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Crimean-Congo hemorrhagic fever (CCHF) is a serious disease with a high fatality rate reported in many countries. The first case of CCHF in Oman was detected in 1995 and serosurveys have suggested widespread infection of humans and livestock throughout the country. Cases of CCHF reported to the Ministry of Health (MoH) of Oman between 1995 and 2017 were retrospectively reviewed. Diagnosis was confirmed by serology and/or molecular tests in Oman. Stored RNA from recent cases was studied by sequencing the complete open reading frame (ORF) of the viral S segment at Public Health England, enabling phylogenetic comparisons to be made with other S segments of strains obtained from the region. Of 88 cases of CCHF, 4 were sporadic in 1995 and 1996, then none were detected until 2011. From 2011-2017, incidence has steadily increased and 19 (23.8%) of 80 cases clustered around Eid Al Adha. The median (range) age was 33 (15-68) years and 79 (90%) were male. The major risk for infection was contact with animals and/or butchering in 73/88 (83%) and only one case was related to tick bites alone. Severe cases were over-represented: 64 (72.7%) had a platelet count < 50 x 109/L and 32 (36.4%) died. There was no intrafamilial spread or healthcare-associated infection. The viral S segments from 11 patients presenting in 2013 and 2014 were all grouped in Asia 1 (IV) lineage. CCHF is well-established throughout Oman, with a single strain of virus present for at least 20 years. Most patients are men involved in animal husbandry and butchery. The high mortality suggests that there is substantial under-diagnosis of milder cases. Preventive measures have been introduced to reduce risks of transmission to animal handlers and butchers and to maintain safety in healthcare settings.

Determining an economically sustainable way to deliver the poliovirus vaccine remains a challenge and a priority. In this article, investigators in Oman show that with a one-fifth dose of the inactivated poliovirus vaccine given intradermally, the seroconversion rates at 7 months of age to all three poliovirus serotypes were equivalent to the rates with the standard full-dose vaccine given intramuscularly. However the median antibody titers were lower with the fractional dose than with the full dose. Investigators in Oman showed that with a one-fifth dose of the inactivated poliovirus vaccine given intradermally, the seroconversion rates at 7 months of age to all three poliovirus serotypes were equivalent to the rates with the standard full-dose vaccine given intramuscularly. In 1988, the World Health Assembly resolved to eradicate poliomyelitis by the year 2000. 1 Substantial progress toward this goal has been made, although eradication remains elusive. One poliovirus serotype, wild poliovirus type 2, has apparently been eradicated, with the last isolation reported in India in October 1999. 2 The number of countries in which the presence of wild poliovirus was never interrupted decreased to 4 in 2009 (from more than 125 polio-endemic countries in 1988), and the number of cases of poliomyelitis decreased by more than 99% during the same period. 3 , 4 As the eradication efforts accelerated, the preparations for the . . .

Acute respiratory infections (ARI), including influenza, comprise a leading cause of morbidity and mortality worldwide. Influenza surveillance provides important information to inform policy on influenza control and vaccination. While the epidemiology of influenza has been well characterized in western countries, few data exist on influenza epidemiology in the Eastern Mediterranean Region. We describe the epidemiology of influenza virus in Oman. Using syndromic case definitions and protocols, patients from four regional hospitals in Oman were enrolled in a descriptive prospective study to characterize the burden of severe acute respiratory infections (SARI) and influenza. Eligible patients provided demographic information as well as oropharyngeal (OP) and nasopharyngeal (NP) swabs. Specimens were tested for influenza A and influenza B; influenza A viruses were subtyped using RT-PCR. From January 2008 through June 2013, a total of 5,147 cases were enrolled and tested for influenza. Influenza strains were detected in 8% of cases for whom samples were available. Annual incidence rates ranged from 0.5 to 15.4 cases of influenza-associated SARI per 100,000 population. The median age of influenza patients was 6 years with children 0-2 years accounting for 34% of all influenza-associated hospitalizations. By contrast, the median age of non-influenza SARI cases was 1 year with children 0-2 years comprising 59% of SARI. Compared to non-influenza SARI cases, a greater proportion of influenza cases had pre-existing chronic conditions and underwent ventilation during hospitalization. Influenza virus is associated with a substantial proportion of SARI in Oman. Influenza in Oman approximately follows northern hemisphere seasonality, with major peaks in October to December and a lesser peak around April. The burden of influenza was greatest in children and the elderly. Future efforts should examine the burden of influenza in other potential risk groups such as pregnant women to inform interventions including targeted vaccination.

Objectives To investigate the course of a community gastroenteritis outbreak by Salmonella and implement interventional activities and roles to prevent occurring such an outbreak in the future. Methods From August 27 to 2 September 2015, 101 individuals were reported among a local community. All affected individuals had a history of food consumption at a local restaurant. A rapid response team conducted active surveillance and interview with the affected individuals and workers of the restaurant. Food items and stools from food handlers and affected individuals were cultured and sent for genotyping. An environmental audit of the restaurant had been conducted. Results The total majority of the affected individuals were male and more than 70% belonged to the young age group from 15 to 45 years. Out of the total, 97% had diarrhea, 70% fever, 56% abdominal cramps and 49% vomiting. All those affected were managed symptomatically except for 14 cases admitted for intravenous rehydration. Breakdown of food safety and basic personal hygiene were detected in the environment of the restaurant and among the workers. There are 39 out of 49 stool cultures of cases, six out of 18 food handlers, and five food samples were positive for Salmonella spp. The identical DNA fingerprinting pattern among S. Weltevreden strains originating from human cases and food was detected. Conclusion This is the first reported community foodborne of S. Weltevreden outbreak in Oman. The importance of food safety and rigors environmental safety is emphasized. Basic personal hygiene and training of food handlers in restaurants are recommended with public health measurements.

Objectives This study aimed to understand the epidemiology of meningitis cases admitted to hospitals in Oman and to identify any changing microbial patterns from the introduction of the new vaccines. Methods A retrospective analysis of all cases of meningitis reported through a national surveillance system. Meningitis is a notifable disease. Results Of a total of 581 cases of meningitis from the period between January 1, 2005 and December 31, 2013, 15% (88) were confrmed to be bacterial in origin and 7.2% (42/581) viral. In 50.9% (296) of patients with suspected pyogenic meningitis, no specific bacterial pathogen were identified, and in 26% of cases (151) a cerebrospinal fluid study could not be undertaken. Among 88 cases with confirmed bacterial pathogens the organisms identified were Streptococcus pneumoniae (65.9%), Neisseria meningitides (18.2%), Haemophilus influenzae (6.8%), and other organisms (9.1%). The peak incidence was in children <2 years of age (39.4%). It showed notable decline in H. influenzae cases as well as pneumococcal meningitis cases, possibly indicative of the successful immunization program. Conclusion A drop in H. Influenzae and pneumococcal meningitis cases was possibly the effect of the introduction of vaccines. It shows the need for improving diagnostic accuracy, laboratory capacities, and quality of surveillance reporting.

Abstract Epidemiological data on acute otitis media (AOM), an infectious disease frequently affecting children, are lacking in some countries. This study was undertaken to assess the incidence of AOM in children ≤5 years in Saudi Arabia, Oman, Pakistan, and Turkey, as well as the economic burden from a parent/caregiver perspective. Medical records of 4043 children (Saudi Arabia = 1023, Oman = 998, Pakistan = 1022, Turkey = 1000) were retrospectively reviewed and the incidence of AOM episodes calculated from suspected and confirmed cases. Using a standardized Health Economics Questionnaire, parents recorded resource use and expenses incurred per AOM episode [in local currency and converted to US dollars (USD)]. The overall incidence of AOM episodes per 1000 person–years was: Saudi Arabia, 207 [95% confidence interval (CI): 178–238]; Oman, 105 (95% CI: 85–127); Pakistan, 138 (95% CI: 116–163); and Turkey, 99 (95% CI: 79–123). The mean total out-of-pocket healthcare expense incurred by parents/caregivers per episode was: Saudi Arabia USD67.1 [standard deviation (SD) = 93.0], Oman USD16.1 (SD = 16.4), Pakistan USD22.1 (SD = 20.5), and Turkey USD33.6 (SD = 44.9). The incidence of AOM episodes varied across all four countries, probably due to different diagnostic and management practices. Nevertheless, our results confirm that AOM causes a substantial burden to public health, reinforcing the need for cost-effective prevention strategies.

Background: During the last two decades, significant changes have taken place in the epidemiology of meningitis, especially due to the global availability and expanding use of Hib vaccines. The introduction of conjugate Hib vaccine in the Expanded Programme of Immunization (EPI) in Oman and recent availability of meningococcal vaccines against serogroups A and C plus the introduction of pneumococcal heptavalent conjugate vaccine are expected to influence the epidemiology of the disease in the country. We conducted this periodic review of acute bacterial meningitis in children younger than five years of age in Oman from January 2000 to December 2005 to reflect changes in the epidemiological pattern of these pathogens. Methodology: Retrospective analysis of all cases of acute bacterial meningitis in children younger than five years of age reported to the Department of Communicable Diseases Surveillance and Control, Ministry of Health, Oman. Results: There were 344 cases of meningitis due to suspected bacterial etiologies reported in children younger than 5 years of age. Although Haemophilus influenzae 76 (22%) was the most common pathogen identified during the study period, the incidence of meningitis due to Haemophilus influenzae has been dramatically reduced since the introduction of conjugate Hib vaccination in Oman in October 2001. Streptococcus pneumoniae 53 (15%) and Neisseria meningitidis 37 (11%) were the next two leading agents of meningitis respectively. In one hundred seventy four (52%) cases of presumptive bacterial meningitis, the etiologic organism remains unidentified. The peak occurrence of meningitis was in young children younger than one year old. The total male to female ratio was 1.4:1 and the case fatality rate (7deaths) was 2%. Conclusions: With the introduction of Hib vaccine in Oman in October 2001, the absolute number of cases due to Haemophilus influenzae significantly declined over the years. The incidence of meningitis due to other pathogens such as S. pneumoniae and N. meningitidis remains steady. There is significant need to improve laboratory methods of bacterial detection and identification, which will help to formulate better antibiotic policies and strengthen control measures through newly introduced vaccines in Oman.

Epidemiological data on acute otitis media (AOM), an infectious disease frequently affecting children, are lacking in some countries. This study was undertaken to assess the incidence of AOM in children ≤5years in Saudi Arabia, Oman, Pakistan, and Turkey, as well as the economic burden from a parent/caregiver perspective. Medical records of 4043 children (Saudi Arabia=1023, Oman=998, Pakistan=1022, Turkey=1000) were retrospectively reviewed and the incidence of AOM episodes calculated from suspected and confirmed cases. Using a standardized Health Economics Questionnaire, parents recorded resource use and expenses incurred per AOM episode [in local currency and converted to US dollars (USD)]. The overall incidence of AOM episodes per 1000 person–years was: Saudi Arabia, 207 [95% confidence interval (CI): 178–238]; Oman, 105 (95% CI: 85–127); Pakistan, 138 (95% CI: 116–163); and Turkey, 99 (95% CI: 79–123). The mean total out-of-pocket healthcare expense incurred by parents/caregivers per episode was: Saudi Arabia USD67.1 [standard deviation (SD)=93.0], Oman USD16.1 (SD=16.4), Pakistan USD22.1 (SD=20.5), and Turkey USD33.6 (SD=44.9). The incidence of AOM episodes varied across all four countries, probably due to different diagnostic and management practices. Nevertheless, our results confirm that AOM causes a substantial burden to public health, reinforcing the need for cost-effective prevention strategies.

Introduction Acute respiratory infections (ARI), including influenza, comprise a leading cause of morbidity and mortality worldwide. Influenza surveillance provides important information to inform policy on influenza control and vaccination. While the epidemiology of influenza has been well characterized in western countries, few data exist on influenza epidemiology in the Eastern Mediterranean Region. We describe the epidemiology of influenza virus in Oman. Methods Using syndromic case definitions and protocols, patients from four regional hospitals in Oman were enrolled in a descriptive prospective study to characterize the burden of severe acute respiratory infections (SARI) and influenza. Eligible patients provided demographic information as well as oropharyngeal (OP) and nasopharyngeal (NP) swabs. Specimens were tested for influenza A and influenza B; influenza A viruses were subtyped using RT-PCR. Results From January 2008 through June 2013, a total of 5,147 cases were enrolled and tested for influenza. Influenza strains were detected in 8% of cases for whom samples were available. Annual incidence rates ranged from 0.5 to 15.4 cases of influenza-associated SARI per 100,000 population. The median age of influenza patients was 6 years with children 0-2 years accounting for 34% of all influenza-associated hospitalizations. By contrast, the median age of non-influenza SARI cases was 1 year with children 0-2 years comprising 59% of SARI. Compared to non-influenza SARI cases, a greater proportion of influenza cases had pre-existing chronic conditions and underwent ventilation during hospitalization. Conclusions Influenza virus is associated with a substantial proportion of SARI in Oman. Influenza in Oman approximately follows northern hemisphere seasonality, with major peaks in October to December and a lesser peak around April. The burden of influenza was greatest in children and the elderly. Future efforts should examine the burden of influenza in other potential risk groups such as pregnant women to inform interventions including targeted vaccination.

During the last two decades, significant changes have taken place in the epidemiology of meningitis, especially due to the global availability and expanding use of Hib vaccines. The introduction of conjugate Hib vaccine in the Expanded Programme of Immunization (EPI) in Oman and recent availability of meningococcal vaccines against serogroups A and C plus the introduction of pneumococcal heptavalent conjugate vaccine are expected to influence the epidemiology of the disease in the country. We conducted this periodic review of acute bacterial meningitis in children younger than five years of age in Oman from January 2000 to December 2005 to reflect changes in the epidemiological pattern of these pathogens. Retrospective analysis of all cases of acute bacterial meningitis in children younger than five years of age reported to the Department of Communicable Diseases Surveillance and Control, Ministry of Health, Oman. There were 344 cases of meningitis due to suspected bacterial etiologies reported in children younger than 5 years of age. Although Haemophilus influenzae 76 (22%) was the most common pathogen identified during the study period, the incidence of meningitis due to Haemophilus influenzae has been dramatically reduced since the introduction of conjugate Hib vaccination in Oman in October 2001. Streptococcus pneumoniae 53 (15%) and Neisseria meningitidis 37 (11%) were the next two leading agents of meningitis respectively. In one hundred seventy four (52%) cases of presumptive bacterial meningitis, the etiologic organism remains unidentified. The peak occurrence of meningitis was in young children younger than one year old. The total male to female ratio was 1.4:1 and the case fatality rate (7 deaths) was 2%. With the introduction of Hib vaccine in Oman in October 2001, the absolute number of cases due to Haemophilus influenzae significantly declined over the years. The incidence of meningitis due to other pathogens such as S. pneumoniae and N. meningitidis remains steady. There is significant need to improve laboratory methods of bacterial detection and identification, which will help to formulate better antibiotic policies and strengthen control measures through newly introduced vaccines in Oman.