Brucellosis in Omani children: a multicenter experience over 15 years.

BACKGROUND: Brucellosis, a common zoonotic disease worldwide, can lead to serious complications in humans. In Oman, the disease occurs most often in the south, but is increasing in the north. OBJECTIVES: Describe brucellosis in children in the Northern Governorate in Oman. DESIGN: Retrospective, observational. SETTINGS: Hospitals in the Northern Governorate in Oman. PATIENTS AND METHODS: We collected data on the demographics, distribution, common clinical presentations, risk factors, laboratory findings, therapy, and complications of confirmed cases of brucellosis. We included all brucellosis cases up to the age of 13 years at the Child Health Department in Royal, Suhar, Al Rustaq and Nizwa Hospitals over a 15-year period. MAIN OUTCOME MEASURES: Descriptive findings of brucellosis. SAMPLE SIZE: 57 confirmed cases. RESULTS: The 57 confirmed cases of Brucella had a mean age of 6 years. Most of the cases were from Dhakhiliya 21 (36.8%) and Batinah 18 (31.6%). Consumption of raw milk was documented in 75% and 41% had animal contact. From 2010, there was a marked rise of the cases with a maximum rise was noticed in 2019 with a total of 10 cases. The main clinical manifestations were fever (92%, n=52), arthritis (44%, n=25), which involved mainly knees and hips. Forty-two had bacteremia, 41% anemia, 10% osteomyelitis/septic arthritis, one case with congenital brucellosis and one case neurobrucellosis (1.8%). Forty cases had positive serology results of which 19 had positive cultures. Most cases had received cotrimoxazole and rifampin as the primary treatment regimen 22 (40%). Four patients relapsed (7%) after treatment completion. CONCLUSION: This study showed the distribution and clinical characteristics of brucellosis in different regions in the Northern Governorate in Oman. Although the numbers of cases remained low, the gradual increase is concerning for public health and preventive strategies. Further studies are needed to compare this data with the Southern region. LIMITATION: Retrospective study with small sample size.

Health care-associated measles outbreak in pediatric wards in a tertiary care hospital: Challenges and Swiss cheese model enforcement for patient safety.

INTRODUCTION: Measles is one of the most contagious of all infectious diseases, for example, up to 9 out of 10 susceptible people with close contact to a measles patient will develop measles. In countries where measles is rare, transmissions in health care facilities have been a key factor in amplifying outbreaks OBJECTIVES: Describe the hospital transmission of measles among unvaccinated children in pediatric service, challenges faced and recommendations for health care settings by applying the Swiss cheese model. METHOD: Between December 2019 and January 2020; multiple exposures to measles cases occurred. The incident and factors that led to the outbreak are described. The matrix and fusion genes, non-coding region sequence analysis was also conducted on the 3 strains isolated from the cases. RESULTS: The outbreak extended from December 2019 to January 2020, which resulted in 110 exposed individuals (85 health care workers and 25 patients). Eleven (44%) children exposed were vaccinated, 14 (56%) were not yet vaccinated, and the measles status of 10 (11.8%) HCWs was not known at the time of the outbreak. Two infants acquired measles in the hospital, and both required ICU care. Three infants and one HCW received immunoglobulin. The phylogenetic tree of the matrix and fusion genes, non-coding region sequencing confirmed that all three cases had 100% identical measles strain. CONCLUSIONS: In countries where measles elimination goals are achieved, a multifaceted approach to prevent measles transmission in health care is vital to maintain patient safety.