Trends of HIV indicators in Egypt from 1990 to 2021: time-series analysis and forecast toward UNAIDS 90-90-90 targets.

BACKGROUND: Infection with Human immunodeficiency virus (HIV) and the development of acquired immunodeficiency syndrome (AIDS) pose severe threats to public health across the world. This study aimed to describe and forecast the trend of HIV indicators, including progress towards the 90-90-90 targets in Egypt since 1990. METHODS: The HIV indicators were graphically described, where the X axis is the time in a year and the Y axis is the value of the selected indicator for each year using data retrieved from UNAIDS. We used the Autoregressive Integrated Moving Average (ARIMA) model to forecast different HIV indicators from 2022 to 2024. RESULTS: Since 1990, HIV prevalence has been < 0.01, the number of people living with HIV (PLHIV) has increased from < 500 to 30,000 with a higher male predominance since 2010, and the number of children living with HIV has increased from < 100 to 1100. The number of pregnant women who needed antiretroviral treatment (ART) to prevent maternofetal HIV transmission increased from < 500 during 2010-2014 to 780 in 2021, the percentage of women who received ART increased from 3% in 2010 to 18% in 2021, the number of children exposed to HIV who did not get infection increased from < 100 in 1990-1991 to 4900 in 2021. The number of AIDS-related deaths increased from < 100 in 1990 to < 1000 in 2021. Based on forecasting, we expect that by 2024 the number of PLHIV will be 39,325(95%CI, 33,236-37,334), 22% (95%CI, 13.0%-32.0%) of pregnant females will have access to ART, 6100(95%CI, 5714-6485) HIV exposed children will not be infected, 77.0%(95% CI 66.0%-86.0%) of the population who knew their HIV status, and 71.0% (95%CI, 61.0%-81.0%) among those who know their HIV status will be on ART. CONCLUSION: HIV is moving forward fast, however, the Egyptian health authority implements different control measures to control its spread.

Assessment of safe injection practices in health facilities in Oman.

BACKGROUND: Unsafe injection practices put patients and providers at risk of infectious and noninfectious adverse events. A 2001 Ministry of Health survey on injection practices in Oman indicated that, while overall standards were good, in some areas there was a need for improvement. AIM: We aimed to evaluate injection safety practices to determine whether facilities meet the requirements for practices, equipment, supplies and waste disposal, and to identify unsafe practices. METHODS: We conducted a national cross-sectional survey in 2007 using the World Health Organization tool to evaluate injection safety practices. Using 2-stage cluster sampling, 80 government and 61 private health facilities were randomly selected and evaluated. RESULTS: There was no shortage of injection equipment nor evidence of attempts to sterilize disposable devices. Care providers immediately disposed of the used needle/syringe in sharps containers. Phlebotomy devices were taken from sealed packets in 96% of facilities. In private facilities, 66.3% of the care providers were fully immunized against hepatitis B. Wearing a new pair of gloves for phlebotomy was observed in only 46% of government and 38% of private health facilities. Many health facilities lacked alcohol-based handrub. CONCLUSIONS: Many injection safety aspects were satisfactory. However there are still opportunities for improvement. Actions are required to make alcohol-based handrub and appropriate sharps containers available and to provide hepatitis B vaccine and training to health care workers in all facilities.

Assessment of hepatitis B immunization programme among school students in Qatar.

BACKGROUND: In 2010, Qatar adopted the target of reducing hepatitis B prevalence to < 1% in children by 2015. The World Health Organization Region for the Eastern Mediterranean is identified with intermediate hepatitis B virus (HBV) endemicity, ranging from 2% to 7%. It is estimated that 4.3 million individuals are living with HBV infection in the Region. AIMS: This study was conducted to assess hepatitis B seroprevalence in children, hepatitis B vaccination coverage, potential exposure to risk factors, and knowledge among parents/guardians about hepatitis B infection. METHODS: We carried out this cross-sectional study in Qatar during the academic year 2015/16. Multistage cluster sampling was used to select a nationally representative sample of 2735 grade 1 school students aged ≥ 5 years. Blood was collected by finger prick and tested using the point-of-care test/rapid test. A self-administered, precoded questionnaire was used to assess parent/guardian knowledge about HBV and collect information on the child's HBV vaccination coverage. RESULTS: All blood samples were HBsAg negative. Qataris had a vaccination card and were totally vaccinated but 17.7% of non-Qataris did not hold a vaccination card and most parents/guardians were not aware of the vaccination status of their children. Children were exposed to various hepatitis B risk practices. Knowledge about hepatitis B among parents/ guardians was low. CONCLUSIONS: Qatar has averted the hepatitis B threat and maintained high vaccination coverage for children.

Cost effectiveness of a pentavalent rotavirus vaccine in Oman.

BACKGROUND: Rotavirus gastroenteritis (RGE) is the leading cause of diarrhea in young children in Oman, incurring substantial healthcare and economic burden. We propose to formally assess the potential cost effectiveness of implementing universal vaccination with a pentavalent rotavirus vaccine (RV5) on reducing the health care burden and costs associated with rotavirus gastroenteritis (RGE) in Oman METHODS: A Markov model was used to compare two birth cohorts, including children who were administered the RV5 vaccination versus those who were not, in a hypothetical group of 65,500 children followed for their first 5 years of life in Oman. The efficacy of the vaccine in reducing RGE-related hospitalizations, emergency department (ED) and office visits, and days of parental work loss for children receiving the vaccine was based on the results of the Rotavirus Efficacy and Safety Trial (REST). The outcome of interest was cost per quality-adjusted life year (QALY) gained from health care system and societal perspectives. RESULTS: A universal RV5 vaccination program is projected to reduce, hospitalizations, ED visits, outpatient visits and parental work days lost due to rotavirus infections by 89%, 80%, 67% and 74%, respectively. In the absence of RV5 vaccination, RGE-related societal costs are projected to be 2,023,038 Omani Rial (OMR) (5,259,899 United States dollars [USD]), including 1,338,977 OMR (3,481,340 USD) in direct medical costs. However, with the introduction of RV5, direct medical costs are projected to be 216,646 OMR (563,280 USD). Costs per QALY saved would be 1,140 OMR (2,964 USD) from the health care payer perspective. An RV5 vaccination program would be considered cost saving, from the societal perspective. CONCLUSIONS: Universal RV5 vaccination in Oman is likely to significantly reduce the health care burden and costs associated with rotavirus gastroenteritis and may be cost-effective from the payer perspective and cost saving from the societal perspective.

Support for Mandatory COVID-19 Vaccines for 5- to 11-Year-Old Children: Cross-sectional study of Omani mothers.

Objectives: This study aimed to investigate the variables that influenced a sample of Omani mothers' support for mandatory COVID-19 vaccines for children. The vaccination against COVID-19 averted millions of fatalities during the COVID-19 pandemic. Nevertheless, a considerable number of parents and caregivers opposed mandating COVID-19 vaccines for children. Methods: This cross-sectional study was conducted at several healthcare facilities in Oman using a structured questionnaire between February and March 2022. Univariable and multivariable logistic regression models were used to analyse the data. Results: A total of 700 Omani mothers (response rate = 73.4%) who had children aged 5-11 years old were included. The median age of the mothers was 38 ± 5.19 years. The results of multivariable logistic regression were generally consistent with those of the univariable analysis except for age (odds ratio [OR] = 1.06, 95% confidence interval [CI]: 0.58-1.93; P = 0.86) and income (OR = 1.09, 95% CI: 0.58-2.03; P = 0.79). Mothers who were vaccine hesitant (OR = 9.82, 95% CI: 5.27-18.28; P <0.001), tested positive for COVID-19 (OR = 3.25, 95% CI: 1.80-5.86; P <0.001) and had one or two doses of COVID-19 vaccines (OR = 5.41, 95% CI: 2.92-10.03; P <0.001) were more likely to refuse mandating COVID-19 vaccines for children 5-11 years old. Conclusion: Mothers who were vaccine hesitant, tested positive for COVID-19 and had one or two doses of COVID-19 vaccines were more likely to oppose mandatory COVID-19 vaccines for young children. The findings should aid public health authorities in designing future childhood vaccine literacy programmes with specific attention to some subgroups in Oman to help reduce opposition to vaccines in future pandemics among mothers.

Elimination of Mother-to-Child Transmission of Hepatitis B Virus in Gulf Cooperation Council Countries: Current Status and Future Prospects.

The WHO member states endorsed the goal to eliminate mother-to-child transmission (EMTCT) of hepatitis B virus (HBV) by 2030, which requires achievement of ≥ 90% coverage with timely hepatitis B birth dose (HepB-BD), three doses of the hepatitis B vaccine (HepB3), and a hepatitis B surface antigen (HBsAg) seroprevalence ≤ 0.1% in children. We assessed the progress made to achieve EMTCT of HBV in Gulf Cooperation Council (GCC) countries. Data was extracted from National Viral Hepatitis Strategic Frameworks and WHO hepatitis B vaccination coverage estimates during 2018-2022 for all GCC countries. We also reviewed the literature to summarize the prevalence of HBsAg in children. During 2018-2022, coverage with timely HepB-BD and HepB3 was > 90% in all countries. All newborns irrespective of whether parents are nationals or immigrants/expatriates receive HepB-BD and other routine immunization vaccines. Prevalence of HBsAg among children was available in three of six GCC countries; it ranged from 0% in Qatar and Saudi Arabia to 0.4% in Oman. Five countries reported screening pregnant women for HBsAg, and three provided antiviral treatment of those eligible, and hepatitis B immunoglobulin to exposed newborns. In conclusion, all GCC countries achieved hepatitis B vaccination targets and countries with available data have either achieved or are close to achieving EMTCT of HBV. Remaining countries need to implement hepatitis B serosurveys to track progress to EMTCT of HBV.

Meningococcal disease within the Gulf Cooperation Council Countries.

This review reports on the recent epidemiology of invasive meningococcal disease (IMD) within the Gulf Cooperation Council (GCC) Countries (focusing from 2012 onwards), the existing immunization strategies and the potential for IMD resurgence. MenACWY vaccination is now established in infant or adolescent immunization programs in Saudi Arabia, Bahrain, Kuwait, and the United Arab Emirates. At present, GCC Countries do not include MenB immunization. National health surveillance reports indicate a total of 156 IMD cases reported across the GCC Countries between 2012 and 2021; between 30% and 80% of cases were reported in individuals aged ≥15 years. Lack of serogroup data hinders the assessment of vaccine impact and decision-making on additional vaccine introductions (e.g. MenB immunization). Hajj/Umrah pilgrimage and the increasing number of large-scale commercial and social events held in the GCC Countries pose a potential risk for future IMD outbreaks. Immunization policies for such events could be strengthened.

Integrated Management of Childhood Illness in Oman: 16 Years of Pre-service Initiatives for Education and Training.

Each year, approximately 10 million children worldwide die before reaching the age of five, yet two-thirds of these deaths could be prevented with effective, low-cost interventions. The Integrated Management of Childhood Illness (IMCI) strategy was adopted in 1996 by the World Health Organization and the United Nations Children's Fund to address the holistic well-being of children. The ultimate goals of IMCI are to develop a healthcare system that adheres to best practices and to improve the knowledge, attitudes, and skills of healthcare professionals. This paper describes the IMCI in pre-service education and training and the steps involved in integrating it into the nursing course on child health at Oman College of Health Sciences. The program aims to reduce the morbidity and mortality rate of children under five years of age, as well as the severity of their diseases. The Oman College of Health Sciences was the first healthcare academic institution in Oman to implement IMCI in nursing education to strengthen the nursing students' knowledge, skills, and clinical practice.

Spontaneous remission of angioimmunoblastic T-cell lymphoma in a child with ataxia-telangiectasia: a case report.

BACKGROUND: Angioimmunoblastic T-cell lymphoma is an uncommon subtype of peripheral T-cell lymphoma in children with fewer than 20 cases reported in literature. CASE PRESENTATION: A 3-year-old Omani boy was diagnosed with ataxia-talengectasia presenting with fever and generalized lymphadenopathy. His biopsy revealed atypical lymphocytic infiltrate consistent with the diagnosis of angioimmunoblastic T-cell lymphoma. Within 3 weeks from the initial presentation and without any neoadjuvant therapy, he showed complete recovery of symptoms with absence of fever and regression of all previously affected lymph nodes. He has remained in remission ever since. CONCLUSION: This is the first report of spontaneous improvement of angioimmunoblastic T-cell lymphoma in a patient with ataxia-telangiectasia who was 3 years old at presentation. Owing to the paucity of similar cases, this report adds valuable diagnostic, therapeutic, and monitoring data.

The Progress Towards National Malaria Elimination: The Experience of Oman.

Objectives: Despite a significant reduction in the global case incidence and mortality of malaria in the past 20 years, malaria continues to wreak havoc on people's health across the globe. Oman is a malaria-free country, meeting the World Health Organization's (WHO) criteria, having no indigenous malaria case documented since 2010, and maintaining that status for three consecutive years. Oman has a national strategy for prevention of re-establishment of malaria and to maintain their malaria-free status. In this paper, we explore Oman's malaria elimination progress and provide recommendations for accelerating and sustaining malaria free status using WHO malaria elimination strategies. Methods: Secondary data from the years 1976 to 2020 was extracted from official sources utilized to assess progress. A review and epidemiological analysis of malaria cases, species classification, and source of infection was conducted. The data and situation were compared to WHO malaria elimination pillars. Results: The number of malaria cases reported from 1976 to 2020 was 298 070, a decline from 1.6 to 0.1 per 1000 population. Of the 4415 cases reported between 1994-2004, 98.0% were classified as imported and 73.0% of people diagnosed with malaria were 20-34 years old. The number of autochthonous cases began to decline in 1994 from a high of 4415 cases (3.6 per 1000 population) to zero by 2004 with no deaths attributed to autochthonous malaria cases after the year 2000. By 2020, Plasmodium falciparum accounted for 86.0% of cases, P. vivax cases declined to 9.0% and P. malaria and P. ovale comprised the remaining 6.0% of case notifications. Conclusions: Oman achieved malaria elimination status in 2013. To maintain this status, it is essential to adopt a national prevention strategy of re-establishment of malaria and maintain malaria-free status targets.

Epidemiology of Varicella Zoster Virus and Herpes Zoster Virus in Gulf Cooperation Council Countries: A Review of the Literature.

INTRODUCTION: The reactivation of varicella zoster virus (VZV) in previously infected individuals can cause herpes zoster (HZ), which is characterized by a localized, painful dermatomal rash. While there is a global trend of increasing HZ cases, there is a lack of research examining the epidemiology of HZ within the Gulf Cooperation Council (GCC) countries. Therefore, we aimed to critically appraise evidence on VZV and HZ epidemiology in the GCC countries and identify gaps in the current literature. METHODS: A literature review was conducted via a comprehensive appraisal of the literature. PubMed and local-language journals were searched to identify articles related to HZ and VZV published up until 31 January 2022, with a sole focus on the GCC countries. Included studies reported on surveillance data, seroepidemiology, and patient outcomes for HZ and VZV, and comprised primary data reports, case series, case reports, narrative and systematic literature reviews, studies reporting HZ incidence or prevalence, and Ministry of Health reports. RESULTS: Thirteen studies were found that reported on VZV seroprevalence in Saudi Arabia, the United Arab Emirates (UAE), and Qatar, ranging from 15.0% to 92.2%, while no data were identified for Bahrain, Kuwait, or Oman. There was very limited country-wide information on the incidence of HZ in GCC countries, and three identified studies reported HZ prevalence as seen in a single clinic, ranging from 0.62% to 2.3%. A single study from Saudi Arabia and government surveillance data reported on the impact of VZV vaccination on VZV infection, though there was no evidence on the impact of VZV vaccination on HZ. CONCLUSION: There is a clear gap in the literature regarding the incidence of HZ infection, and the impacts of HZ and VZV vaccinations in the GCC countries. Further research into the epidemiology of HZ is necessary to inform the implementation of vaccination programs in the GCC countries.

COVID-19 Among Omani Pilgrim Returnees From the Ashura Mass Gathering.

Background The annual Ashura pilgrimage is a mass Islamic gathering during which millions of worshippers converge in the city of Karbala in Iraq. We report on the incidence of the coronavirus disease 2019 (COVID-19) in Omani pilgrims returning from Karbala in the month of Muharram (August) 2021 during the COVID-19 pandemic. Methodology This is a retrospective study using an electronic, self-completed, and Arab-language survey, composed of 17 questions, that was distributed to all pilgrims returning from Karbala. Participation was voluntary, and consent with confidentiality was obtained. Data on the demographics including sex, COVID-19 vaccination record, type of vaccine, duration of stay, compliance with wearing a face mask, using hand sanitization, and polymerase chain reaction (PCR) results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus before the departure from Oman, upon the return to Oman, and on the eighth post-quarantine day were collected. The responses were collected from the period between August 28, 2021, and September 25, 2022. Statistical association and analysis were performed using the Statistical Package for Social Sciences (SPSS) software (IBM SPSS Statistics, Armonk, NY). Results Out of 250 pilgrims, 139 responded to the survey. Fifty-two participants (37.4%) were males, and 87 (63.6%) were females. None of the pilgrims had positive SARS-CoV-2 PCR results before their departure from Oman. Only four pilgrims (2.9%) were detected positive on PCR by the end of a compulsory quarantine on the eighth day after arrival to Oman. No hospital admissions were recorded. The vast majority of the pilgrims were vaccinated with two doses of COVID-19 vaccination, while some few pilgrims were not vaccinated at all. Most of the pilgrims were also compliant with mask wearing, and just over half the pilgrims were compliant with hand sanitization. No significant statistical association was found between contracting SARS-CoV-2 virus infection and taking SARS-CoV-2 vaccination, the number of vaccination doses, having had COVID-19 before, wearing a mask, or compliance with hand sanitization. Conclusion The incidence of COVID-19 cases among pilgrims returning from Iraq during the COVID-19 pandemic was low. No significant difference was noted between pilgrims vaccinated and compliant with the protective measures and those who were not vaccinated or compliant. Herd immunity could be a possible explanation for the low incidence of COVID-19 infection. Larger studies are needed to investigate the incidence of COVID-19 in Ashura pilgrims.

Reply to Hamzavi et al. Comment on "Islam et al. Helminth Parasites among Rodents in the Middle East Countries: A Systematic Review and Meta-Analysis. Animals 2020, 10, 2342".

Rodents serve as an important reservoir or carrier of zoonotic pathogens on a global scale [...].

External validation of the parental attitude about childhood vaccination scale.

Introduction: Internal validation techniques alone do not guarantee the value of a model. This study aims to investigate the external validity of the Parental Attitude toward Childhood Vaccination (PACV) scale for assessing parents' attitude toward seasonal influenza vaccination. Methods: Using a snowball sampling approach, an anonymous online questionnaire was distributed in two languages (English and Arabic) across seven countries. To assess the internal validity of the model, the machine learning technique of "resampling methods" was used to repeatedly select various samples collected from Egypt and refit the model for each sample. The binary logistic regression model was used to identify the main determinants of parental intention to vaccinate their children against seasonal influenza. We adopted the original model developed and used its predictors to determine parents' intention to vaccinate their children in Libya, Lebanon, Syria, Iraq, Palestine, and Sudan. The area under the curve (AUC) indicated the model's ability to distinguish events from non-events. We visually compared the observed and predicted probabilities of parents' intention to vaccinate their children using a calibration plot. Results: A total of 430 parents were recruited from Egypt to internally validate the model, and responses from 2095 parents in the other six countries were used to externally validate the model. Multivariate regression analysis showed that the PACV score, child age (adolescence), and Coronavirus disease 2019 (COVID-19) vaccination in children were significantly associated with the intention to receive the vaccination. The AUC of the developed model was 0.845. Most of the predicted points were close to the diagonal line, demonstrating better calibration (the prediction error was 16.82%). The sensitivity and specificity of the externally validated model were 89.64 and 37.89%, respectively (AUC = 0.769). Conclusion: The PACV showed similar calibration and discrimination across the six countries. It is transportable and can be used to assess attitudes towards influenza vaccination among parents in different countries using either the Arabic or English version of the scale.

Mothers' Intention to Vaccinate Their Children Aged 5-11 Against COVID-19: A Cross-sectional Survey.

Objectives: COVID-19 vaccines lower the risk of infection hospitalization, and death. Despite the safety and effectiveness of COVID-19 vaccines, some caregivers are hesitant to vaccinate their children against COVID-19. In this study, we explored the factors that influence Omani mothers' intentions to vaccinate their 5-11 year-old children. Methods: Of the 954 mothers approached, 700 (73.4%) participated in a cross-sectional face-to-face interviewer-administered questionnaire in Muscat, Oman, between 20 February and 13 March 2022. Data on age, income, level of education, trust in doctors, vaccine hesitancy, and intention to vaccinate their children were collected. Logistic regression was used to assess determinants of mothers' intention to vaccinate their children. Results: Most mothers had 1-2 children (n = 525, 75.0%), had a college degree or higher education (73.0%), and were employed (70.8%). More than half (n = 392, 56.0%) reported that they were likely or very likely to get their children vaccinated. The intention to get children vaccinated was associated with older age (odds ratio (OR) = 1.05, 95% CI: 1.02-1.08; p =0.003), trust in their doctor (OR = 2.12, 95%, CI: 1.71-2.62; p < 0.001), and low vaccine hesitancy (OR = 25.91, 95% CI: 16.92-39.64; p < 0.001). Conclusions: Understanding the factors that influence caregivers' intentions to vaccinate their children against COVID-19 is important for the development of evidence-based vaccine campaigns. To increase and sustain high vaccination rates for COVID-19 vaccination in children, it is critical to address the factors that cause caregiver hesitation about vaccines.

Determinants of parental seasonal influenza vaccine hesitancy in the Eastern Mediterranean region: A cross-sectional study.

Background: Seasonal influenza vaccine can reduce the risk of influenza-associated hospitalizations and deaths among children. Given that parents are the primary decision makers, this study examined the parental attitude toward childhood influenza vaccine and identified determinants of vaccine hesitancy (VH) in the Eastern Mediterranean region (EMR). Methods: A cross-sectional study was conducted using an anonymous online survey in 14 EMR countries. Parents of children aged 6 months to 18 years were included. The Parent Attitude about Childhood Vaccines (PACV) was used to assess VH. Chi square test and independent t-test were used to test for association of qualitative and quantitative variables, respectively. A structural equations model (SEM) was used to identify direct and indirect determinants of parental VH. Results: Almost half of the parents were hesitant about vaccinating their children against influenza (50.8%). Parental VH was significantly higher among older mothers (37.06 ± 8.8 years, p = 0.006), rural residents (53.6%, p < 0.001), high-income countries residents (50.6%, p < 0.001), and mothers with higher educational levels (52.1%, p < 0.001). Parents of school-aged children (5-9 years) (55.6%, p < 0.001), children free from any comorbidities (52.5%, p < 0.001), children who did not receive routine vaccination at all (51.5%, p = 0.03), children who were not vaccinated against COVID-19 (54.3%, p < 0.001), in addition to parents who were not vaccinated against influenza (57.1%, p < 0.001) were significantly associated with increased likelihood of VH. Parents who were depending on healthcare provider as a source of information regarding vaccines were less likely to report VH (47.9%, p < 0.001), meanwhile those who used social media as their source of health information showed a significantly higher VH (57.2%, p < 0.001). The SEM suggested that mother's age, residence, country income level, child gender, total number of children and source of information regarding vaccines had a direct effect on VH. Meanwhile, parents vaccinated against influenza, children completely or partially vaccinated with routine vaccines and children vaccinated against Coronavirus disease 2019 (COVID-19) had an indirect effect on VH. Conclusion: A high proportion of included parents were hesitant to vaccinate their children against seasonal influenza. This attitude is due to many modifiable and non-modifiable factors that can be targeted to improve vaccination coverage.

Agile Teams and Lean Methods in a Tertiary Care Hospital During COVID-19 Pandemic.

Objectives: To share the experience of Agile Teams using Lean Method to facilitate improvement projects during the COVID-19 pandemic. Methods: A tertiary hospital in Oman mobilized agile teams using lean methods to streamline the workflow during the early stages of COVID-19 pandemic in year 2020. Results: The collaborative network generated by the agile teams increased interdepartmental engagement within the hospital and trimmed workflows, thus improving patient care despite the pandemic. Conclusions: Agile teams using lean methods demonstrably enhance collaboration and efficiency in healthcare, leading to improved patient care.

Alarming Antibiotic Resistance in Pediatric Oncology Patients: A Three-Year Prospective Cohort Study from Oman.

Background: Bloodstream infections (BSI) are severe and challenging oncological complications, with a consequent high morbidity and mortality in the immunocompromised. We reviewed the profile and susceptibility of bacteria associated with infections in children under 13 years of age receiving chemotherapy. Methods: Prospective cohort study of pediatric oncology patients was conducted between January 2015 and October 2017 at the Royal Hospital in Oman. Patient demographics, clinical data, laboratory parameters, microbial etiology and susceptibility, and outcomes were retrieved and analyzed. Results: A total of 74 episodes of positive bacterial blood cultures were detected in 38 oncology patients (positive blood culture rate of 51%). Fifty-seven percent were positive for gram-negative organisms with Klebsiella (21%) being the most common gram-negative organism cultured, and the most common gram-positive organism was Staphylococcus (coagulase negative Staphylococcus (CONs) and S. Aureus) (30%). The majority of patients had gastrointestinal complaints (74%), and almost half (51%) had prolonged periods of neutropenia (>7 days). One third of gram-negative organisms were resistant to four or more antibiotics with a major resistance of 31% to piperacillin-tazobactam. Of the gram-positive organisms, 38% were resistant to at least four antibiotics and 30% were pan-resistant (except for vancomycin). Conclusion: The gram-negative organisms were dominant in BSIs with Klebsiella being the most common culprit. Bacteremia was prevalent, however, high resistance to first-line antibiotics was documented amongst gram-negative isolates, demanding strategies to ensure our patients' safety.

Knowledge, Attitude, and Acceptability of COVID-19 Vaccine in Oman: A Cross-sectional Study.

Objectives: To evaluate the knowledge, attitude, and acceptance of COVID-19 vaccine among the general population of Oman, on the eve of the rollout of vaccination program in the country. Methods: A cross-sectional study was conducted using a structured and validated online questionnaire. Adults residing in Oman were invited to participate in the study between 22 and 24 December 2020. Logistic regression analysis was used to identify the factors associated with COVID-19 vaccine acceptability. Results: Of the total of 966 participants, the majority (612; 63.4%) were women. Most participants were younger than 40 years (572; 59.3%). Participants displayed good awareness about COVID-19 (946; 97.9%) and the global vaccine development initiatives (831; 86.0%). Only 265 (27.4%) participants were willing to get themselves vaccinated. The majority were either uncertain 365 (37.8%) or unwilling 336 (34.8%). The main driver of vaccine acceptance was to protect oneself and others (186/265; 70.0%). The main reasons given for vaccination hesitation/refusal were concerns over possible side-effects (505/701; 72.0%), safety concerns (386/701; 55.0%), and ineffectiveness of the vaccine (107/701; 15.3%). Conclusions: On the eve of the first-ever rollout of COVID-19 vaccine in Oman in December 2020, the surveyed residents of the country expressed significant hesitancy to get themselves vaccinated. Participants' perceptions of risk of contracting COVID-19, their trust in vaccines, government, and their health system were important predictors of vaccine acceptance. These results enabled development of strategies to address such concerns to facilitate vaccine acceptance among the residents of Oman. The results of this study can be used by researchers to conduct comparative research in future, with more emphasis on Omani youth (< 40 years).

A Systematic Review of Influenza Epidemiology and Surveillance in the Eastern Mediterranean and North African Region.

Seasonal influenza represents a huge health burden, resulting in significant mortality and morbidity. Following the 2009 H1N1 pandemic, focus has been directed on the burden of influenza globally. Country and regional disease burden estimates play important roles in helping inform decisions on national influenza intervention programmes. Despite improvements in influenza surveillance following the 2009 pandemic, many opportunities remain unexplored in the Eastern Mediterranean and North African (EMNA) region, which has a high prevalence of patients with chronic disease and thus a population at high risk of influenza complications. We conducted a systematic literature review of Embase, Medline, Scopus and the Cochrane Database of Systematic Reviews from 1 January 1998 to 31 January 2020 covering the EMNA region with the aim to describe the epidemiology of influenza in the region and assess the influenza epidemiological surveillance research landscape. Relevant data on study characteristics, population, clinical/virology characteristics and epidemiology were extracted and summarised descriptively. Of the 112 studies identified for inclusion, 90 were conducted in the Eastern Mediterranean region, 19 in North Africa and three across the EMNA region. Data were reported on 314,058 laboratory-confirmed influenza cases, 96 of which were derived from surveillance systems. Amongst the surveillance studies, the percentage of positive cases reported ranged from 1% to 100%. The predominantly identified influenza strain was strain A; H1N1 was the most prominent circulating subtype. Typing was performed in approximately 75% and subtyping in 50% of studies, respectively. Data on those considered most at risk for influenza complications were collected in 21% of studies, highlighting a regional gap for these data. Our review reveals existing gaps in regional estimates of influenza health and economic burden, hospitalisation rates and duration, and highlights the need for robust and high-quality epidemiology data to help inform public health interventions.