Community Foodborne of Salmonella Weltevreden Outbreak at Northern Governorate, Sultanate of Oman.

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.

Chronic Q Fever Endocarditis in an Omani Child: The First Pediatric Case Report from Oman.

Q fever endocarditis is the most common presentation of chronic infection of Coxiella burnetii, but it rarely occurs in the pediatric age group. We report the first case of Q fever endocarditis in an Omani child. The affected 11-year-old female lives in the Al Batinah governorate in the north of Oman and was known to have congenital heart disease. She presented with features of chronic blood culture-negative endocarditis. The C. burnetii infection was confirmed with the indirect immunofluorescence assay. The patient responded well to a combination of doxycycline and hydroxychloroquine therapy.

Estimating the burden of influenza-associated hospitalization and deaths in Oman (2012-2015).

BACKGROUND: Influenza is a serious vaccine-preventable disease with high incidence, hospitalization, and mortality in high-risk groups. The epidemiology, seasonality, and risk factors for influenza are well defined in most of the temperate countries, but estimating influenza burden in the World Health Organization (WHO) Region for the Eastern Mediterranean is scarce. In Oman, despite the advancements in influenza surveillance, the clinical burden and seasonality of influenza remain not fully understood. OBJECTIVES: To estimate the incidence of influenza-associated hospitalizations and in-hospital death in Oman. PATIENTS AND METHODS: Influenza-associated hospitalizations and in-hospital deaths were estimated using hospital discharge records based on ICD-10 codes (J09-J18), results of virological analysis and population census for the period between 2012 and 2015. RESULTS: During 2012 and 2015, we identified a total of 19 405 influenza-associated hospitalization and 847 deaths. Influenza positivity percentage ranged from 6.4% in 2013 to 20.6% in 2015. Influenza-associated hospitalization incidence rate was 7.3 (95% CI: 6.4-8.1) per 100 000 in 2013 and 27.5 (95% CI: 25.9-29.1) per 100 000 in 2015 with an overall rate of 20.6 (95% CI: 19.9-21.3) per 100 000. The highest incidence of influenza-associated death was among those aged ≥65 years and ranged between 39.5 (95% CI: 27.3-51.8) per 100 000 in 2014 and 11.3 (95% CI: 7.5-15.1) in 2015. CONCLUSIONS: Influenza causes a substantial number of hospitalizations and deaths in Oman. Hospitalization rates were highest among children, and adults ≥65 years showed the highest death rate. The potential value of using seasonal influenza vaccine in these groups should be considered.

Epidemiology of travel-associated infections in Oman 1999-2013: A retrospective analysis.

BACKGROUND: The number of travelers in Oman has increased significantly in the last 2 decades with an increase in the expatriate population workforce leading to the emergence of infections related to travel. This paper aims to highlight the burden of travel-related infections in Oman. METHOD: Our study is a descriptive record-based review and analysis of travel-associated diseases over a 14 year time period from 1999 to 2013. The data was sourced from the communicable disease surveillance system, and central public health laboratory results. RESULTS: From 1999 to 2013 there were a combined total of 7022 cases of cholera, chikungunya, dengue, filariasis, leptospirosis, meningococcal infection, poliomyelitis, measles, schistosomiasis, viral hepatitis (A), typhoid and para-typhoid reported to and subsequently investigated by the Department of Communicable Diseases. Among these cases, 558 (7.9%) were attributed to travel. Fifty percent of these patients were admitted to hospitals. CONCLUSION: Travel-associated infections account for about 8% of notifiable infections in Oman and have low mortality rate. However, some travel-associated infections are considered as a threat to polio eradication and measles elimination programs. Furthermore, some can cause outbreaks that can overwhelm the healthcare system.

The epidemiology and outcomes of infective endocarditis in a tertiary care hospital in Oman.

OBJECTIVES: We undertook this study to describe the epidemiological and clinical features of infective endocarditis (IE) and to study the complications and management of IE in a tertiary care hospital in Oman. METHODS: This is a retrospective study of 58 adult patients (>13 years of age) admitted to the Royal Hospital with IE from June 2006 to June 2011. RESULTS: Of the 58 patients, 40 (69%) were males, and 18 (31%) were females (ratio 2.2). The median age was 43.6 years (range: 14-85). Forty-eight cases (82.7%) had native valves, nine patients (15.6%) had prosthetic valves, and one case (1.7%) had a pacemaker. The most commonly involved valves were mitral (33, 56.9%) and aortic (23, 39.7%). The blood cultures were positive in 47 (81%) patients, and the most commonly isolated organisms were Streptococci spp., which were found in 20 (34.5%) patients, and Staphylococci spp., which were found in 19 (32.8%) patients. The complication rate was 21%. A total of 15 (25.9%) patients underwent surgical intervention, and the in-hospital mortality rate was 27.6%. CONCLUSIONS: Native-valve IE is the predominant type of endocarditis and is more of an acute disease. The prevalence of Staphylococci spp. IE is similar to that of Streptococci spp. IE, and its associated mortality remains high.

A hospital acquired outbreak of Bacillus cereus gastroenteritis, Oman.

OBJECTIVES: To investigate the course of a hospital acquired outbreak of Bacillus cereus gastroenteritis outbreak, and the interventions that were taken to prevent such an outbreak from occurring again. METHODS: On May 3-5 2008, 58 cases of gastroenteritis were reported among patients and their attendants in a referral hospital in Oman. All affected had eaten meals served by the hospital kitchen the previous day. An outbreak investigation team conducted active surveillance and interviewed people about symptoms and food consumed on the preceding day in the hospital. Food samples from the kitchen and faecal samples from the kitchen staff and those affected were cultured. An environmental audit of the kitchen was conducted. RESULTS: The majority of the 58 persons affected by the outbreak were adult females, predominantly attendants of patients. 90% had diarrhoea and 10% had vomiting, usually mild. All those affected were managed symptomatically except for two patient attendants who required intravenous rehydration. The meal exposure histories implicated at least one meal from the kitchen. Many violations of basic food hygiene standards were observed in the kitchen. Toxin producing B. cereus was isolated from faeces of 3/12 (25%) patients and 19/25 (76%) of food handlers, and 35/61 (57%) of food samples from the kitchen. CONCLUSION: This is the first report of a nosocomial outbreak of foodborne B. cereus infection from this region. The importance of appropriate epidemiological and microbiological investigation and public relations management is emphasized, in addition to the need for continuing training of food handlers and rigorous enforcement of food hygiene regulations.