Risk factors for measles outbreak in Ataq and Habban districts, Shabwah governorate, Yemen, February to May 2018

Abstract Background Recent conflict and war in Yemen lead to collapse of the health system, decrease of immunization coverage and spread of many outbreaks. On May 22, 2018, the surveillance officer in Shabwah governorate reported an increased number of suspected measles. On May 24, 2018, a team from Yemen-Field Epidemiology Training Program was sent to investigate. The aims were to describe the outbreak, determine the risk factors for measles infection and recommend control measures. Methodology A descriptive followed by case-control study design (1:2 ratio) were performed. National Measles Surveillance Program case definition and predesigned questionnaire were used to collect data from 73 cases and 146 controls. Attack rate (AR), adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) were calculated. P value < 0.05 was considered as the cut point for significant. Epi info version 7.2 was used. Results A total of 73 suspected cases were found. Almost 53% were from Habban district, 63% were males and 56% were among age group < 5 years. The overall AR was 82/100,000 population. Measles was significantly associated with contact with case (aOR = 27.3, 95% CI:1.3–551.7), malnourished children aged 6–60 months (aOR = 24.9, 95% CI;1.9–329.6) and unvaccinated children (aOR = 17.2, 95% CI:2.9–100.7). The six collected blood samples found to be positive for measles IgM. Conclusions Measles outbreak in Ataq and Habban districts was confirmed. Contact with measles cases, malnutrition and un-vaccination were the potential contributing factors of measles outbreak in Shabwah governorate. An urgent vaccination campaign with health education interventions are highly recommended. Reactivation of the outreach immunization services and strengthening surveillance and response systems are top priority to take place at district and governorate levels.

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Preventing Emergency Vehicle Crashes: Status and Challenges of Human Factors Issues

Human Factors The Journal of the Human Factors and Ergonomics Society ◽

10.1177/0018720818786132 ◽

2018 ◽

Vol 60 (7) ◽

pp. 1048-1072 ◽

Cited By ~ 5

Author(s):

Hongwei Hsiao ◽

Joonho Chang ◽

Peter Simeonov

Keyword(s):

Risk Factors ◽

Human Factors ◽

Red Light ◽

Control Measures ◽

Current Status ◽

Emergency Vehicle ◽

Vehicle Crashes ◽

Contributing Factors ◽

The Road ◽

On The Road

Objective: This study reports current status of knowledge and challenges associated with the emergency vehicle (police car, fire truck, and ambulance) crashes, with respect to the major contributing risk factors. Background: Emergency vehicle crashes are a serious nationwide problem, causing injury and death to emergency responders and citizens. Understanding the underlying causes of these crashes is critical for establishing effective strategies for reducing the occurrence of similar incidents. Method: We reviewed the broader literature associated with the contributing factors for emergency vehicle crashes: peer-reviewed journal papers; and reports, policies, and manuals published by government agencies, universities, and research institutes. Results: Major risk factors for emergency vehicle crashes identified in this study were organized into four categories: driver, task, vehicle, and environmental factors. Also, current countermeasures and interventions to mitigate the hazards of emergency vehicle crashes were discussed, and new ideas for future studies were suggested. Conclusion: Risk factors, control measures, and knowledge gaps relevant to emergency vehicle crashes were presented. Six research concepts are offered for the human factors community to address. Among the topics are emergency vehicle driver risky behavior carryover between emergency response and return from a call, distraction in emergency vehicle driving, in-vehicle driver assistance technologies, vehicle red light running, and pedestrian crash control. Application: This information is helpful for emergency vehicle drivers, safety practitioners, public safety agencies, and research communities to mitigate crash risks. It also offers ideas for researchers to advance technologies and strategies to further emergency vehicle safety on the road.

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Recurrence of measles in central Italy: the experience of a hospital in Rome

Microbiologia Medica ◽

10.4081/mm.2019.7999 ◽

2019 ◽

Vol 34 (1) ◽

Author(s):

Andrea Petrucca ◽

Antonella Alari ◽

Styliani Papadopoulou ◽

Crisitina Petrucci ◽

Iolanda Santino

Keyword(s):

Healthcare Workers ◽

Adult Population ◽

Vaccination Campaign ◽

Central Italy ◽

Immunization Coverage ◽

Public Health Issue ◽

High Morbidity ◽

Major Public Health Issue ◽

Measles Outbreak ◽

Catch Up

Measles continue to be a major public health issue worldwide with high morbidity and mortality rates. The disease is still endemic in Europe and during 2017 a vast outbreak was described in Italy, Romania and Hungary, which led to thousands of new cases and several deaths. In Italy, 3931 confirmed cases of measles were reported to the Italian national surveillance system from many Italian administrative regions; Lazio, in central Italy, exhibited the highest number of infected patients 1322 (33.63%) and as well as the highest incidence. In this study, we describe the results of a retrospective analysis, carried out during 2016 and 2017, concerning the measles antibody prevalence in patients and healthcare workers attending the Sant’Andrea Hospital of Rome (Lazio). A total of 94 patients (median 30 years of age) were screened in 2016, and 316 (median 40 years of age) during 2017, with an increase of 236% compared to previous year. During 2017, 41 confirmed cases of measles were reported while none in 2016 (P<0.007), and we found a suboptimal immunization coverage in our cohort of patients. Furthermore, measles surveillance of Sant’Andrea healthcare workers during the study period involved 208 personnel units (median >47 years of age) and only one confirmed measles infection was recorded in 2017. These results suggest that there is still an unvaccinated portion of the adult population, who sustain the endemic circulation of measles in Italy. In addition to reach herd immunization on children of 2 years old, catch-up vaccination campaign targeting adult population in Italy and other European countries needs to be implemented to prevent future measles outbreak.

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A ASSESSMENT OF RISK FACTORS AND DETERMINATION OF VACCINE EFFICACY FOR MEASLES OUTBREAK DURING APRIL 2017 IN DHOK KAZIN, ISLAMABAD

Pakistan Journal of Public Health ◽

10.32413/pjph.v8i4.124 ◽

2019 ◽

Vol 8 (4) ◽

pp. 190-196

Author(s):

Muhammad Wasif Malik ◽

Mumtaz Ali Khan ◽

Muhammad Salman ◽

Muazam Abbas Ranjha ◽

Tayyab Razi Rathore ◽

...

Keyword(s):

Risk Factors ◽

Vaccine Efficacy ◽

Attack Rate ◽

Vaccine Coverage ◽

Disease Outbreak ◽

Control Measures ◽

Age Group ◽

Health Administration ◽

Female Ratio ◽

Measles Outbreak

Background: On 13th April 2017, 3 measles cases were reported in Dhok Kazin, Islamabad to National Institute of Health, Islamabad. Federal Disease Surveillance & Response Unit on request of Islamabad Capital Territory (ICT) health administration started disease outbreak investigation and active case finding. The study was aimed to identify risk factors associated with disease outbreak, to assess vaccine coverage and vaccine efficacy in the outbreak area, and to suggest control measures. Methods: To determine possible risk factors age and sex matched case-control study was conducted in April, 2017. A case was defined as "Any resident of Dhok Kazin, presented with fever and maculopapular rash with any of signs/symptoms like coryza, conjunctivitis, cough, otitis media or pneumonia after March 20 to April 30, 2017". For each case 04 matched controls were selected. A structured questionnaire prepared to collect data. Vaccine coverage survey was conducted. Uni and multivariate analyses and vaccine efficacy were calculated. Results: A total of 14 cases identified including 11 cases found on active search. Cases were compared with 57 matched controls. Mean age was 39 months (range 08- 132 months). Among cases male to female ratio observed was 1:2.5. Overall attack rate was 1.2%, while most severely affected age-group was <12 months (AR=10.3%). The most common complications were diarrhea n=8 (57.1%) and pneumonia n=1 (7.1%). On vaccine coverage survey in 230 households, 31(70.5%) out of 44 children checked were vaccinated. The un-vaccinated children had attack rate of 14.3% while vaccinated had attack rate of 6.7%. The vaccine efficacy calculated was 53%. Significant association found in risk factors were; contact with positive case [OR 19.5, 95% CI; 4.5-84, P=0.00], unvaccinated children [OR=10.0, 95%, CI;1.2.0-49.3, P= 0.003], Mother illiteracy [OR 10.2, 95% CI; 2.5-41, P=0.00], Misconception about vaccination [OR 13.2, 95%, CI;3.1-57.1, P=0.00), vaccinator not visited home as a part of outreach activity [OR=6.4, 95%CI;1.7-23.4, P=0.00]. Reasons for non-vaccination were found to be misconception about vaccination (OR=34.8, 95%CI=5.5-219.7) and mother's illiteracy (OR=6.4, 95%CI=1.2-34.8). Conclusion: Most severely affected age group was 12 months and below. Low immunization rates were the most probable cause of outbreak. Case contacts, partial vaccination, misconception of vaccination, no visit of vaccinator to home, and mother's education were risk factors significantly associated with Measles outbreak. Findings were shared with the district health authorities for implementation of control measures.

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Global importation and population risk factors for measles in New Zealand: a case study for highly immunized populations

Epidemiology and Infection ◽

10.1017/s0950268817000723 ◽

2017 ◽

Vol 145 (9) ◽

pp. 1875-1885 ◽

Cited By ~ 3

Author(s):

D. T. S. HAYMAN ◽

J. C. MARSHALL ◽

N. P. FRENCH ◽

T. E. CARPENTER ◽

M. G. ROBERTS ◽

...

Keyword(s):

Risk Factors ◽

New Zealand ◽

Age Groups ◽

Immunization Coverage ◽

Control Measures ◽

Rubella Vaccine ◽

Population Immunity ◽

Measles Outbreaks ◽

Importation Risk

SUMMARYAs endemic measles is eliminated through immunization, countries must determine the risk factors for the importation of measles into highly immunized populations to target control measures. Despite eliminating endemic measles, New Zealand suffers from outbreaks after introductions from abroad, enabling us to use it as a model for measles introduction risk. We used a generalized linear model to analyze risk factors for 1137 measles cases from 2007 to June 2014, provide estimates of national immunity levels, and model measles importation risk. People of European ethnicity made up the majority of measles cases. Age is a positive risk factor, particularly 0–2-year-olds and 5–17-year-old Europeans, along with increased wealth. Pacific islanders were also at greater risk, but due to 0–2-year-old cases. Despite recent high measles, mumps, and rubella vaccine immunization coverage, overall population immunity against measles remains ~90% and is lower in people born between 1982 and 2005. Greatest measles importation risk is during December, and countries predicted to be sources have historical connections and highest travel rates (Australia and UK), followed by Asian countries with high travel rates and higher measles incidences. Our results suggest measles importation due to travel is seeding measles outbreaks, and immunization levels are insufficient to continue to prevent outbreaks because of heterogeneous immunity in the population, leaving particular age groups at risk.

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Collision Risk Circumstances and Traffic Routeing in the Approaches to the Strait of Juan de Fuca

Journal of Navigation ◽

10.1017/s0373463300010961 ◽

1992 ◽

Vol 45 (3) ◽

pp. 400-413

Author(s):

Brad Judson

Keyword(s):

Risk Factors ◽

Traffic Management ◽

Risk Control ◽

Control Measures ◽

Collision Risk ◽

Contributing Factors ◽

Marine Traffic ◽

Measurement And Analysis ◽

Juan De Fuca ◽

Test Of Significance

1. Introduction. This paper is concerned with collision risk reduction through the identification, measurement and analysis of contributing factors and the evaluation of risk control measures appropriate to the approaches to the Strait of Juan de Fuca. Risk factors were identified through a traffic survey and collision probabilities were estimated and modified by a simulated modification to traffic routeing. Marine collision risk analyses have tended to describe the circumstances of collisions without comparison to the conditions encountered by marine traffic. In the absence of any test of significance, such an analysis is revealing yet provides an incomplete basis for traffic management decisions. This study examines the importance of contributing factors through such a comparison.

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Nationwide outbreak of Salmonella serotype Kedougou associated with infant formula, Spain, 2008

Eurosurveillance ◽

10.2807/ese.15.22.19582-en ◽

2010 ◽

Vol 15 (22) ◽

Author(s):

J Rodríguez-Urrego ◽

S Herrera-León ◽

A Echeita-Sarriondia ◽

P Soler ◽

F Simon ◽

...

Keyword(s):

Risk Factors ◽

Infant Formula ◽

Ad Hoc ◽

Univariate Analysis ◽

Medical Practitioner ◽

Case Definition ◽

Control Measures ◽

Formula Milk ◽

Medical Practitioners ◽

One Year

On 5 August 2008, the National Centre of Microbiology in Madrid, Spain, notified an increase in Salmonella Kedougou isolations compared to 2007, with 21 cases including 19 children under one year of age. Active case finding and a matched case-control study were carried out to confirm this increase, identify source, transmission mode and risk factors in order to implement control measures. Cases were defined as any child under one year of age with S. Kedougou isolated since 1 January 2008, and were matched for age, sex, medical practitioner and diagnosis week with controls who were selected among patients of the cases' medical practitioners. An ad hoc questionnaire was completed for cases and controls and a univariate analysis was conducted to identify risk factors. We found 42 isolates from 11 of the 19 Spanish Regions. Completed questionnaires were available for 39 of 42 patients identified; 31 were children under one year of age and fulfilled the case definition. The median age of the 31 cases was 4.3 months and 13 were male. Main symptoms were diarrhoea (n=31) and fever (n=13). Ten cases required hospitalisation. All 31 cases had consumed infant formula milk of Brand A which was associated with illness in the univariate analysis (exact matched odds ratio: 74.92; 95% confidence interval: 12.89-∞). All patient isolates showed indistinguishable pulsed-field gel electrophoresis and antimicrobial susceptibility patterns. Five milk samples from three cases' households were negative for Salmonella. Our results suggest that Brand A was the transmission vehicle of S. Kedougou in the outbreak that occurred in Spain between January and August 2008. Food safety authorities recalled five batches of Brand A milk on 26 August 2008. No further cases have been detected as of 15 September 2009.

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FACTORS ASSOCIATED WITH A MEASLES OUTBREAK IN DISTRICT SKARDU, GILGIT BALTISTAN, PAKISTAN

Pakistan Journal of Public Health ◽

10.32413/pjph.v9i1.220 ◽

2019 ◽

Vol 9 (1) ◽

pp. 30-33

Author(s):

Zakir Hussain ◽

Abdul Wali Khan

Keyword(s):

Risk Factors ◽

Vaccination Coverage ◽

Maculopapular Rash ◽

Control Measures ◽

Factors Associated ◽

Measles Outbreak ◽

History Of ◽

Measles Vaccination ◽

Associated Risk Factors ◽

Gilgit Baltistan

Background: In Pakistan, annually 20,000 children deaths reported due to measles. This outbreak was investigated with the objectives to identify the associated risk factors and recommend appropriate control measures to prevent future outbreaks. Methods: A case was defined as any child presented with fever, generalized maculopapular rash with one of the following symptoms; cough, coryza or conjunctivitis during March-April 2011 in Skardu district. Two healthy age and sex matched controls were selected for each case from the same neighborhood. Information was collected on demographics, date of onset of illness and possible risk factors. Results: A total of 29 suspected measles cases were identified. The overall attack rate was 19% and the most affected age group was 9-19 months (attack rates 16%). Measles vaccination was lower among children with measles (OR. 4, C.I 1.8-12.5, p<0.05). The proportion of parents who consider measles as dangerous was significantly higher among the parents of cases (OR 3.6, CI 1.4-9.3, P 0.006). Better educated mothers were more likely to get their child vaccinated (OR 4, CI, 2.1-7.9, p<0.05) and history of contact was found associated with the disease (OR 7.2, CI 3.5-12.7, p 0.002). Multivariate analysis yielded significant association of following risk factors; vaccination status (OR 3.8, CI 1.8-12.5, p 0.005) and history of contact (OR 3.2, CI 1.0-10.7, p<0.05) with the disease. Conclusion: Lower vaccination coverage and lack of awareness about measles among parents was the most probable cause of this outbreak. Improvement in routine vaccination coverage and health education on the safety of immunization was recommended.

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Measles outbreak in Dubrovnik-Neretva County, Croatia, May to June 2018

Eurosurveillance ◽

10.2807/1560-7917.es.2020.25.7.1900434 ◽

2020 ◽

Vol 25 (7) ◽

Author(s):

Morana Tomljenovic ◽

Mato Lakic ◽

Tatjana Vilibic-Cavlek ◽

Sanja Kurecic Filipovic ◽

Vesna Visekruna Vucina ◽

...

Keyword(s):

Primary Care Physicians ◽

Case Definition ◽

Control Measures ◽

Rt Pcr ◽

Serum Samples ◽

Extensive Search ◽

Measles Outbreak ◽

History Of ◽

Definition Of ◽

Outbreak Case

In May 2018, measles was introduced in the Dubrovnik region by an adult who recently travelled to Kosovo*. Control measures and an outbreak investigation were implemented: 15 epidemiologically-linked cases met the outbreak case definition of a visitor/resident of Dubrovnik-Neretva County with laboratory-confirmed measles and symptom onset beginning on May 19. New cases were identified through hospitals and primary care physicians. Throat swabs, urine and/or serum samples were collected from outbreak cases. RT-PCR detection of viral RNA and IgM/IgG was used to confirm infection. The median age of cases was 33 years, with one 8 month-old infant. Vaccination status was unknown for 9 cases, three were unvaccinated, one case had history of one dose and two cases reported receiving two doses of measles-containing vaccine. There were 11 hospitalisations and one person developed pneumonia. Control teams undertook an extensive search of contacts and implemented a range of control measures. Despite the outbreak occurring at the beginning of the summer tourism season, it was contained and did not spread to neighbouring regions. With continuing measles transmission in Europe, even small outbreaks create a burden on the health system in countries which have eliminated measles, and illustrate the importance of maintaining high immunisation coverage.

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1513Foodborne Outbreak in the Central Prison, Amanat Al-Asimah, Yemen-October, 2020

International Journal of Epidemiology ◽

10.1093/ije/dyab168.028 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Salwa Al-eryani ◽

Mohammed qeran ◽

labibah Saeed ◽

Yasser Ghaleb

Keyword(s):

Risk Factors ◽

Negative Impact ◽

Poor Country ◽

Case Definition ◽

Foodborne Illness ◽

Control Measures ◽

Logistic Analysis ◽

Important Health ◽

Contaminated Food ◽

Water Tanks

Abstract Background Foodborne diseases continuous to be one of important health problem in Yemen. On October 9, 2020, the surveillance officer in Amanat Al-Asimah reported increased number of diarrhea cases in the prison. On October 10, 2020, team from Y-FETP was sent to determine the magnitude of the outbreak, identify risk factors and recommend control measures. Methods Descriptive and case control study with a ratio of (1: 1) was conducted. Case defined as any person in prison developed of diarrhea or vomiting/nausea or abdominal cramps from 1st-15th October. Control defined as: any person in prison not developed of diarrhea or vomiting or any symptoms. Data was collected by using prepared line list and multivariable logistic analysis used for identifying risk factors. Results A total of fifty-one cases met the case definition. All cases were males with the mean of age (31.3±3.06). Al-Qala’ah ward was the most affected area (AR 5.7/100) and none of the cases died. The implicated food items were: tomato sauce (OR 4.92: CI 2.11-11.49) and potato sauce (OR 5.68: CI 2.29-14.07). Tanks were open and in bad condition and handling of food were poor. Laboratory results of examined food and water samples revealed Shigella flxneri sero type II and coliform growth and Staph. aurous were isolated from nasal of 3 cookers. Conclusions The foodborne outbreak in prison was associated with eating contaminated food in main restaurants. Monitoring of food consumed, rigorous implementation of food handling instructions and health education of handlers, and periodic inspection of water tanks in prisons are recommended. Key messages Highlight the importance of foodborne illness which leads to a negative impact on affected people loss of work, medical costs, long-term disability, and even death.in addition to bad impact on the economy especially in a poor country such as Yemen which has lacked awareness of the foodborne illness and doesn't have any surveillance system and regulation

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Sorting the Wheat from the Chaff: Vaccine-Associated Rash Illness Occurring amidst a Large Measles Outbreak—Minnesota, 2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx180.007 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S736-S737

Author(s):

Karen Martin ◽

Rajal Mody ◽

Malini Desilva ◽

Emily Banerjee ◽

Anna Strain ◽

...

Keyword(s):

Public Health ◽

Vaccination Campaign ◽

Health Resources ◽

Clinical Information ◽

Control Measures ◽

Mmr Vaccine ◽

Public Health Action ◽

Measles Outbreak ◽

Health Action ◽

Council Of State

Abstract Background During April–June 2017, Minnesota experienced the state’s largest measles outbreak in 27 years. A vaccination campaign was implemented. Numerous vaccine-associated rash illnesses (VARI) were detected. VARI is non-contagious, but difficult to distinguish from measles clinically. Often, public health control measures need to be implemented before wild-type measles can be differentiated from VARI by viral genotyping. We compared clinical characteristics of VARI and confirmed measles cases to inform testing practices. Methods We defined measles cases per the Council of State and Territorial Epidemiologists. VARI was defined as a rash occurring in a person within 21 days after receipt of measles, mumps, and rubella (MMR) vaccine, and in whom a measles vaccine strain (genotype A) was detected in naso/oro- pharyngeal swab or urine samples. Minnesota’s immunization information system monitored MMR doses administered. We collected clinical information through routine case investigation. Results Over 42,000 MMR doses above expected were administered during the outbreak. We identified 71 measles cases and 30 VARI. The median age of VARI patients was 1.2 years (range 10 months–48 years) and for measles cases 2.8 years (range 3 months–57 years). VARI diagnosis increased with rising MMR administration (figure); rash onset occurred a median of 11 (range 7–18) days after MMR receipt. Most VARI (97%) occurred following first MMR dose. The presence of fever was similar among VARI and measles cases (97% of VARI vs. 100% of measles cases; P = 0.12), but differences were seen in the proportion with cough (30% vs. 96%; P < 0.001), coryza (47% vs. 85%; P < 0.001), conjunctivitis (23% vs. 68%; P < 0.001), and exposure to infectious measles cases (0% vs. 96%). Conclusions Surges in MMR administration and heightened community awareness during a measles outbreak can result in a large number of VARI, consuming considerable public health resources. When evaluating the need to suspect measles among patients with febrile rash, clinicians should consider time since MMR administration, clinical presentation, and history of measles exposure. Collecting appropriate specimens for timely virus genotyping could inform appropriate public health action. Disclosures All authors: No reported disclosures.

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