A second local dengue fever outbreak: A field experience from Muscat Governorate in Oman, 2022.

Background: Dengue fever is an infectious disease of global health concern. This study aimed to describe the epidemiology and field experience of a locally transmitted outbreak of dengue fever in Muscat Governorate, Oman from mid-March to mid-April 2022, and the multi-sectoral approach to control the outbreak. Methods: Data were collected from an electronic e-notification system, active surveillance and contact investigations. Results: Of 250 suspected and probable cases, 169 were confirmed as dengue fever with DENV-2 serotype. Of these, 108 (63.9%) were male and 94 (55.6%) were Omani. The mean age was 39 years (standard deviation 13 years). Fever was the most common symptom and occurred in 100% of cases. Haemorrhagic manifestations occurred in 10% (n=17) of cases. Hospitalization was required for 93 cases (55.1%). The field investigation included 3444 houses and other suspected sites. Breeding sites for Aedes aegypti were identified in 565 (18.5%) sites visited. Interventions to control the outbreak included environmental and entomological assessment of the affected houses and surrounding areas (400 m radius of each house). Conclusion: Outbreaks are expected to continue, with the possibility of severe cases due to antibody-dependent enhancement. More data are required to understand the genetics, geographical spread and behaviour of A. aegypti in Oman.

Contact tracing in the context of COVID-19: a case study from Oman.

In April 2020, the Ministry of Health (MoH) in Oman, a high-income country in the Eastern Mediterranean Region (EMR), implemented a robust contact tracing (CT) system for COVID-19. To capitalise on Oman's experience, EMRO has developed a case study presenting the methodology used to conduct the CT activities, main functions of the system, challenges encountered, lessons learnt, and the way forward. To develop the case study, a key informant interview was conducted virtually with the CT focal point in the MoH, using a semistructured questionnaire adapted from the WHO questionnaire for the assessment of CT activities. The Oman MoH launched a CT system based on three complementary digital tools: Tarassud plus, Medical Scout and HMushrif applications. Oman's CT strategy classifies contacts into close and casual contacts. Only close contacts are listed using the Tarassud plus application, while casual contacts are requested to self-monitor for 14 days using the other two applications. With the evolution of the outbreak, Oman MoH implemented stricter policies and prioritised the follow-up of close contacts to keep the CT activity manageable. Community health workers and volunteers facilitated the CT activities through sensitisation of the local community to the follow-up process and reducing the COVID-19-associated stigma. Challenges encountered revolved around contact data management, given the offline in-operability of the applications, and lack of national risk communication guidelines to address community concerns and widespread rumours.

Challenges and Opportunities for Public Health Service in Oman From the COVID-19 Pandemic: Learning Lessons for a Better Future.

Despite the apparent challenges inflicted by COVID-19 globally, the pandemic provided an opportunity to utilize and expand existing public health capacities for a more adaptive and resilient system during and after each wave of the disease. This paper provides a narrative review of Oman's public health response to the COVID-19 pandemic from January 2020 to July 2021, and the challenges it faced for a more rapid and efficient response. The review demonstrates that the three main pillars influencing the direction of the pandemic and aiding the control are Oman's unified governmental leadership, the move to expand the capacity of the health care system at all levels, and community partnership in all stages of the response including the COVID-19 vaccination campaign. The opportunities identified during response stages in the harmonization of the multisectoral response, streamlining communication channels, addressing vulnerable communities (dormitories, residences at border regions), and providing professional technical leadership provide an excellent precursor for expediting the transformation of Oman's health care system to one with a multisectoral holistic approach. Some of the major challenges faced are the shortage of the public health cadre, lack of a fully integrated digital platform for surveillance, and the scarcity of experts in risk communication and community engagement. A future health system where the center for diseases surveillance and control acts as a nucleus for multisectoral expertise and leadership, which includes community representatives, is crucial to attain optimum health. The destruction inflicted by this prolong COVID-19 pandemic at all levels of human life had valued the importance of investing on preventive and preparedness strategies.

The Impact of Mobility Restriction Strategies in the Control of the COVID-19 Pandemic: Modelling the Relation between COVID-19 Health and Community Mobility Data.

BACKGROUND: Non-pharmaceutical interventions (NPIs), particularly mobility restrictions, are mainstay measures for the COVID-19 pandemic worldwide. We evaluated the effects of Oman's mobility restriction strategies to highlight their efficacy in controlling the pandemic. METHODS: Accessible national data of daily admissions and deaths were collected from 1 April 2020 to 22 May 2021. Google Community Mobility Report (CMR) data were downloaded for the same period. Among six CMR categories, three were used and reduced to one index-the community mobility index (CMI). We used a generalised linear model with a negative binomial distribution combined with a non-linear distributed lag model to investigate the short-term effects of CMI on the number of admitted PCR-confirmed COVID-19 cases and deaths, controlling for public holidays, day of the week, and Eid/Ramadan days. RESULTS: We demonstrated the feasibility of using CMRs in the evaluation and monitoring of different NPIs, particularly those related to movement restriction. The best movement restriction strategy was a curfew from 7 p.m. to 5 a.m. (level 3 of CMI = 8), which had a total reduction of 35% (95% confidence interval (CI); 25-44%) in new COVID-19 admissions in the following two weeks, and a fatality reduction in the following four weeks by 52% (95% CI; 11-75%). CONCLUSION: Evening lockdown significantly affected the course of the pandemic in Oman which lines up with similar studies throughout the world.

The role of children and adolescents in the transmission of SARS-CoV-2 virus within family clusters: A large population study from Oman.

BACKGROUND: In Oman, many extended families tend to live in one household. Some families can include 20-30 individuals with the majority of them being children. This study investigates the role of children in spreading SARS-CoV-2 causing COVID-19 within family clusters in Oman. METHODS: This retrospective study includes data of 1026 SARS-CoV-2 positive children (≤18 years) collected from the national surveillance database for COVID-19 between 1 February 2020 and 30 May 2020. RESULTS: We included 1026 patients. Most, 842 were Omani (82%), 52% male, and 28.5% asymptomatic. Close to the half of symptomatic 419 (40%), patients presented with fever associated with other respiratory symptoms. Fifty pediatric patients were index cases who transmitted the virus to 107 patients in total (86 adults and 21 children) with a mode of 1. There is no statistical significance of all studied risk factors in the transmission of the SARS-CoV-2 virus including age, gender, and cycle threshold (CT) value. CONCLUSIONS: According to this study, children are not to be considered a significant driver of transmission of SARS-CoV-2 in Oman.

COVID-19 epidemic monitoring after non-pharmaceutical interventions: The use of time-varying reproduction number in a country with a large migrant population.

BACKGROUND: COVID-19's emergence carries with it many uncertainties and challenges, including strategies to manage the epidemic. Oman has implemented non-pharmaceutical interventions (NPIs) to mitigate the impact of COVID-19. However, responses to NPIs may be different across different populations within a country with a large number of migrants, such as Oman. This study investigated the different responses to NPIs, and assessed the use of the time-varying reproduction number (Rt) to monitor them. METHODS: Polymerase chain reaction (PCR) laboratory-confirmed COVID-19 data for Oman, from February 24 to June 3, 2020, were used alongside demographic and epidemiological information. Data were arranged into pairs of infector-infectee, and two main libraries of R software were used to estimate reproductive number (Rt). Rt was calculated for both Omanis and non-Omanis. FINDINGS: A total of 13,538 cases were included, 44.9% of which were Omanis. Among all these cases we identified 2769 infector-infectee pairs for calculating Rt. There was a sharp drop in Rt from 3.7 (95% confidence interval [CI] 2.8-4.6) in mid-March to 1.4 (95% CI 1.2-1.7) in late March in response to NPIs. Rt then decreased further to 1.2 (95% CI 1.1-1.3) in late April after which it rose, corresponding to the easing of NPIs. Comparing the two groups, the response to major public health controls was more evident in Omanis in reducing Rt to 1.09 (95% CI 0.84-1.3) by the end of March. INTERPRETATION: Use of real-time estimation of Rt allowed us to follow the effects of NPIs. The migrant population responded differently than the Omani population.