Importance of Tuberculosis Screening of Resident Visa Applicants in Low TB Incidence Settings: Experience from Oman.

INTRODUCTION: For Oman, a country targeting tuberculosis (TB) elimination, TB among expatriates is a major challenge. Thus, screening for active TB using chest X-ray was made mandatory for expatriates' residency renewals. OBJECTIVE: To estimate the incidence of bacteriologically confirmed TB and assess impact of chest X-ray based TB screening among expatriates in Muscat Governorate. METHODS: Applicants for residency and renewals were mandated for chest X-ray-based TB screening in 2018. We collected data of screened subjects with radiological suspicion of TB who were subjected to further bacteriological evaluation. RESULTS: Of 501,290 applicants screened during the study period, 436 (0.09%) had X-ray findings suggestive of TB. Among the 436, TB was confirmed in 53 (12.2%; 95% CI 9.2-15.6), giving an overall prevalence of 10.6 (95% CI 8-13.9) per 100,000 applicants (number needed to be screened 9458). Among renewals, the point prevalence of TB was 10.5 per 100,000 expatriates screened (95% CI 6.9-14.04 per 100,000), with a mean follow-up period of 11.8 years. CONCLUSION: Our findings are consistent with the recommendation for utilization of chest X-ray as a preferred tool for active case finding in the setting of expatriate screening. Our findings are also suggestive of the need for latent TB screening and ruling out TB prior to latent TB treatment.

Tools to implement the World Health Organization End TB Strategy: Addressing common challenges in high and low endemic countries.

AIM: The purpose of this viewpoint is to summarize the advantages and constraints of the tools and strategies available for reducing the annual incidence of tuberculosis (TB) by implementing the World Health Organization (WHO) End TB Strategy and the linked WHO TB Elimination Framework, with special reference to Oman. METHODS: The case-study was built based on the presentations and discussions at an international workshop on TB elimination in low incidence countries organized by the Ministry of Health, Oman, which took place from September 5 to September 7, 2019, and supported by the WHO and European Society of Clinical Microbiology and Infectious Diseases (ESCMID). RESULTS: Existing tools were reviewed, including the screening of migrants for latent TB infection (LTBI) with interferon-gamma release assays, clinical examination for active pulmonary TB (APTB) including chest X-rays, organization of laboratory services, and the existing centres for mandatory health examination of pre-arrival or arriving migrants, including examination for APTB. The need for public-private partnerships to handle the burden of screening arriving migrants for active TB was discussed at length and different models for financing were reviewed. CONCLUSIONS: In a country with a high proportion of migrants from high endemic countries, screening for LTBI is of high priority. Molecular typing and the development of public-private partnerships are needed.

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.

Oman's progress towards reaching "Ultimate Intervention Goals" for the surgery "S" component of SAFE strategy for the elimination of blinding trachoma in 2008.

BACKGROUND: A community based survey for Trachomatous Trichiasis (TT) was conducted in the high (TT >5% in 1997) and meso endemic areas (TT 1% to 5% in 1997) of Oman during 2008-09. METHODS: Investigators examined Omanis 40 age years and older from randomly selected villages. Eyes were examined for TT and vision. The medical history of surgery and advice given for TT surgery were recorded. The TT cases that were unadvised by health staff were defined as un-approached cases. Cluster adjusted prevalence of TT and risk of TT by gender were estimated. RESULT: We examined 4,951 of 5,268 persons in high-endemic areas and 965 of 993 (97.2%) persons in meso-endemic areas. The cluster adjusted prevalence of TT in the high and meso endemic areas were 7.54% (95% Confidence Interval [CI] 6.78-8.30) and 1.69% (95% CI 0.88-2.50) respectively. There were 5 TT patients in high endemic areas and none in meso-endemic areas who were not approached or managed in the past. The prevalence of TT across all ages was less than 1 per 1,000 of the population in all wilayats of Oman. Females had a significantly higher risk of cluster adjusted TT compared to males (Odds Ratio = 1.87 [95% CI 1.85-1.89]). The prevalence of blindness was 0.5% among TT cases in high endemic areas. CONCLUSION: Oman seems to have reached the Ultimate Intervention Goals (UIGs) of the "S" (Surgery) component in 2008 in high and meso-endemic areas. The efforts of existing eye services could be better evaluated if un-approached TT cases are used to calculate the TT prevalence. Oman needs to focus more on females with TT to reach the UIGs.