Communicable Diseases

Bulletin

Quarterly Summary Report

Fourth Quarter – 2017 (Oct-Dec)
www.haad.ae Volume 8; Issue Number 4; 2017
Distribution of Notified Cases in Abu Dhabi Emirate,
by Region (Quarter 4, 2017)

Distribution of Notified Cases in Abu Dhabi Emirate,

by Age Group and Gender (Quarter 4, 2017)
 ■
Communicable Diseases Bulletin
I
Table 1: Distribution of Notified Cases in Abu Dhabi Emirate,
by Region (Quarter 4, 2017)
Abu Al
AIAin
Dhabi
Region
Dhafra TOTAL
Region Year Total
Cases Re!!ion
2017
Quarter 4, 2017 Ql Q2 Q3 2017 2016 2015
Q4
AFP* 1 1 0 1 6 0 2 9 8 6
Brucellosis 7 13 1 21 29 20 21 91 118 75
Chickenpox 937 102 55 1475 1549 1136 1094-J.- 52541' 4819 4614
Cholera 0 0 0 1 1 6 o-J.- 8 8 6
Haemophilus
0 0 0 1 0 1 0 2 1 2
influenzae
Hepatitis B 231 39 8 230 301 276 278 1085-J.- 1138 1121
Hepatitis C 143 31 12 246 184 213 186-J.- 829 852 776
Influenzae (A, B,
7755 2680 512 2871 1292 885 109471' 159951' 6774 2847
HlNl & Unspecified)
Malaria* '11 295 82 23 149 453 907 400-J.- 1909 1848 1940
Measles* 0 3 0 13 11 11 3-J., 38-J.- 63 117

Meningitis Bacterial 12 3 0 13 8 9 151' 45 49 49

Meningitis Viral 13 1 0 24 12 14 14 64-J.- 133 79

Mumps 45 6 3 59 64 40 54 217-J.- 296 240
Pertussis 4 1 0 17 10 18 5-J.- 50 51 31
Rubella* 0 2 0 5 7 9 2-J.- 23-J.- 73 134
Scabies 462 52 13 616 559 409 527 21111' 1907 1579
Tetanus 1 0 0 0 0 0 1 1-J.- 5 0
Tuberculosis
75 46 12 122 140 129 133 5241' 407 339
(Pulmonary) *
Tuberculosis (Extra-
35 21 1 81 68 69 57-J.- 2751' 259 231
Pulmonary)
Typhoid /Paratyphoid
22 10 10 41 43 62 42-J.- 188-J.- 251 275
Fever
Other Diseases 1152 527 59 1243 1672 1403 1738 6056 5210 4086

TOTAL$ 11190 3620 709 7229 6409 5617 15519 34774 24270 18547

Grand total including ruled

out notifications 13071 3744 943 8741 7768 6974 17758 41241 28354 21858

* Illnesses covered by national control programs (only confirmed cases and cases that cannot be ruled out are included in the table).
'11 All notified malaria cases are "imported".
$ Total number of notifications including gastrointestinal infections. For more details about gastrointestinal infections,
refer to table 3 and 4.
1'-J,lndicates increase or decrease in numbers of notified cases during the 4th quarter of 2017 compared to previous quarters.
1'-J,lndicates increase or decrease in numbers of notified cases over Ql - Q4 2017 as compared to the previous two years.

Volume 8 I Issue 4; 2017 0

Quarterly Summary Report - 2017

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

by Age Group and Gender (Quarter 4, 2017)

17758 Σ

Highlighted cells (with red numbers) indicate age/gender groups with highest three numbers of reported cases for the given illness.
$ Total number of notifications including gastrointestinal infections. For more details about gastrointestinal infections, refer to table 3 and 4.
Σ The grand total for Q4 2017 after including all ruled out notifications is 17758.

4 www.haad.ae
 Communicable Diseases Bulletin

Table 3: Distribution of Gastrointestinal Infections in Abu Dhabi

Emirate, by Region (Quarter 4, 2017)

(Enterohemorrhagic)

(Enterohemorrhagic)

* 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 4th quarter of 2017 compared to previous quarters.
↑↓ Indicates increase or decrease in numbers of notified cases over Q1-Q4 2017 as compared to the previous two years.

Table 4: Distribution of Gastrointestinal Infections in Abu Dhabi

Emirate, by Age Group and Gender (Quarter 4, 2017)

(Enterohemorrhagic)

(Enterohemorrhagic)

Highlighted cells (with red numbers) indicate age/gender groups with highest three numbers of reported cases for the given illness.
Σ The grand total of gastrointestinal infection for Q4 2017 after including all ruled out notifications is 430.

Volume 8 / Issue 4; 2017 5

Quarterly Summary Report - 2017
Monthly Trends for Selected Notified Diseases, Abu Dhabi Emirate
(Q1-Q4/2017 vs. Q1-Q4/2016 and 2015)
Chickenpox
Figure 1: Pattern in Q4 2017 is similar to the pattern seen in 2015 & 2016
with slight increase in number of reported cases compared to Q4-2016.
Hepatitis A
Figure 3: Number of reported cases is less compared to 2016 with similar
pattern where the increase usually occurs after school breaks.
Malaria
Figure 5: Malaria cases follow the same pattern in Q4/2017 with slight
decrease in number of reported cases compared to the past two years.
6 www.haad.ae
Foodborne Illness (FBI)
Figure 2: Number of reported cases in Q4 2017 is less compared to
Q3 2017 and higher compared to the same period in 2016. 61% of
the reported cases had growth of salmonella in stool culture.
Influenza
(A, B, H1N1 & Unspecified)
Figure 4: A clear seasonal peak is noted in the number of influenza cases
reported in Q4 2017. One of the reasons could be that many healthcare
facilities introduced the influenza rapid test in 2017, which probably
resulted in better identification of influenza cases and accordingly
increase in number of reported cases.
Measles (Rubeola)
Figure 6: Number of measles cases continue to decline compared to
previous years and previous quarters of 2017 with Zero cases in Oct.
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 the Abu Dhabi Emirate AMR surveillance system.

No trend

No trend
No trend

No trend

No trend
No trend
No trend

No trend
No trend
No trend
No trend
No trend
No trend
No trend
No trend

No trend
No trend
No trend
No trend
No trend

No trend
No trend
No trend
No trend
No trend

No trend
 Communicable Diseases Bulletin

Visa Screening Applicants, Abu Dhabi Emirate (Quarter 4, 2017)

Visa Screening Applicants, Abu Dhabi Emirate (Quarter 4, 2017)
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, and
Visa screening
leprosy. Screening is mandatory
for Hepatitis for all expatriates
B and syphilis applying
is limited to for work and/or
few occupational residence
categories. in Abu
The Department of
Dhabi Emirate. It consists mainly of screening for
Health (DoH) Visa Screening Standard is available online at:Human Immunodeficiency Virus (HIV), pulmonary
tuberculosis, and leprosy. Screening for Hepatitis B and syphilis is limited to few occupational
categories. The Department of Health (DoH) Visa Screening Standard is available online at:
http://www.haad.ae/HAAD/LinkClick.aspx?fileticket=rPUOPzw3_Gw%3D&tabid=820
http://www.haad.ae/HAAD/LinkClick.aspx?fileticket=rPUOPzw3_Gw%3D&tabid=820
On average, around 250,000 people apply for visa medical screening every quarter in Abu Dhabi Emirate.
During the fourth quarteraround
On average, of 2017, a totalpeople
250,000 of 363,780
apply applicants werescreening
for visa medical screenedevery
at all quarter
DOH-licensed Screening
in Abu Dhabi
Centers (thereDuring
Emirate. are 14the
centers
fourthin the three
quarter regions
of 2017, of Abu
a total Dhabi applicants
of 363,780 Emirate). were screened at all DOH-
licensed Screening Centers (there are 14 centers in the three regions of Abu Dhabi Emirate).

400000 New
363780 50
44 Renewal
350000 45 42
300000 283632 40 37
35
250000 223988
No. of Applicants

No. of Cases

30 26
200000 25
139792
150000 20

100000 80148 15
10
50000
5
0 0
M F New Renew TOTAL PCR+ve PCR-ve & Culture+ve
Gender Visa Status Lab result

Figure
Figure 15:15:
VisaVisa screening
screening applicants
applicants during the fourth
during Figure
Figure 16:16: Active
Active TB TB cases
cases detected
detected by visa
by visa screening
screening
thequarter
fourth quarter
of 2017. of 2017. inin
Abu Dhabi Emirate (Q4 2017).
Abu Dhabi Emirate (Q4 2017).

Table 13: Number and rate of positive cases among new and renewal visa applicants during the fourth
quarter of 2017.
Table 13: Number and prevalence rate of positive cases among new and renewal visa applicants during the fourth
quarter of 2017.

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

Visa Status New Renew New Renew New Renew New Renew New Renew
Rate*Number of Cases 60 13 139 7 86 63 0 0 169 172
Prevalence* 42.9 5.8 486.7 36.8 61.5 28.1 0 0 591.8 903.3
Rate
Overall
20.1 306.7 41.0 0 716.4
* Rate: the number of positive cases per 100,000 visa screened applicants.
Prevalence
** Applies to tested
* Prevalence: theoccupational categories
number of positive only
cases per (New=
100,000 28,559;
visa Renew=
screened 19,042).
applicants.
** refers
*** This Appliesto
to active
tested occupational
TB cases onlycategories only (New=
confirmed by PCR28,559; Renew= 19,042).
and culture.
*** This refers to active TB cases only confirmed by PCR and culture.

11 | P a g e

Volume 8 / Issue 4; 2017 11

Quarterly Summary Report - 2017

Topic of the volume

Intestinal Amebiasis

Figure 17: Ameba trophozoite (CDC).

Introduction:
Amebiasis refers mainly to the parasitic infection of the large intestine with Entamoeba histolytica (E.
histolytica). Two species of parasite with the same morphological characteristics have been recognized - E.
histolytica and Entamoeba dispar (E. dispar). It is now recognized that only E. histolytica is able to cause
invasive disease.
E. histolytica is a uni-cellular parasite that has two forms: a motile form, called the trophozoite, and a cyst
form. Anyone is prone to infection, although it is more common in people who live in tropical areas with
poor sanitary conditions.
Incubation period: varies from few days to several months or years, commonly 2-4 weeks.
Clinical picture (signs and symptoms):
Most intestinal infections are asymptomatic although potentially pose an infectious risk due to excretion
of infectious cysts. Symptomatic illnesses vary widely in severity, ranging from mild chronic diarrhea,
to fulminant bloody dysentery. Extraintestinal amebiasis can also occur (e.g. hepatic and brain cysts or
abscesses).
Transmission:
Transmission is mainly by ingestion of mature cysts in fecally contaminated food or water but person-to-
person spread is also recognized.
The cysts can survive days to weeks in the external environment because of the protection of their walls and
are responsible for transmission. Trophozoites passed in the stool are rapidly destroyed once outside the
body, and if ingested would not survive exposure to the gastric environment.

12 www.haad.ae
 Communicable Diseases Bulletin

Case definition:

Confirmed Intestinal Amebiasis:

A clinically compatible illness that is laboratory confirmed*.

Confirmed Extra-intestinal Amebiasis

• A parasitologically confirmed infection of extraintestinal tissue OR
• Symptomatic persons (with clinical or radiographic findings consistent with extraintestinal
infection), AND
• Demonstration of specific antibody against E. histolytica
*Laboratory criteria for diagnosis:
Any one of the following:
• Demonstration of cysts or trophozoites of E. histolytica in stool
• Demonstration of trophozoites in tissue biopsy or ulcer scrapings by culture or histopathology.

Treatment:
Amebic colitis is treated first with a nitroimidazole derivative and then with a luminal agent to eradicate
colonization. Paromomycin is safe, well tolerated, and effective in the treatment of intestinal amebiasis,
including patients with HIV infection.
For extra-intestinal amebiasis like amebic liver, abscess can be cured without drainage by using
metronidazole. Treatment with a luminal agent should also follow. Disseminated amebiasis should be
treated with metronidazole, which can cross the brain-blood barrier. Empirical antibacterial therapy should
be used concomitantly if perforated bowel is a concern.
Asymptomatic carriers should be also treated with luminal amebicide to eradicate infection and hence
reduce the risk of transmission.

Amebiasis is a reportable disease in UAE and should be reported within 7 calendar days of
identification using the e-notification system: https://bpmweb.haad.ae/UserManagement/MainPage.html

Epidemiology of Amebiasis
Global situation:
Amebiasis occurs worldwide, but it is most common in tropical areas with crowded living conditions and
poor sanitation. Africa, Mexico, parts of South America, and India have significant health problems.
Symptomatic intestinal amebiasis occurs in all age groups. Liver abscesses due to amebiasis are 10 times
more frequent in adults than in children. Very young children seem to be predisposed to fulminant colitis.
Infection with E. histolytica is the fourth leading cause of death and the third leading cause of morbidity due
to protozoan infections worldwide.

Volume 8 / Issue 4; 2017 13

Quarterly Summary Report - 2017

Worldwide, approximately 50 million cases of invasive E. histolytica disease

occur each year, resulting in as many as 100,000 deaths.

Worldwide, approximately 50 million cases of invasive E. histolytica disease occur

each year, resulting in as many as 100,000 deaths.

This represents the tip of the iceberg because

only 10%-20% of infected individuals
become
This represents the tip ofsymptomatic.
the iceberg because only
10%-20% of infected individuals become
Amebiasis in Abu Dhabi: symptomatic.

Between 1 January 2015 and 31 December 2017, 2311 cases of amebiasis were reported by three regions
Amebiasis in Abu Dhabi:
of Abu Dhabi Emirate (Abu Dhabi, Al Ain and Al Dhafra).
Between 1 January 2015 and 31 December 2017, 2311 cases of amebiasis were reported by
Reported cases
three in Abu
regions Dhabi
of Abu region
Dhabi counted
Emirate for 53.4%
(Abu Dhabi, Al Ainout
andof
Al total cases while in Al Ain and Al Dhafra region
Dhafra).
it was 31.1% and 15.5%amebiasis
Reported respectively
cases(figure 18). region counted for 53.4% out of total cases while in Al
in Abu Dhabi
Ain and Al Dhafra region it was 31.1% and 15.5% respectively (figure 18).
The diagnosis of amebiasis in healthcare facilities in Abu Dhabi Emirate is mainly based on identifying
The diagnosis of amebiasis in healthcare facilities in Abu Dhabi Emirate is mainly based on
E.histolytica cysts/trophozoites in stool samples using microscopic examination either by iodine staining or
identifying E.histolytica cysts/trophozoites in stool samples using microscopic examination either by
by wet iodine
mount. staining or by wet mount.
Risk Factors
Risk Factors identified in identified in investigated
investigated casesDhabi
cases in Abu in Abuinclude
Dhabi include
traveltravel history
history outside
outside UAEUAE priorto onset
prior
to onset and eating undercooked seafood or meat.
and eating undercooked seafood or meat.
1000
2015 2016 2017 839 865
No. of notified cases

800
607
600 515
411
400 309 296
192 231
200 106 132 119

0
Abu Dhabi Al Ain Al Dhafrah Total
Region
Figure 18: Distribution of notified amebiasis cases in Abu Dhabi Emirate by year (2015 – 2017).
Figure 18: Distribution of notified amebiasis cases in Abu Dhabi Emirate by year (2015 – 2017).

In 2017, prevalence rate of Amebiasis

In 2017, prevalence cases cases
rate of Amebiasis (per 100,000 population)
(per 100,000 population)was
was48.6 amonglocals,
48.6 among locals, which was
which
was higher
higher than than rateexpatriates
25.3 among of the diseases among
(figure expatriates (25.3) (figure 19).
19).

14 | P a g e

Figure 19: Rate of amebiasis cases per 100,000 in Abu Dhabi Emirate, by nationality status (2015 – 2017).

14 www.haad.ae
 Communicable Diseases Bulletin

Investigation approach to Amebiasis by Communicable Diseases Department - DoH:

The following information should be obtained from confirmed cases:
• Relevant history of symptoms in the case and any close contacts
• Suspected food or water source
• Occupation
• History of travel, especially to endemic countries, even if travel occurred several months
prior to diagnosis.
• Area of residence.
Additional control measures should be taken:
• Advise household members and other close contacts to have microscopic examination
of feces.
• Report suspected food or water sources to the concerned authorities
• Work restrictions are implemented on amebiasis cases reported among food handlers
and other high risk occupations until treatment is completed.
• Provide advice and education to cases or guardians on preventive measures and personal
hygiene.
Prevention:
Persons who pass E. histolytica cysts in their stool can transmit the infection to others. The risk of
spreading infection is low if the infected person is treated with antibiotics and practices good personal
hygiene and health habits that prevent the infection, this includes:
• Drinking from safe water resources especially when travelling to endemic countries.
• Washing fruits and vegetables well before eating
• Pasteurization of dairy products
• Avoid eating undercooked meat and sea food
• Hand hygiene after using the bathroom and before eating
• Improved sanitation and sewage treatment and disposal.

Volume 8 / Issue 4; 2017 15

Quarterly Summary Report - 2017

Sharing Reports
Burden of Influenza in Abu Dhabi Emirate, 2014 - 2017
Introduction
Influenza is a contagious respiratory illness caused by influenza viruses. Influenza viruses can spread easily
by droplets made when people with influenza cough, sneeze or talk. As well, a person might get influenza
infection by touching surface or object contaminated with the influenza virus.
A person who has influenza can infect other people starting from 1 day before symptoms develop and up to
5 to 7 days after becoming sick. Children may pass the virus for longer than 7 days. Others asymptomatic
persons can spread the virus along the course of infection. Consequently, the mode of influenza virus
transmission increases the burden of the diseases in the community, especially for people who are more
susceptible to get the influenza complications (immunocompromised, children, etc.).
Although influenza activity typically begin in the late fall and peaks in mid- to late winter months, influenza
viruses circulate year-round and remain a threat to persons who are very young or old or who have chronic
medical conditions.
In Abu Dhabi Emirate, influenza is a notifiable disease by law and cases should be reported to DoH through
the electronic notification system. It helps DoH to monitor changes in the disease activity, severity, and
strains circulating in Abu Dhabi Emirate, which greatly help in improving preparedness plans for influenza
season every year. In addition, people who came in contact with influenza case and at high risk of serious
influenza complications is referred for antiviral prophylaxis.
Influenza Case Definition:
According to DoH, a clinical influenza case definition is an acute respiratory tract illness characterized by
sudden onset of fever of > 38 ºC, headache, myalgia, prostration, coryza, sore throat and/or cough.
Laboratory Criteria:
Any one of the following:
• Virus isolation from: nasopharyngeal aspirate or throat washing from the suspected individual
• Direct detection of influenza viral antigen
• Serology: Fourfold rise in antibody titer between early and late serum
Case classification
Suspected:
A clinically compatible case without laboratory confirmation
Probable:
A clinically compatible case that is considered to be epidemiologically linked to a probable or
confirmed case.
Confirmed:
A clinically compatible case that is laboratory confirmed.

16 www.haad.ae
 Communicable Diseases Bulletin

Epidemiology
According to the notifications of infectious diseases received through DoH electronic system, there is an
increase in the number of influenza cases 1,659 cases in 2014 to 16,003 cases in 2017. As well, the prevalence
rate of influenza increased dramatically from 60.2/100,000 in 2014 to 526.8/100,000 in 2017 (Figure 20).
As per the WHO mapping for the respiratory specimens that tested positive for influenza in 2017, different
parts of the world including North America, Western Africa, parts of Asia like China, India and Iran as well
as the Arabian peninsula, had an increase in the overall influenza activity. In addition, enhanced laboratory
diagnostic tools and improved compliance in reporting infectious diseases by the healthcare facilities in Abu
Dhabi Emirate, could contribute to the increased number of notified cases in 2017.

Figure 20: Notified Influenza (A, B, H1N1, & Unspecified) cases in Abu Dhabi Emirate, by Year (2014 – 2017).

The monthly distribution of influenza cases over the last four years, shows that influenza season starts early
September and ends by late April (Figure 21). In 2017, there was a sharp increase in the total number of
notified cases compared to the previous three years.

Figure 21: Monthly distribution of notified Influenza cases (A, B, H1N1 and Unspecified) in Abu Dhabi Emirate.

In 2017, (figure 22) the Epicurve shows that the dominant type of influenza at the beginning of influenza
season is type A. Some of the confirmed influenza A cases were screened for influenza A serotypes and it
was found that 11% of screened cases were H1N1.

Volume 8 / Issue 4; 2017 17

Quarterly Summary Report - 2017

Figure 22: Number of Lab. confirmed Influenza reported in Abu Dhabi Emirate, by influenza type (2017).

The most affected age group in 2017 is from 1 to 4 years of age (Figure 23) which is expected as children are
one of the highest risk group. As per data available for 2017 cases, males are affected with influenza more
than females (Figure 24).

Figure 23: Notified Influenza cases (A, B, H1N1, & Unspecified) in Abu Dhabi Emirate, by age group in 2017.

Figure 24: Notified Influenza cases (A, B, H1N1, & Unspecified) in Abu Dhabi Emirate, by gender in 2017.
Out of 16003 influenza cases reported in 2017, 68.8% of them were expatriates compared to 31.2% UAE
national as shown in figure 25.

18 www.haad.ae
 Communicable Diseases Bulletin

Figure 25: Percentage of influenza cases, by nationality status, 2017.

Conclusion:
Seasonal influenza viruses circulate worldwide and have become a serious public health concern as the
influenza viruses adapt themselves to environmental changes by undergoing gene mutation. Therefore,
strengthening influenza response capacities include diagnostics, antiviral susceptibility monitoring, disease
surveillance and outbreak responses can greatly decrease the burden of the disease in the community.
Applying preventive measures, such as increasing vaccine coverage especially among high-risk groups, is an
important tool to minimize the effect of seasonal influenza.

Volume 8 / Issue 4; 2017 19

objectives
 Communicable Diseases Bulletin

Flash-on-an-Illness
Candida auris
Background:
Candida auris (C. auris) is an emerging multidrug-resistant yeast that has been associated with healthcare-
associated infections and outbreaks with significant mortality. C. auris may causes serious infections such
as bloodstream, wound and ear infections. It also has been isolated from respiratory and urine specimens,
but it is unclear if it causes infections in the lung or bladder.
C. auris presents a serious global health threat. The Department of Health-Abu Dhabi and the US Centers
for Disease Prevention and Control (CDC) are concerned about C. auris for three main reasons:
1. C. auris is often multidrug-resistant, meaning that it is resistant to multiple antifungal drugs
commonly used to treat Candida infections,
2. C. auris is difficult to identify with standard laboratory methods, and it can be misidentified
in labs without using specific technology. Misidentification may lead to inappropriate
management,
3. Moreover, this organism has caused outbreaks in health care settings, so it’s essential to
recognize it rapidly in inpatients in order to take appropriate precaution measures to stop
the spread.
Symptoms
Fever & chills are the most common symptoms of invasive C. auris infection that do not improve after
antibiotic treatment for a suspected bacterial infection.
Transmission
C. auris can spread either from person to person (including from people without symptoms), or by contact
with contaminated surfaces or equipments. C. auris can potentially survive on surfaces for several weeks.
Laboratory diagnosis
Like other Candida infections, C. auris infections are commonly diagnosed by culturing blood or from
other body fluids. However, C. auris is more difficult to identify from clinical specimen than other Candida
species, with yeast identification systems using traditional biochemical methods sometimes misidentifying it
as other yeast species, particularly Candida haemulonii. Molecular methods based on sequencing the D1-D2
region of the 28s rDNA or the Internal Transcribed Region (ITS) of rDNA also can identify C. auris.
Risk factors
Early evidence suggest that the risk factors for C. auris infections are generally similar to risk factors for
other types of Candida infections, which include:
• Recent surgery,
• Having Diabetes mellitus,
• Prolonged Intensive Care Unit Stay,
• Patient with invasive procedure or central line,
• Broad-spectrum antibiotics use.

Volume 8 / Issue 4; 2017 23

Quarterly Summary Report - 2017

Infections have been found in patients of all ages, from preterm infants to elderly. Some asymptomatic
people who are carrying C. auris can cause a serious problem for hospitalized patients. C . auris can
occasionally get into surgical wounds or the blood stream and enter the body during delivering medical
treatment including operations or when urinary catheters or drips are inserted. Infections are usually mild
but can become more severe in rare cases where patients have other serious illnesses.
Treatment
C. auris is frequently resistant (%R) to antifungal agents commonly used to treat Candida infections:
• Azoles: Fluconazole: 93 %R, voriconazole: 54% resistant);
• Polyenes: Amphotericin B: 35%R;
• Echinocandins (e.g. caspofungin): 7%R.
Multidrug-resistance is common (41%), and 4% of C. auris isolates are resistant to all three major antifungal
classes.
In some cases, multiple antifungal drugs at high doses might be needed to effectively treat the infection.
Tables 14 and 15, show the recommended treatment of C. auris infection in adults and children ≥ 2 months
of age.
Table 14: Treatment of adults and children ≥ 2 months of age:

Enhinocandin
Adult dosing Pediatric dosing
Drug
loading dose 200mg IV,
Anidulafungin not approved for use in children
then 100mg IV daily
loading dose 70mg IV, loading dose 70mg/m2/day IV, then 50mg/m2/day
Caspofungin
then 50mg IV daily IV (based on body surface area)

Micafungin 100mg IV daily 2mg/kg/day IV, with option to increase to

4mg/kg/day IV in children 40kg

For neonates and children < 2 months of age, the initial treatment of choice is amphotericin B deoxycholate,
1 mg/kg daily. If unresponsive to amphotericin B deoxycholate, liposomal amphotericin B, 5mg/kg daily,
could be considered. In exceptional circumstances, where central nervous system involvement has been
ruled out, echinocandins may considered with caution at the following doses:
Table 15: Neonates and Children < 2 months of age:

Echinocandin Drug Neonatal dosing

Caspofungin 25mg/m2/day IV (based on body surface area)

Micafungin 10mg/kg/day IV

24 www.haad.ae
 Communicable Diseases Bulletin

CDC does not recommend treatment of C. auris cultured from non-invasive sites when there is no
evidence of infection. Similar to recommendations for other Candida species, treatment is generally
indicated only if a clinical disease is present

Decrease the risk of spreading C. auris

• Patients with suspected or confirmed C. auris should be placed in private rooms or cohort
with other patients with the same infection;
• Follow hand-hygiene guidelines;
• Use gowns and gloves when in contact with, or caring for patients who are symptomatic/
carrier with C. auris for all interactions that may involve contact with the patient or
potentially contaminated areas in patient environment;
• Dedicate medical equipment to the patient/carrier.
Global epidemiology of Candida auris
C. auris is a yeast species first isolated from the external ear canal of a patient in Japan in 2009. Since then
C. auris has been associated with a wide range of clinical infections, in many countries globally. It has caused
single cases or multiple cases in Germany, Kuwait, Malaysia, Norway, Canada, Colombia, India, Israel, Japan,
Kenya, Oman, Pakistan, Panama, South Korea, South Africa, Spain, UAE, UK, USA, and Venezuela (Figure 26).
In some countries, it has causes prolonged outbreaks.

Figure 26: Countries from which Candida auris cases have been reported, as of February 28, 2018 (U.S. CDC)
(https://www.cdc.gov/fungal/diseases/candidiasis/tracking-c-auris.html).

Volume 8 / Issue 4; 2017 25

Quarterly Summary Report - 2017

C. auris may cause severe illness or death in hospitalized patients. In some patients, it can enter the
bloodstream and spread throughout the body, causing serious invasive infections. This fungus often
does not respond to commonly used antifungal drugs, making infections difficult to treat.

Summary
• C. auris, an emerging species, has posed new challenges and threats, including nosocomial
transmission, and multidrug-resistance, and requires ongoing vigilance to prevent its
spread
• It is important that laboratories review their practices in order to correctly detect and
identify C. auris from clinical specimen, and for health care facilities to implement
recommended infection control practices to prevent the spread.
• In Abu Dhabi Emirate, SEHA and private healthcare facilities should notify DoH of
suspected/confirmed cases of C. auris through Infectious Diseases Notification System
(IDN).
• For further details on lab diagnosis, susceptibility testing, surveillance, treatment, and
infection prevention and control of C. auris see DoH Circular DG-61/2017
(21 Dec 2017), available online.

26 www.haad.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 Abdulla (Senior Officer, Communicable Diseases Department, DoH).
- Dr. Ahmed Khudhair (Senior Officer, Communicable Diseases Department, DoH).
- Mrs. Wafa Aldhaheri (Senior Officer, Communicable Diseases Department, DoH).
- Dr. Tahera Al Ameri (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).
- Mr. Darren Joubert (Senior Officer, Occupational Health, DoH).

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

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

Mrs. Wafa Aldhaheri
Communicable Diseases Department
Department of Health
Tel: +971 (3) 716 5020
E-Mail: waldhaheri@doh.gov.ae

Volume 8 / Issue 4; 2017 27