the International AIDS Conference in Washington made presentations on two
HIV-positive men who developed lymphoma. In both cases, their treatment included a bone marrow
transplant, which results in a new immune system. The bone marrow donors did not have HIV, but
did not have the rare genetic variant like in the reported cured case a couple of years back. However,
researchers could not detect any HIV genetic material in the patients’ blood until seventeen months
after the transplants. They say this can be due to the antiretroviral drugs the patients are taking, and
only when they can successfully stop their medication can they be considered cured of HIV. However,
marrow transplantation is not currently considered as a treatment option for HIV.
Promising malaria vaccine from algae!
The difficulty to develop a vaccine against malaria is that it requires producing complex three-dimen-
sional proteins similar to those made by the parasite. Biologists at the University of California, in col-
laboration with a professor of medicine who is a leading expert in tropical diseases, have succeeded in
engineering algal proteins that are structurally similar to the native malaria proteins and elicit antibodies
that recognize Pfs25 and Pfs28 from P. falciparum. When injected into laboratory mice, such proteins
made antibodies that bind the surface of in-vitro cultured P. falciparum sexual stage parasites and
therefore blocked malaria transmission from mosquitoes. Thus, algae are promising organisms for
producing malaria vaccine.

The volume “Flash- on-an-Illness”:
Typhoid/Paratyphoid fever
Illness and cause: Typhoid fever is a life-threatening illness caused by the bacterium Salmonella
Typhi (Salmonella enterica serotype Typhi). Paratyphoid fever is a similar illness caused by S. Para-
typhi A, B, or C. These bacteria live only in humans, and infected people carry the bacteria in their
blood stream and intestinal tract, and shed them in their stool and urine (with about 1-3% of cases
continue carrying the bacteria and shedding them for more than a year after recovery “chronic carri-
ers”). The illness is common in most parts of the world, but mainly in developing countries. Cases in
industrial countries are mostly acquired while traveling internationally.
Source of infection: People get infected through contaminated drinking water or food (i.e. eating
food or drinking beverages that have been handled by a person who is shedding the bacteria, or if
sewage contaminated with the bacteria gets into the water you use for drinking or washing food).
Large epidemics are most often related to fecal contamination of water supplies or street vended
foods.
Clinical picture: The illness has an insidious onset characterized by fever (usually sustained fever as
high as 39°-40° C), headache, constipation, malaise, chills, myalgia, loss of appetite, and may have
abdominal pain, diarrhea and vomiting. The serious complications of typhoid fever generally occur after
2–3 weeks. Confusion, delirium, intestinal perforation, and death may occur in severe cases. Case-fatality
rates of 10% in Typhoid fever can be reduced to less than 1% with appropriate antibiotic therapy.
Diagnosis: The etiologic agent may be recovered from the bloodstream or bone marrow, and oc-
casionally from the stool or urine. Therefore, diagnosis depends on isolation of S. Typhi from blood,
stool, or other clinical specimen. Widal test alone is not sufficient for diagnosis.
Treatment: Three commonly prescribed antibiotics are ampicillin, trimethoprim-sulfamethoxazole, and
ciprofloxacin. Persons given antibiotics usually begin to feel better within 2 to 3 days, and deaths rarely
occur. However, in recent years, development of antibiotic resistance has resulted in more challenges.
Occurrence: Typhoid/paratyphoid fever is most prevalent in poor areas that are overcrowded and
have poor access to sanitation. South-Central Asia, Southeast Asia, and Southern Africa are re-
gions with high incidence. Worldwide, there are about 21 million cases of typhoid fever and 200,000
deaths occur every year. An additional 6 million cases of paratyphoid fever are estimated to occur
annually.
In Abu Dhabi Emirate, brucellosis is a reportable infectious disease that needs to be notified
within one calendar day
The incidence of typhoid/paratyphoid during 2011 was 17 per 100,000 population. However, about
three quarters of the cases were reported based on positive serological testing, which is not sufficient
for diagnosis.
HAAD Case Definition for Reporting
Probable Confirmed
A clinically compatible A clinically compatible case that
case that is epide- is lab confirmed by isolation of
miologically linked to the bacteria from blood, stool, or
a confirmed case in an other specimen.
outbreak.
Below are some figures that show the epidemiology of typhoid/paratyphoid fever during 2011 in the
Emirate of Abu Dhabi, and sources of infection.

Epidemiology of Typhoid/Paratyphoid fever in Abu Dhabi Emirate, 2011
Notified Typhoid/Paratyphoid in AD Emirate by

Region, 2011
Most of the 350
cases were 303
reported from 300 Notified Typhoid/Paratyphoid in AD
Abu Dhabi city, Emirate by Nationality, 2011
250 Abu Dhabi
but in the vast
No. of Cases
9%
majority it was 200 Eastern
based on
serological 150 Western
testing only, and 68
100
in absence of
any epidemio- 50 23 91%
logical link to a
confirmed case. 0
Abu Dhabi Eastern Western
Region
Notified Typhoid/Paratyphoid in AD Emirate

Of those with
by Age and Gender, 2011 Notified Typhoid/Paratyphoid in AD Emirate
by Risk Factors 2011 travel history,
140 the majority of
cases (86%)
120 2% were coming
Female 13% Unknown back from
100
South Asia.
Male Travel History
No. of Cases
80 21%
Suspected Food
60
Others
40 64%
20
The increase in number of reported cases

y
14
34
+
1-
-2
-4
-5
-6
65
<1
5-
-
15
25
35
45
55
during the last two years coincide with the

Age in years implementation of the e-notification and
improvement in reporting. However, the
majority were not confirmed.
Only culture
positive cases Reported Typhoid/Paratyphod by testing
Typhoid / Paratyphoid in Abu Dhabi Emirate
are considered results in AD Emirate, 2011
confirmed.
(2005-2011)
500
Widal test is not Widal test Culture Not tested
394
enough for 400 347
diagnosis.
No. of Cases
6%
300
20%
163
200 129
81 82
57
74% 100
0
2005 2006 2007 2008 2009 2010 2011
Year

Editorial Board
- Dr. Farida Al Hosani (Manager, Communicable Diseases Department, HAAD)
- Dr. Mariam Al Mulla (Senior Officer, Communicable Diseases Department, HAAD)
- Dr. Ahmed Abdulla (Senior Officer, Communicable Diseases Department, HAAD)
- Dr. Badreyya Al Shehhi (Senior Officer Vaccines, Communicable Diseases Department, HAAD)
- Dr. Kamal Jaafar (Senior Regional Officer, Communicable Diseases Department, HAAD)
- Dr. Ahmed Khudhair (Senior Regional Officer, Communicable Diseases Department, HAAD)
- Dr. Lamees Abu Haliqa (Senior Regional Officer, Communicable Diseases Department, HAAD)
- Dr. Bashir Aden (Senior Officer, Surveillance Section, HAAD)
- Dr. Ghada Yahia (Senior Regional Officer, Communicable Diseases Section, HAAD)
Scientific Board
- Dr. Iain Blair (Associate Professor, Community Medicine, UAEU)
- Prof. Tibor Pal (Professor, Department of Medical Microbiology, UAEU)
- Dr. Agnes Sonnevend (Assistant Professor, Department of Medical Microbiology, UAEU)
- Dr. Rayhan Hashmey (Consultant Infectious Diseases, Tawam Hospital)
- Dr. Ahmed Al Suwaidi (Consultant Pediatric Infectious Diseases, Assistant Professor, UAEU)
- Dr. Bashir Aden (Senior Officer, Surveillance Section, HAAD)
- Dr. Jamal Al Mutawa (Manager, External Services Department, HAAD)
We are glad to invite your participation in this bulletin,

please contact:
Dr. Ghada Yahia
Communicable Diseases Department, HAAD
Tel: 03 7041130
Fax: 03 7679556
Email: gyahia@haad.ae

Volume 3 Issue 2 2012 2nd Quarter Apr Jun

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Volume 3 Issue 2 2012 2nd Quarter Apr Jun

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Quarterly Summary Report

Second Quarter – 2012 (Apr – Jun)

The advancements in vaccine programs to target vaccine preventable illnesses

Introducing adult vaccines is a new concept in our community that is expected

Dr. Farida Al Hosani, Manager

Page 2 Quarterly Summary Report: 2nd Quarter - 2012

III Notified illnesses in Abu Dhabi Emirate by region 4

IV Notified illnesses in Abu Dhabi Emirate by age & 5

V Monthly trends for selected notified diseases in Abu 6

VI Visa screening applicants in Abu Dhabi Emirate 7

VII Topic of the volume: Adult Vaccination Program 8-10

VIII Sharing Reports: Figures from Premarital screening 11

IX Contribution: Judicious use of antibiotics 12

XI Flash news 15-16

XII The volume “Flash- on-an-Illness”: Typhoid/Paraty- 17-18

Quarterly Summary Report: 2nd Quarter - 2012 Page 3

Abu Eastern Western Total Cumulative in Abu Dhabi Emirate

Malaria * 383 202 107 265 692 957 967 439

Grand total including ruled out notiﬁcations 12411 13506 8544

Illnesses covered by national control programs

Page 4 Quarterly Summary Report: 2nd Quarter - 2012

Foodborne Illness 31 38 62 76 33 27 10 14 20 32 6 10 4 5 4 1 1 167 207 374

Hepatitis B 16 11 45 38 14 22 3 23 4 13 2 3 84 110 194

Hepatitis C 2 1 14 27 12 37 5 44 4 18 3 2 40 129 169

Malaria 2 2 7 6 11 167 4 261 4 129 65 31 1 2 29 663 692

Scabies 4 1 5 4 6 2 33 5 56 4 36 1 14 4 1 17 159 176

Quarterly Summary Report: 2nd Quarter - 2012 Page 5

2011 Foodborne Illnesses

Number of notified cases

Page 6 Quarterly Summary Report: 2nd Quarter - 2012

. Visa screening applicants during first quarter 2012

Male Female New Renew Total

HIV Hepatitis B*** Tuberculosis** Leprosy Syphilis***

Overall Prevalence 12.2 563.1 46.5 0 547.9

Quarterly Summary Report: 2nd Quarter - 2012 Page 7

Adult Vaccination Program

The Health Authority of Abu Dhabi (HAAD) officially an-

Why to vaccinate adults?

“Adult high risk groups” to be vaccinated

Page 8 Quarterly Summary Report: 2nd Quarter - 2012

Fill a short quiz to know what vaccines you need to have!

Are you a healthcare professional?

Vaccine Suggested if Number of doses

You are a healthcare worker and may not have

If a microbiologist and routinely exposed to isolates of N. Single dose every 3 years

Travelers to certain places shall receive the recommended adults vaccines!

Quarterly Summary Report: 2nd Quarter - 2012 Page 9

High Risk Groups

Vaccine Indication Vaccine Indication

• All Adults ≥ 65years without a history of • All unvaccinated healthcare

• Persons with rabies-prone animal bite • Hajj and Umrah pilgrims

• All unvaccinated healthcare professionals • Unvaccinated postpartum

Page 10 Quarterly Summary Report: 2nd Quarter - 2012

Figures from HAAD Premarital Screening Report, 2011

Marriage Consanguinity Rate by Nationality, Abu Dhabi, 2011 Consanguinity

10.0% 8.2% 7.3%

Smoking and types

Quarterly Summary Report: 2nd Quarter - 2012 Page 11

Implementation of an antimicrobial stewardship program is the recommended strategy to help

Page 12 Quarterly Summary Report: 2nd Quarter - 2012

1) Meetings and Workshops with Po-

Al Ain workshop for Police Social Support

2) CME on Malaria Prevention in Travelers from UAE

Quarterly Summary Report: 2nd Quarter - 2012 Page 13

HIV Hepatitis B* Tuberculosis Leprosy Syphilis***