Regional contributions and synergies for. Global Health Security. Abstracts Book. 27th Nov - 1st Dec Brussels, Belgium

Transcription

1 Regional contributions and synergies for Global Health Security Abstracts Book 27th Nov - 1st Dec 2017 Brussels, Belgium

2 Design by:

3 Funded by the European Union Regional contributions and synergies for Global Health Security The MediPIET Project ( Further Development and Consolidation of the Mediterranean Programme for Intervention Epidemiology Training ) is funded by the European Union under the Instrument for Peace and Stability (IFS/2013/ ), as part of the CBRN Centres of Excellence Initiative. ECDC (European Centre for Prevention and Disease Control), scientific leader of the MediPIET project, chairs the Scientific Committee of the MediPIET ASC The MediPIET Project is implemented by the Consortium composed by FIIAPP (the International and Ibero-American Foundation for Administration and Public Policies) and ISCIII (Institute of Public Health Carlos III).

4 4 / Regional contributions and synergies for Global Health Security Table of Contents Welcome from the hosting institution 6 Forewords 10 MediPIET Participating Countries and Institutions 18 Keynote Speaker 30 Members of the Scientific Committee 34 Abstract reviewers 44

5 / 5 Parallel Session A Food & Water Borne Diseases 48 Parallel Session B Zoonoses & Vector Borne Dieseases 54 Parallel Session C Vaccine Preventable Diseases 60 Parallel Session D Antimicrobial Resistance 66 Parallel Session G Miscellaneous 84 Poster Session 29.1 Influenza, Acute Respiratory Infections & Tuberculosis 102 Parallel Session E Hepatitis B, C & HIV 70 Plenary Oral Session H Use of surveillance data 90 Poster Session 29.2 Zoonoses & Vector Borne Diseases 106 Parallel Session F Influenza, SARI 76 Parallel Session I Surveillance Systems 96 Poster Session 29.3 Non Communicable Diseases 112 Poster Session 29.4 Hepatitis Virus B & C 118 Poster Session 30.2 Anti Microbial Resistance 136 Poster Session 30.5 Surveillance 152 Poster Session 29.5 Knowledge, Attitudes and Practices 124 Poster Session 30.3 Surveillance of Non-Communicable Diseases 140 Poster Session 30.1 Outbreak Investigation 130 Poster Session 30.4 Human Inmunodeficiency Virus & Sexual Transmitted Infections 146

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7 Welcome from the hosting institution

8 8 / Welcome from the hosting institution Regional contributions and synergies for Global Health Security

9 Welcome from the hosting institution / 9 Eddie Maier Deputy Head of Unit Head of Sector CBRN DG DEVCO - European Commission Dear guests, dear fellows, dear supervisors and coordinators, dear participants, dear friends, It is a great honour to welcome you, on behalf of the European Commission, to the Third Annual Scientific Conference of MediPIET (ASC Medi- PIET), which will be held in Brussels, Belgium, from 28th to 30th of November The theme of this ASC targets Regional contributions and synergies for Global Health Security. The conference is mainly focused on infectious diseases across the Mediterranean, beyond South East Europe regions but also worldwide in regard of getting evidence for the prevention and control of diseases, and for public health policy making. MediPIET ASC 2017 will contribute to the further development of a community of practice bringing together junior and senior experts in the fields of public health and field epidemiology from the Balkans, the Mediterranean and the Black Sea countries. As part of the training objectives of MediPIET Programme, the Annual Scientific Conference aims at providing the opportunity to fellows and other epidemiologists of the region to present the results of their field epidemiology activities such as research projects, outbreak investigations, evaluations of surveillance systems, International assignments and allow the exchange between representatives of the Public Health Institutions and stakeholders involved in the project. Furthermore this year the ASC location, at the centre of the European institutions, will allow interactions with other interested parties. The European Commission s Directorate-General for International Cooperation and Development (DG DEVCO) has funded MediPIET since its very beginning in Four years later, MediPIET has reached a state of maturity to become a truly regional tool for cooperation in the field of intervention epidemiology. Global health security is a shared responsibility that cannot be achieved by a single actor or sector of government. Its success depends upon collaboration not just between governments, but within administrations, particularly among the health, security, environment and agriculture sectors. MediPIET will continue to work to build regional capacity and nations capacity to prevent, detect, and respond to infectious diseases threats whether naturally occurring, deliberate, or accidental capacity that once established would mitigate the devastating effects of Ebola, MERS, other highly pathogenic infectious diseases, and possible bioterrorism events. The European Commission as co-organiser is indebted to the Consortium (FIIAPP- ISCIII) and ECDC- this Conference would not have been possible without their dedication. Our gratitude goes to efforts of all individuals, such as all MediPIET National focal points and local experts, members of Scientific Advisory Board and other key members for their dedicated long-term work. We look forward to welcoming you in Brussels, at the heart of Europe, for an enriching exchange of views and best practices on global health security.

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11 Forewords

12 12 / Forewords Regional contributions and synergies for Global Health Security Foreword by the Chair of the Scientific Committee Professor Karl Ekdahl Chair of the Scientific Committee Head of Public Health Capacity and Communication, ECDC The theme of the Third MediPIET Annual Conference is Regional Contributions and Synergies for Global Health Security. This is a theme that embodies the spirit of MediPIET. In the MediPIET network, 23 countries (including two observer countries and three EU Member States), the European Centre for Disease Prevention and Control (ECDC), the European Commission, and partner organizations are joining forces to build regional capacities in support of a world with a higher level of health security. Health security and capacity building to counter health threats starts at the national level, but by working together we could find the necessary synergies to make the sum become bigger than its individual parts. MediPIET is bringing together fellows and supervisors across the Mediterranean and Black Sea regions, and the outcome is not only better trained field epidemiologists, but also a strong network of professionals knowing each other and the specific situations in the countries across the region. Linking professionals across borders and finding common language, tools and skills for joint efforts and actions to prepare for and respond to public health emergencies is a feat of which the importance cannot be overestimated. It is in this context I am proud to have the Third MediPIET Annual Conference as a very visible proof of all these efforts. During the three-day conference, we will learn from 129 presentations (oral and poster presentations), we will discuss the content and benefit from the conclusions. The MediPIET region is diverse and the experiences of the participants drawn from many different settings and contexts. This multitude of experiences will add to the lessons-learnt from the presentations. But we should never forget why we are doing all this. Unlike for the more predictable non-communicable diseases, we will continue to find new challenges related to emerging and re-emerging infections. The first MediPIET Annual Conference in Skopje, took place in the backdrop of Ebola and MERS-CoV, the second in Marrakech during the Zika pandemic, and this third Conference in the aftermath of one of the largest plague epidemics the world has experienced in recent years. We don t know yet what we will see a year from now, but we can be certain that the challenges will continue. To meet these challenges, the MediPIET network is a vital building block for regional preparedness and capacity building, and the second cohort of MediPIET fellows to be graduated during the conference is a solid proof of its strength. It is therefore both my honour and pleasure to welcome you all to the conference, and I m looking forward to three days of vivid scientific discussions.

13 Forewords / 13 Foreword by the Director of the National Centre of Epidemiology (Spain) Dr. Isabel Noguer Director of the National Centre of Epidemiology Institute of Health Carlos III (ISCIII) My Institution is proud to be participating in such a singular project, gathering the European, Mediterranean and Black Sea countries. Our involvement in Field Epidemiology Training Programmes (FETP) is gaining new views and ways of dealing with regional and world common challenges. MEDIPIET started in 2013 as a singular Field Epidemiology Training Program (FETP) project, since it is the first time we have gathered public health professionals from different regions, in order to deal with biological and other environmental risks. The context of regional security and public health protection have been the common framework for this already 4 years experience initiative. Within these four years, we have coped with communicable diseases and new challenges like Ebola, Zika or MERS-CoV, all of them affecting simultaneously different regions and populations. A strong network of senior professionals has been created and currently working, much guidelines best practices and procedures have been shared and two cohorts of fellows trained. This linkage has been developed easily, since professional common interest and scientific views among epidemiologists were always present. This year we are celebrating the MEDIPIET third Annual Scientific Conference (ASC), where we are glad to confirm attendance from multilateral agencies, European Commission and a strong participation from MEDIPIET countries. We will have opportunities to learn from many and diverse experiences and scientific approaches to deal with diseases and environmental risks. During The ASC the second cohort of MEDIPIET fellows are expected to be graduated. Now we are looking for the near future and the sustainability of country experiences and regional networking in order to strengthen regional security and field epidemiology best practices. Instituto de Salud Carlos III as EU-MEDIPIET counterpart is looking forward to provide its more than 20 years experience in FETP to step forward MEDIPIET experience, since we consider it is time to consolidate regional collaboration and professional networking. We thank our colleagues from ECDC, all the EU-Institutions and multilateral counterparts to believe and provide resources in such as unique experience that need to be consolidated to face unpredictable and future challenges.

14 14 / Forewords Regional contributions and synergies for Global Health Security José Jaime de Domingo Angulo Foreword by the MediPIET Team Leader Dear MediPIET Family, It is a great honour to address some words to the participants at the Third MediPIET Annual Conference. This Abstract book is the compilation of the efforts of the epidemiologists belonging to the MediPIET region and those that are outside of our natural borders. This Conference is the last one of the current implementation period of the project but Medi- PIET Network is working to find a solution for the continuation of the Programme and the Network. Therefore, we should be confident on the future. This book shows the scientific works approved by the MediPIET Scientific Committee and represent a large example of what the community in the field of epidemiology has been doing during The total abstracts submitted for this edition was 180 and 130 have been selected to be presented during the Conference. Only two years ago, MediPIET presented 64 abstract at its Conference in Skopje, last year in Marrakesh the number increased to 96 and this year, MediPIET has recognised the international standard quality to 130 abstracts. In two years MediPIET Annual Scientific Conference has been identified by the scientific community as an important event to present and disseminate their works. This year we can welcome also participants from other countries that do not belong to MediPIET Network: Ethiopia, Ghana, India, Nigeria, Pakistan and Zimbabwe. MediPIET network can be proud of the interest that this Conference has raised among the international scientific community. This Conference is devoted to identify the regional contributions and synergies for Global Health Security. Global health security is a shared responsibility that cannot be achieved by a single actor or sector of government. Its success depends upon collaboration among the health, security, environment, and agriculture sectors, as described in the Global Health Security Agenda. MediPIET Network is one the key actors that are contributing and will contribute for the achievement of Global Health Security aim: having a world safe and secure from global health threats posed by infectious diseases. MediPIET Network should strengthen its links with the sectors mentioned above using the National Team and inviting them to be part of it. The contribution of all actors in each National Team should also share with the CBRN National Teams in the whole MediPIET countries using our well stablished Network. I am sure that MediPIET Network contribution will create complementarities and synergies that other International or Regional Agencies and countries institutions involved in this issue will take into account, use and appreciate. This way of working will accelerate the institutional capacity building of our countries and will tight the links among all these actors for the future. I also would like to make a special mention to the relationship among the MediPIET countries and the European Union countries. This regional approach has always led our activities looking for a permanent exchange of knowledge and experiences that can be incorporated to the countries health system in favour of the population living in Europe and in Mediterranean countries. But still, this year we count with the participation of new countries that will present their research, their way to work and their ideas. This is a new opportunity to increase the possibilities to be right when we face a new challenge. Benefit from this opportunity!

15 Forewords / 15 I would like to take advantage of this tribune to render thanks to all facilitators, fellows and external students involved in MediPIET activities for their active participation, support and commitment and the abstracts reviewers for the time devoted to examine them and provide the authors with valuable comments. MediPIET has contributed to train 22 fellows and more than 500 epidemiologists from 20 Mediterranean, Balkan and Black Sea countries, reinforcing the regional epidemiology workforce. I would like to make a special mention to the fellows of the second cohort that are going to be graduated, congratulate them for their personal and professional success and wish them all the best in the future. We will all together work for the continuation of MediPIET and its cohorts. I really hope you have been able to appreciate the quality of the training received and use this knowledge in your day to day work for the benefit of the population in your countries has been a very demanding year for Medi- PIET. Mutual collaboration, the feeling that this Programme and Network is useful for all of us and the high level of satisfaction stressed by the stakeholders have motivated us to accomplish the activities, duly, and on time. Finally, I would like to thank all MediPIET Team for their commitment and good job during the last four years. I also would like to stress my gratitude to the MediPIET Consortium, ECDC, DG-SANTE, DG-JRC and DG-DEVCO for the support and guidance received during the implementation of the project. I really think that all together have helped the partner countries to make a great step forward to the consolidation of their field epidemiology systems.

16 16 / Forewords Regional contributions and synergies for Global Health Security Foreword by the Chair of the Training Centres Forum Nissaf Bouafif ep Ben Alaya Director, Observatory of New and Emerging Diseases, Ministry of Health of Tunisia The MediPIET Training Centre Forum (TCF) gathers all representatives of MediPIET training sites to provide guidance to the MediPIET Scientific Coordinators on technical and practical issues related to networking, sustainability and evaluation. The TCF is organized in different Working Groups and sets its program and agenda through regular face to face meeting. The TCF provides strategic advice and suggestions for future development of MediPIET, provides technical advices on implementation and evaluates the program outcomes regularly at scientific and technical level. In addition, the Operational Group assists the Training Scientific Coordinators for urgent matter needed at short notice, advices coordinators and supervisors when needed and participates to site visit appraisal. The TCF has also created a strong networking between our countries and other international networks in different domains related to global health security such as WHO, EMPHNET, and ACDC. The MediPIET ASC is not only a meeting to develop scientific exchange between public health institutions and experts but also an opportunity to reinforce networking at regional and international level. As TCF Chairperson, it is my honor to warmly welcome all participants of the conference and all MediPIET National Focal points and all partners to the TCF meeting to continue our partnership and discussion about the sustainability and the planning of next period of the project based on the lesson learned, the needs and priorities identified by countries.

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19 MediPIET Participating Countries and Institutions

20 20 / MediPIET Participating Countries and Institutions Regional contributions and synergies for Global Health Security Ukraine France Bosnia and Herzegovina Serbia Moldova Spain Montenegro Albania Kosovo (1) former Yugoslav Republic of Macedonia Georgia Armenia Greece Turkey Tunisia Lebanon Morocco Algeria Libya Egypt Israel Palestine (2) Jordan Partner countries EU countries Observer countries (1) This designation is without prejudice to positions on status, and is in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence. (2) This designation shall not be construed as recognition of a State of Palestine and is without prejudice to the individual positions of the Member States on this issue.

21 MediPIET Participating Countries and Institutions / 21 Albania The National Institute of Public Health (IPH) in Tirana is a research institution under the auspices of the Albanian Ministry of Health and Social Protection (MoH&SP). The IPH core functions are as follows: (i) IPH supports technically the Albanian MoH&SP with information and advice; (ii) IPH researches and collects data on public health issues; (iii) IPH performs continuous public health education for health professionals; (iv) IPH has the national Center of Laboratories of Expertise and Reference; (v) IPH administers Vertical Prevention Programs, and; (vi) IPH hosts the National Epidemiological Observatory. The Albanian IPH is part of MediPIET since 2013 serving also as a training site. Albania will have trained three fellows through MediPIET program by the end of Algeria Institut National de Santé Publique, Algérie The National Institute of Public health is in charge of: Surveillance activities, including diseases surveillance, laboratory surveillance, environmental factors surveillance and cost-effectiveness studies. Development and implementation of diseases control programmes followed by monitoring / evaluation. Health protection and health promotion Training Research

22 22 / MediPIET Participating Countries and Institutions Regional contributions and synergies for Global Health Security Armenia National center for disease control and prevention of the ministry of health of the republic of armenia. NCDC of the MoH of the Republic of Armenia was established in It is a multilevel organization which has 13 branches, including Reference Laboratory Center, Acoustic Scientific Center, 10 regional and 1 Yerevan territorial branches. NCDC Armenia is the main public health body in the Republic of Armenia, and its functional tasks are maintaining the health of the population, disease prevention and health promotion, through risk assessment, management and communication, organization of preventive and anti-epidemic measures, organization and implementation of laboratory investigations and response measures during outbreaks. NCDC Armenia operates in the field of communicable and non-communicable diseases, poisoning, environmental hygiene, chemical and radiological safety, healthy lifestyle, sustainable development of public health staff, applied scientific researches. The NCDC of Armenia has been approved as MediPIET training site in June 2017 Bosnia Herzegovina The Institut for Public Healthof Federation of Bosnia and Herzegovina and the Public Health Institute of the Republic of Srpska. Public health activities in B&H are performed by two institutes, each of them covering an autonomous entities as suggest by their respective name : the Institut for Public Health of Federation of Bosnia and Herzegovina and the Public Health Institute of the Republic of Srpska. These activities include health promotion and disease prevention, control of communicable and non-communicable diseases, surveillance and health statistics, health and environmental research in public health and continued professional education in order to preserve or improve population s health. The Faculty of Medicine, University of Sarajevo contributes to human resource capacity development by offering three years specialization training in epidemiology to medical doctors. Faculties of medicine organize and gives training courses with lectures and case studies and supervise and facilitates the programmes candidates with staffing and space during entire 3 years of their specialization.

23 MediPIET Participating Countries and Institutions / 23 Egypt Ministry of Health and Population: The Ministry of Health in Egypt was established on January 1936 with the vision of providing healthy and productive life for the population. It has a mission of increasing the quality of life of Egyptians by reducing morbidity, mortality and disabilities. This is done through providing, managing and developing a comprehensive package of health services. The structures of ministry of health in Egypt is concerned with preventive and curative medical services which include but not limited to the services of primary health care; Epidemiology& surveillance department (DES), Communicable diseases control department, Expanded program of immunization program (EPI), Central public health laboratories (CPHL), Endemic & vector borne diseases department, Infection control, Quarantine department, Environmental health department also MOHP include many sectors; Registries, pharmaceutical and new medication licensing, implementation of quality management, family planning and human resources and sustainable development. The ministry is providing training of public health officers through many programs including; Field epidemiology training programs (FETP) and is continuously conducting medical research to improve the type and quality of medical services provided to the population. Former Yugoslav Republic of Macedonia The Institute of Public Health of the Republic of Macedonia (IPH) is a leading professional public health institution of ertiary level in Macedonia. The Institute is a teaching basis of the Faculty of Medicine in Skopje for subjects of public health, its scope of work also includes scientific and research activities. IPH stands at the top of the organizational pyramid of the public health institutions in the country and coordinates the work of 10 regional Centers of Public Health in the field of prevention and control of communicable and non-communicable diseases. Applying the guiding principles of public health approach, ecological model, promotion, prevention, education, investigation, economic evaluation, multidisciplinary aspect and collaboration, IPH implements its public health activities. Some of them are: Public health surveillance, prevention and control of communicable and non-communicable diseases and control of health risks; Development of policies and institutional capacity for planning and management of activities in public health; Health promotion; Centre of Public health referent laboratories; Monitoring, evaluation and analysis of the nutritional status of populations of interest; Strengthening of institutional capacity for regulation and enforcement in public health harmonisation of the existing standards and norms with the EU standards The IPH has been part of MediPIET project since its beginnings in 2013and we believe that IPH made successful contribution to the development of the project. IPH was selected by ECDC and MediPIET team as a Training Centre and is hosting MediPIET fellows and will have trained 4 fellows by the end of 2017.

24 24 / MediPIET Participating Countries and Institutions Regional contributions and synergies for Global Health Security Georgia National Center for Disease Control and Public Health is a state institution, under Ministry of Health, Labor and Social Affairs of Georgia. Major fields of activities: Public Health State Programs: Immunization, safe blood, TB, HIV/AIDS, Screening, Surveillance, Mother and Child health, Occupational Health; Communicable Diseases Surveillance: Vaccine-preventable, Influenza, air-borne, water-borne and food-borne, nosocomial, vector-borne, parasitic, zoonotic, especially dangerous pathogens, viral hepatitis, STI/HIV / TB; Non-communicable Diseases Surveillance: Cardiovascular, Cancer, Diabetes, CRDs, Risk-Factors, Health Promotion, Behavioral Health; Environmental Health; Medical Statistics; Public Health Laboratories and their network coverage. Public Health Emergency response Jordan Ministry of Health The main vision of the MOH is to ensure a healthy community within a leading comprehensive health system ensuring equity, efficiency and high quality at the regional level. The Ministry of Health undertakes all health affairs in the Kingdom and its tasks and duties include: Maintaining public health by offering preventive, treatment and health control services. Organizing and supervising health services offered by the public and private sectors. Providing health insurance for the public within available means. Establishing and controlling the management of health educational and training institutes and centers according to relevant provisions of the legislations enacted The NCDC of Georgia has been approved as MediPIET Training site in June 2017

25 MediPIET Participating Countries and Institutions / 25 Kosovo* The Institute of Public Health is a research Institute, technical advisory body of the Ministry of Health and also is part of Medical Faculty involved in education process and research too. Institute of Public Health of Kosovo* (NIPHK) is organized on departments: Department of Epidemiology, Department of Human Ecology, Department of Microbiology, Department of Social Medicine, and Department of Health Information System. The mission of NIPHK is to: To control and prevent communicable diseases, To develop strategies in terms of control and prevent communicable disease, To investigate health risk factor and current health state, To promote good behavior and healthy life, To increase quality of life. The NIPHK is a MediPIET training site since 2015 and will have trained 2 MediPIET fellows by end of * This designation is without prejudice to positions on status, and is in line with UNSCR 1244 and the ICJ Opinion on the Kosovo Declaration of Independence. Lebanon The Epidemiology Surveillance Program at the Ministry of Public Health (Esumoh), Lebanon. Esumoh was first created in 1995, as one component of the World Bank project for rehabilitation of the health sector in Lebanon after the civil war. The main objective was to support the MOPH public functions in re-activating surveillance of mandatory communicable diseases. Notification of communicable diseases was already stated by the Law on communicable diseases issued in Since 2000, the Esumoh was integrated within the MOPH architecture: additional staff was recruited and peripheral teams were designated. Moreover the functions were expanded including diseases surveillance, outbreak detection and investigation, public workforce capacity building, contribution to WHO/GOARN field missions... In 2014, the Esumoh is declared as MediPIET pilot training site. The supervisors are Dr Nada Ghosn and Dr Ghada Abou Mrad. The MediPIET fellows enrolled in the first 2 cohorts are Mrs Nadine Haddad, Mrs Hala Abou Naja, Ms Majd Saleh and Ms Zeina Farah. The MediPIET national committee includes as experts Dr Rita Feghali (Lebanese University), Dr Ziad Khatib (Balamand University), and Dr Iman Abbas (national CBRN task force). Esumoh will have trained 4 MediPIET fellows by the end of 2017.

26 26 / MediPIET Participating Countries and Institutions Regional contributions and synergies for Global Health Security Libya The National Centre for Disease Control (NCDC) is one of the MOH specialized centres focuses in the control of communicable and non-communicable diseases through the development of national plans and strategies based on scientific evidence. It benefits from a very effective network involving national stakeholders and NGOs and international organisations such as WHO. The centre, through its experts and country wide surveillance system, branches and facilities, conducts and organizes capacity development and training programmes targeting medical and health personnel from various sectors to ensure effective implementation and follow up of the strategy work plan. Moldova The National Center for Public Health (NCPH) is a scientific and applied institution directly subordinated to the Ministry of Health, Labor and Social Protection. The Centre monitors and assesses public health and healthcare systems, and on evidence based approach providing support for public health legal framework development. The NCPH is responsible for most of the public health core functions at the national level, including development and monitoring of implementation of legislative and regulatory framework for public health; ensure management of epidemiological surveillance of communicable diseases and early warning and response system; surveillance of non-communicable diseases with identification of community health problems; preparedness and response to public health emergencies; health promotion and communication; organization and deliver quality control program for laboratories, serving as a reference laboratory; collaborates with relevant international organizations and public health services; serves as a training center for undergraduate and postgraduate continuing professional training; performs public health-related research. The NCPH of the Republic of Moldova is part of MediPIET since 2014, became as a training site in 2015 and will have trained 2 MediPIET fellows by end of 2017.

27 MediPIET Participating Countries and Institutions / 27 Montenegro Institute For Public Health is a highly specialized medical institution at the tertiary level of health care, whose activity is focused on preserving and improving the health of citizens of Montenegro. In carrying out these activities the Institute performs the numerous tasks through epidemiological, microbiological, environmental health and social medicine units. All units are scientific base of School of Medicine, University of Montenegro. The IPH of Montenegro is a MediPIET Training site since 2015 and will have train one MediPIET fellow by end of Morocco The Ministry Of Health is responsible for the development and the implementation of policies related to population s health and is coordinating activities with the different department in charge of promoting the physical, mental and social well-being of the inhabitants. It standardizes and coordinates all activities contributing to the improvement of the health s population, through better distribution of resources in regard of prevention, health care and assistance. The MOH is also in charge of developing and implementing the legal and technical aspects of the national policy in regard of the drugs and pharmaceutical products. The MOH follows the International health Regulation and implements protocol accordingly.

28 28 / MediPIET Participating Countries and Institutions Regional contributions and synergies for Global Health Security Palestine Health System in Palestine. The health system in the State of Palestine consists of five main providers where the Ministry of Health (MOH) is the main health provider followed by United Nation Relief Work Agency (UNRWA), Non governmental organization (NGOs), Military Medical services (MMS) and the privet sector. MOH has the vision of ensuring integrated comprehensive health system that contributes to improved quality health services, sustainable promotion of health status, and addressing the key determinants of health in Palestine. The MOH is the Umbrella of all health providers supervising and controlling the health conditions. In accordance to the public health law in Palestine, communicable diseases are treated free of charge and without health insurance and according to the same law all health providers in Palestine should report to the MOH all the Communicable diseases and mainly to the Preventive Medicine department in the ministry which is considered as the main body in the country dealing with communicable diseases through different activities (vaccination, surveillance, notification, outbreak investigation, strategic planing...etc Serbia Institute of Public Health of Serbia Dr Milan Jovanović Batut was established on the Republic level and represents an expert institution for Public Health, which provides advice, support and guidance for the Serbian government and all departments for public health and conducts independent researches on issues related to public health in Serbia. The activity of the Institute is defined by the Health Care law which under public health considers realization of public interest by creating conditions for the preservation of public health through organized comprehensive social activity aimed at preserving the physical and mental health, and environmental protection, and prevention of risk factors for disease and injuries, which is accomplished by application of health technologies and measures aimed at promoting health, preventing disease and improving quality of life. Regarding that, Institute s main areas of activity are: analysis, planning and organization of health care, information with biostatistics, health promotion, control and disease prevention, hygiene and human ecology and microbiology. The main tasks of the Institute are: The National Public Health Institute plays a complementary role in supporting and providing the decision and policy makers with the needed data for action. The Ministry of Health in collaboration with the National Public Health Institute has been approved as MediPIET Training site in June Health analysis and planning that includes monitoring the health issues, reporting on health and planning health services, analysis of health risks in the community and supporting the improvement of quality of care; Collecting data on health and health care use within the jurisdiction of national statistics, maintenance of databases on the resources of health care system, providing data from population studies and providing health information for the effective coverage of health intended for government agencies and the public; Health promotion in community, health education and health care of vulnerable population groups and groups with special needs; Control and prevention of infectious and noninfectious diseases, and maintaining and improving readiness in emergency cases; Monitoring of environmental risks on the health of the population, controlling the food safety, the safety of water, sanitary inspection and hygiene standards control; Public health microbiology and clinical microbiology The IPH of Serbia is a MediPIET training site since 2015 and will have trained 2 MediPIET fellows by end of 2017.

29 MediPIET Participating Countries and Institutions / 29 Tunisia The Observatory of National New and Emerging Diseases was created in The principal mission is the implementation of an early warning system according to «New and Emerging diseases». Activities: Detect public health events requiring rapid investigation and response Reinforce surveillance and response system of the national surveillance system: including Risk assessment, Identify effective prevention measures, Training in field epidemiology, Research activities, National surveys, among others. Scientific monitoring: Collect and analyze available data on new and emerging diseases to identify potential threats Epidemiological surveillance: Promote the ability of the national epidemiological surveillance system in the areas of early detection, rapid response and investigation Microbiological monitoring: Rapid identification of microbial strains responsible for new and emerging diseases International surveillance: Collect data on the situation of new and emerging diseases worldwide, including those with epidemic potential Climate monitoring: Integrating monitoring of climatic factors with health effects GIS: Implement geographic information systems integrating environmental and climate data Sociological monitoring: Collect data and conduct studies on the habits, the emerging social determinants of behavior Entomological monitoring: Collect data on emerging vectors and develop a risk mapping Training in the field of Epidemiology, risk assessment and management Contribute to the dissemination of valid and relevant information in the field of new and emerging diseases Develop a proactive partnership with the media and communication specialists The ONNED is a MediPIET training site since 2014 and will have trained 4 MediPIET fellows by end of Ukraine Public Health Centre of Ministry of Health of Ukraine (PHC- MOH-UA) The PHC-MOH of Ukraine is the new State Institution created by merging multiple institutions in order to improve and optimise all activities related to Public Health in Ukraine. It became officially operational in November 2016 but structurally, its organisation is still ongoing. The Public Health Centre s mission is to ensure quality of life and health in Ukraine through: Disease prevention and health promotion of Ukrainians. Countering potential health threats. Effective response to public health emergencies. Introduction of information and communication policy. Key objectives of the PHC mission: Ensure the efficiency of functioning of the multisectoral public health system. Reduce the burden of morbidity, that will optimize the health care expenses. Create a national source of public health independent expert analysis. Become an equal partner of the European network of relevant institutions. To form the prestige of Public Health area.

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31 Keynote Speaker

32 32 / Keynote Speaker Regional contributions and synergies for Global Health Security

33 Keynote Speaker / 33 Oliver Morgan PhD MSc FFPH Dr. Oliver Morgan is the Director of the Health Emergency Information and Risk Assessment Department in the WHO Health Emergencies Programme. From 2007 through 2016, Dr. Morgan worked for the US Centers for Disease Control and Prevention during which time he held critical leadership positions in the Ebola response between November 2014 and February 2016 (CDC Atlanta Ebola Response Incident Manger and CDC Country Director in Sierra Leone). From March 2010 to October 2014, Dr. Morgan was the CDC Country Director in the Dominican Republic. Dr. Morgan was an Epidemic Intelligence Service Officer at CDC from 2007 to 2009 with the International Emerging Infections Program, during which time he conducted projects in Thailand, Bangladesh, Kenya, Uganda, and Guatemala. Before joining CDC, Dr. Morgan worked for the UK Health Protection Agency, leading epidemiological investigations of outbreaks (enteric, vaccine preventable, hospital acquired, zoonotic, respiratory, and sexually acquired infections), chemical and radiation exposure incidents, terrorist bombings in London, natural disasters, and humanitarian civil conflicts. Dr. Morgan has also worked as a consultant to WHO/PAHO in several countries. Dr. Morgan s academic achievements include a doctorate in epidemiology from Imperial College London and extensive publication in peer reviewed journals and reference books.

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35 Members of the Scientific Committee

36 36 / Members of the Scientific Committee Regional contributions and synergies for Global Health Security Chair of the Scientific Committee Karl Ekdahl Professor Karl Ekdahl is head of the Public Health Capacity and Communication Unit at the European Centre for Disease Prevention and Control (ECDC), where he is responsible for the Centre s activities related to capacity building, preparedness, training and communication. He has worked for more than 20 years with communicable disease prevention at regional, national and international levels. In ECDC, he was the first expert in place at the start-up of the agency in 2005 and he has since then held various senior positions including acting Director. He is a specialist in infectious diseases, and prior to joining ECDC he was Deputy State Epidemiologist for Sweden. In 2007, he was appointed Adjunct Professor in Infectious Disease Epidemiology at the Karolinska Institutet in Stockholm. He is also the former Editor-in-Chief of the scientific journal Eurosurveillance. Professor Ekdahl was responsible for the initiation phase of MediPIET, and is now Chair of the MediPIET Scientific Advisory Board and the Scientific Committee for the Annual Scientific Conference. Members of the Scientific Committee Delphine Antoine Delphine Antoine (MSc, PhD) is coordinator of scientific training at the French national public health Agency since December She has worked on public health infectious disease epidemiology (mainly on tuberculosis) from 1998 to 2015 at national level, in France and in the United Kingdom at the Health Protection Agency, and at the EuroTB programme of tuberculosis surveillance in the WHO Europe Region. Previously she was in charge of national surveys and studies on psychiatry and drugs misuse at the French ministry of health. Her main topic of expertise are infectious disease epidemiology, tuberculosis and migrant health and public health training. Member of the MediPIET Scientific Advisory Board since end of Marie Roseline Darnycka Bélizaire She received her medical degree from the Latin American School of Medicine in Cuba where she also obtained the specialization in Family and Community Medicine. She has been trained in public health, Field Epidemiology and Applied ologies for Epidemiological Investigation in Spain and in clinical trial at David Rockefeller Center for Latin American Studies at Harvard University. She has been working in epidemiology, public health and European projects at the Spanish Institute of health Carlos III in Marie Roseline Darnycka has teaching experience in epidemiology and public health at the Autonomous University of Madrid in the master degree of Tropical Medicine, in Africa with WHO, at the Spanish School of Public Health and in training programmes such as MediPIET for which she is coordinating scientific activities for Montenegro. She has extensive and noteworthy experience in evaluation and monitoring of development projects in Africa, Latin America and in the Middle East. She also worked in non-communicable diseases as the scientific manager of the prominent European project addressing chronic disease and healthy ageing across the life cycle to reach a common strategy among European and accessing countries to minimize impacts of chronic diseases in Europe. During the recent years main focus of her work is on preparedness and response for public health emergencies in the African region as WHO Health Security and Emergency officer in Country Office Mauritania. Marie Roseline Darnycka is a MediPIET Scientific Coordinator.

37 Members of the Scientific Committee / 37 Nissaf Bouafif Nissaf Bouafif ép Ben Alaya, MD, MSc. I received my medical degree from the faculty of Medicine of Tunis. I did my specialization in preventive medicine, public health, epidemiology and biostatistics at the faculty of Medicine of Tunis. I did a first Master Degree in Public Health at the University of Paris VI, Faculty of Medicine Pierre et Marie Curie, France and a second Master Degree in Epidemiology, Biostatistics and modeling at the University of Victor Segalen, Bordeaux, France. I start my professional activity at the Pasteur Institute of Tunis as Specialist in preventive medicine working on the surveillance of leishmaniasis in Tunisia, then at University of Claude Bernard, Lyon 1, France as Assistant Professor of epidemiology working on Nosocomial infection surveillance. Back to Tunisia I was graduated to Assistant Professor at the faculty of Medicine of Tunis and Pasteur Institute of Tunis working on different research activities related to infectious diseases especially hepatitis and leishmaniasis. Since 2010 I was graduated as associated professor of preventive medicine and Epidemiology at the faculty of Medicine of Tunis and recruited as Deputy Director at the Observatory of New and Emerging Diseases. I was graduated as Director of Health surveillance since 2013 and as General Director of the Observatory of New and Emerging Diseases since July I am the Head of Preventive medicine and Epidemiology Department at the faculty of Medicine of Tunis since July 2014 and the coordinator of the Master of Epidemiology and Biostatistics at the University of Tunis Manar. I also coordinate training on Field Epidemiology since 2011 at national and regional level. José Jaime de Domingo Angulo Advance Agriculture Engineer (M Sc. Level), Master in Direction and Management of Social Security Systems, my main professional experience is framed in the area of International Institutional Relations. This know-how and skills have been developed in my capacity as International civil servant (EC desk Officer), as executive of NGOs, in my position as Director of private companies and as Team Leader of EUROsociAL Health and MediPIET Projects (both financed by EC). I have devoted the majority of my career to work in Humanitarian Aid and International Cooperation fields, in favour of people living in Africa, Middle East, Balkans and Latin America with focus on strengthening the institutional capacity of countries. Sahar Mahmoud Samy Sahar Mahmoud Samy, epidemiologist with master degree in public health. My currier start as a pediatrician after getting a master degree in pediatrics and fellow ship of Family Medicine where I worked as Family Physician in primary health care unit. I moved to work at the communicable disease department- preventive sector Ministry of Health- Egypt as the Executive director of Hepatitis unit where we coordinate with WHO, CDC, NAMRU Pasteur Institute and other stakeholders to develop the National Plan for Prevention and Control of Viral hepatitis. Being FETP Coordinator (Field Epidemiology Training Program), I moved to the surveillance unit at MOH participating in all its activities besides training our residents upon surveillance, outbreak investigation, epidemiology, scientific writing. Ibrahim Iblan PHD. Dr MEDICAL COLLEGE ADEN, YEMEN (1985). He did the Diploma of Community Medicine, Jordan 2007 and graduate of the Jordan Field Epidemiology Training Programme (JFETP) in Dr. Iblan is the Director of the Field Epidemiology Training Programme of Jordan (FETP) since 2011 till now.

38 38 / Members of the Scientific Committee Regional contributions and synergies for Global Health Security Paata Imnadze Professor Paata Imnadze MD, PhD, Science Director, National Center for Disease Control and Public Health, Georgia. He is member Elect, Academician of Georgian Academy of Sciences of Preventive Medicine (1994-pres.); Member from WHO European Region Joint Coordinating Board, UNICEF/UNDP/ World Bank /WHO Special Programme for Research and Training in Tropical Diseases ( ); Vice President, Scientific Association of Infectious Diseases, Parasitic Diseases, Epidemiology and Microbiology of Georgia (2004-pres); Member of Intergovernmental Working Group on the Revision of the IHR ( ); Member of the WHO European Technical Advisory Group of Experts on Immunization ( ); Member of National Council on Bioethics (2005-pres.); member of Editorial Board of the WHO policy document Essential elements for the development of intersectional Food Safety Strategies in Europe (2006); Vice President, Biosafety Association of Central Asia and Caucasus ( ); Member of Editorial Group Environmental health inequalities in Europe WHO Euro (2012); President, Georgian Association of Public Health (2014-pres.). Prof. Imnadze Over the last 20 years has carried out several microbiological and epidemiological investigations on various dangerous, vaccine-preventable and other infection diseases pathogens, their risk factors and prevention activities. Asmae Khattabi, MSc, PhD received her MSc degree in Environmental sciences and a PhD thesis in epidemiology and health surveillance having joined the Ministry of Health in 1996, she sated up an epidemiological surveillance of envenoming within the National Poison Control and Pharmacovigilance Centre. Since 2012, she works as a professor of Epidemiology and Biostatistics at the National School of Public Health, she was a Morocco-FETP coordinator and a deputy director in charge of research, cooperation and continuous training. She has consulting experience with UNFPA and WHO. Asmae Khattabi Barbora Kinross (Mgr., M.A., MPH) is a Scientific Officer for Public Health Capacity at ECDC and the ECDC Liaison Officer for MediPIET. Prior to joining ECDC, Barbora served at the Ministry of Health of the Czech Republic, where she was responsible for the agenda of international organizations (WHO and other UN agencies). She also worked at the World Health Organization (Country Office for the Czech Republic) and The Lancet (Elsevier Ltd.). Barbora holds Masters degrees in public health (MPH), English philology (Mgr.) and international studies and diplomacy (M.A.). She has particular interest in the areas of capacity building, health promotion and public health policy and legislation and published several book chapters on tobacco control. Barbora Kinross Angeliki Lambrou My name is Angeliki Lambrou and I am an epidemiologist. Since my early student years I had a special interest in health and I was happy to study nursing at the University of Athens, Greece. During my postgraduate studies in Public Health I had the opportunity to explore my growing interest in Epidemiology and continued my studies at a doctoral level in Harvard University, Boston, USA from where I graduated with a Doctor of Science in Epidemiology and Environmental Health. My research focused on exposure to metals, epigenetic mechanisms and cognitive function. Currently, I am working as the head of the Laboratory-based Surveillance Office in the Department of Epidemiological Surveillance and Intervention of the Hellenic Center for Disease Control and Prevention located in Athens, Greece. My everyday work involves coordinating and implementing lab-based surveillance, designing and initiating web-based applications in the national surveillance systems, updating sentinel surveillance systems as well as participating in outbreak investigations and research projects. Being an EPIET supervisor as well as a member of the MediPIET Scientific Advisory Board since 2014.

39 Members of the Scientific Committee / 39 Concha Martin de Pando Concha Martin de Pando is the MediPIET Liaison Officer. She is Epidemiologist. Her background is Psychology (Autonomous University of Madrid), with a Master Degree in Gender and International Development; Fellow of Cohort 16 of the Spanish Field Epidemiology Training Programme (PEAC) at Institute of Health Carlos III. With more than twenty years of experience, she worked with displaced population, refugees in armed conflict mainly in Training, Health, Mental Health, Gender and Human Rights. She gained experience in different regions: Latin America, Africa and the Mediterranean & Balkan Regions and at different institutions: Universities, local NGO s, International organizations such as UNICEF, UNESCO, UN Peace Keeping Mission and more recently in EU funded Projects. She has been working in PH and Epidemiology in the Mediterranean region since 2007 based in the Spanish National Institute of Health Carlos III. She coordinated the Training and Capacity Building in Preparedness and Response in EPISOUTH and EPISOUTH Plus Projects. She coordinated the Nautilus Simulation Exercise, a Post Command Simulation Exercises in PH threats in the Mediterranean region in 2013, where 20 Mediterranean and Balkan countries took part and with the involvement of EU Commission, ECDC and WHO. Centre for Bio-medical Research Network in Epidemiology and Public Health CIBERESP ISCIII She started her involvement in MediPIET since She is the Coordinator of the MediPIET Annual Scientific Conference. María Victoria Martínez de Aragón Medical epidemiologist, Master in Public Health and Master in Field Epidemiology. Joined the Spanish Public Health Service in 1976, at the Institute for Public Health Carlos III (ISCIII). She is the director of the Spanish Field Epidemiology Training Program since September 2012, and during She is member of the MediPIET Scientific Advisory Board. Her professional activity has been developed in many areas of field epidemiology, such as public health surveillance, alert and response and risk analysis, field investigations, coordination of surveillance and laboratory networks, mortality and health situation analysis, including training in all these areas. She has contributed to capacity building in field epidemiology at national and international levels, through the Spanish Agency for Cooperation and Development and the Centres for Disease prevention and Control (CDC-USA) ( ) where she worked as technical advisor, for the implementation of a public health reinforce capacity project, which included the implementation and development of the Regional FETP Program of Central America and Caribbean, and the Dominican Republic country Program. Nikoletta Mavroedi Nikoletta Mavroeidi, with a medical degree and PhD from the Athens University Medical School and MPH from the National School of Public Health is the chief Scientific Coordinator in MediPIET since March She has been working in public health epidemiology for the last 20 years, associating field work and public health practice with training activities in the academic setting and in field epidemiology training programmes at the European and international level. Nikoletta had occupied posts of responsibility in the Hellenic CDCP for 10 years, in CDs surveillance, response and preparedness, including mass gatherings, and in the WHO Mediterranean Zoonosis Control Program for 4 years. She has been the National Focal point for the revision of IHR and the PH Training National Focal point at ECDC in During the recent years her main focus of activities is on PH and field epidemiology training and tutoring and research protocols development.

40 40 / Members of the Scientific Committee Regional contributions and synergies for Global Health Security Nana Mebonia Nana Mebonia, MD, PhD, Professor, at the Department of Epidemiology and Biostatistics, Tbilisi State Medical University (TSMU) and head of division of Chronic Diseases, National Center for Disease Control and Public Health of Georgia. She is a member of Public Health scientific counsel at the TSMU. She is MediPIET alternative Focal Point in Georgia since Nana was engaged in international STOP-POLIO project as the WHO consultant assigned in Abuja, Nigeria (2012). Her responsibilities during the mission were to provide technical assistance for polio eradication activities and provide trainings for public health practitioners in analytical epidemiology and using statistical tools. Over the last 15 years her scientific work mostly are dedicated to cancer risk factors, epidemiology and prevention. Isabel Noguer She is cardiologist, Master on Public Health by École Nationale de Santé Publique, Rennes (France) and PhD at Universidad Rey Juan Carlos. Spain. Director of the National Centre of Epidemiology. ISCIII. Spain. Head of National Public Health Surveillance system, preparedness and response in Spain. From 2014 on She worked was the Deputy Director General Institutional Relations. National Plan on Drugs. Ministry of Health and Social Policy. Head of the EU Spanish Presidency in 2010, Chairwomen of the EU- Horizontal group on Drugs ; and as Deputy Director General Department of International Research Programs and Institutional Relations. Head of ISCIII s International Relations and Manager of the European Research Office Senior Advisor and Director of the National Plan on AIDS. Ministry of Health and Consumer Affairs, Spain. Head of the HIV/AIDS STD surveillance and international cooperation with LAC and African Countries. Lecturer of Public Health and HIV/AIDS (National School of Public Health). Head of HIV/ AIDS training programs for Latin America (Spanish Agency for International Co-operation). Member of the Euro-HIV steering group (European Centre for the epidemiological surveillance on HIV/AIDS) She worked as manager GDR in PAHO/Washington DC. Head of the Office of Gender, Diversity, Human Rights and Bioethics. Leading Regional Plan on Bioethics, human Rights, gender, Indigenous people and minorities in Latin American and Caribbean countries. ( ). Her areas of expertise were HIV/AIDS, STD and TB; Control and prevention of communicable diseases, in particular HIV and STD; Epidemiology/Public health; Health information s systems; Drug Addiction International Programs; International Research Programs/European Research Projects; Bioethics and Health administration and management. At international level, she is Member alternate of the Advisory Forum ECDC; ECDC National Focal Point on CD Surveillance in Spain. She has also worked as consultant with World Bank in the field of HIH/AIDS in India, Brazil and Argentina among others. Adela Paez Jimenez is based at ECDC as Scientific Coordinator of MediPIET since mid-july She did the FETP in Spain (PEAC) in , right after the MPH. Holder of a Doctorate in Clinical Epidemiology by the Public Health School of Paris VI, she has over twelve years of experience as epidemiologist in Europe (Institut de Veille Sanitaire, Institut Pasteur), Middle-East (Ain Shams University- Faculty of Community Medicine), West and Central Africa (UNAIDS Regional Support Team) and Latin America and the Caribbean (PAHO/WHO AMRO). Adela Paez Jimenez

41 Members of the Scientific Committee / 41 Nada Ghosn, MD, received her medical degree with the Diplôme d Etudes Spécialisées in Public Health from the University of Lille II. She works at the Lebanese Ministry of Public Health, where she is appointed as head of the Epidemiology Surveillance Program since July She gives lectures on epidemiology and public health at the Lebanese University. Nada Ghosn Dr Isme Humolli, Medical Epidemiologist works at National Institute of Public Health of Kosova (NIPHK). Also is Professor of Epidemiology at Medical Faculty (University of Pristina). Dr Humolli is Head of Epidemiology Department at NIPHK. For years was coordinating Expanded Program of Immunization in Kosovo. She is responsible for Emergencies in Public Health and IHR focal point. Dr Isme Humolli is MediPIET National Focal Point and First line supervisor. Isme Humolli Fernando Simón Soria Medical Doctor and Epidemiologist trained in Spain, England and France, Fernando Simón is holding the post of Director of the Spanish Coordinating Centre for Health Alerts and Emergencies at the Ministry of Health, Social Services and Equality since He has extensive experience in public health surveillance, research, planning preparedness and control of infectious diseases in different settings. He was head of the Alert and Response Unit at the Spanish Instituto de Salud Carlos III between 2003 and 2011 and previously occupied posts of responsibility in public health and epidemiology sectors in several countries and international organizations in Africa, Latin America and Europe. Fernando Simón has also teaching experience in epidemiology at the Spanish School of Public Health and in several training programmes for different universities, the EU, ECDC and WHO. He is member of the Advisory Forum of the ECDC and National Coordinator for the Spanish Competent Bodies for the ECDC. He is also responsible for the Focal Point for the EWRS, alternate member of the Health Security Committee of the EU and director of the Spanish Contact Point for the International Health Regulations (2005) / WHO. During the recent years main focus of his work is on preparedness and response planning. Member of the MediPIET Scientific Advisory Board since Vinciane Sizaire Vinciane Sizaire is a medical doctor and has a Master s Degree in Epidemiology from the London School of Hygiene and Tropical Medicine. After a few years practicing as a family doctor in Belgium, she worked with Médecins Sans Frontières, especially in the Former Soviet Union (FSU) in the area of International Public Health Management, focusing mainly on tuberculosis and then worked as MSF TB advisors at headquarter. After completing her training in Field Epidemiology (EPIET) in the National Centre of Epidemiology of the Carlos III Institute in Madrid, Spain, she worked in the EpiSouth-Plus project on training and capacity building in generic preparedness and response. Since February 2014, she works in the MediPIET programme as coordinator for the integration of four Black Sea countries (Armenia, Georgia, Moldova and Ukraine) into the MediPIET programme.

42 42 / Members of the Scientific Committee Regional contributions and synergies for Global Health Security Carmen Varela Veterinarian with a Masters in Applied Epidemiology, currently she leads the Training Network Strengthening (TNS) Group in the Public Health Training Section of the Public Health Capacity and Communication Unit (PHC) at the ECDC, where - since she has contributed to building public health capacity in the EU through training, pandemic preparedness, monitoring of public health threats, rapid risk assessment and support to response activities. Former Academic Coordinator of the Spanish Field Epidemiology Training Programme (PEAC) ( ) some of her key areas of interest are: core competency development, training needs assessment and multidisciplinary training in public health surveillance and response. Carmen is an observer to the MediPIET Working Group on Networking of the Training Centres Forum. Ahmed Zaghloul Medical Doctor and Epidemiologist, received his medical degree from Egypt. He has extensive experience in public health surveillance, event based surveillance, epidemic intelligence, preparedness and control of infectious diseases, emergency operations and international health regulations. He worked at the IHR(2005) NFP for Egypt between 2012 and 2015, coordinating the activities of IHR implementation. He also worked as a trainer/mentor for FETP Egypt including field work of outbreak investigation and research studies. Previously worked with MoH Egypt as family physician preparing primary health care units for total quality management accreditation. He is currently working as a MediPIET scientific coordinator Members of the Organising Committee Anne- Sophie Lequarre Dr Anne-Sophie Lequarre is a veterinarian with a PhD in molecular biology applied to veterinary sciences. She worked for twenty years at different universities on research topics related to animal health and animal production. She is now a scientific officer at the Joint Research Centre of the European Commission supervising projects reducing the emergence and the impact of potential biological threats. MediPIET is one of the projects funded by the CBRN Centres of Excellence initiative, an initiative contributing to the stability and peace of countries surrounding the European Union. Teresa González de Jesús is the Communications Officer and the last one to join the MediPIET team. Graduated in Translation and Interpretation by the Universidad Autónoma de Barcelona, she holds the Master in International Relations of the Diplomatic School of Madrid and a Master in Communication and International Affairs, focused on the specific field of interest of Morocco. She has several years of experience in communication and logistics and an advanced knowledge on international markets and politics in several countries and organisations in Latin America and Europe. Teresa González de Jesús

43 Members of the Scientific Committee / 43 Enric is MediPIET Project Officer at FIIAPP. He is a Political Scientist and holds a Master in International Relations with particular interest in the Mediterranean and Middle Eastern regions. He has experience in project management at national and international level having previously worked at UNESCO in the field of ICT for Development and Internet Governance, and at several Universities and research centres in Science Policy development and EU-funded projects. He has also worked as freelance consultant and is currently embarked in a PhD research in Political Theory. Enric Ibarz Logistic officer of MediPIET. Building engineer, master in project management and master in real state management. He worked for more than 20 year making buildings as site manager, project manager and as director of technical department. In 2013 he started to work for FIIAPP as logistic officer and he is full time logistic officer for MediPIET since April Roberto Medina Other members of the Organising Committee Jose Jaime de Domingo Vinciane Sizaire Concha Martin de Pando Adela Páez Jimenez Ahmed Zaghloul Marie Bélizaire Nikoletta Mavroeidi Role / Affiliation MediPIET Team Leader MediPIET Coordinator for Black Sea countries MediPIET Liaison Officer MediPIET Scientific Coordinator MediPIET Scientific Coordinator MediPIET Scientific Coordinator MediPIET Scientific Coordinator

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45 Abstract reviewers

46 46 / Abstract reviewers Regional contributions and synergies for Global Health Security Albania Eugena Tomini. Institute of Public Health Genc Burazeri. Institute of Public Health Czeck Republic Alena Petrakova. Palacky University Faculty of Medicine and Dentistry Egypt Sahar El Shurbagy. Director of FETP. Ministry of Health and Population France Delphine Antoine. Scientific and international Office. National Public Health Agency. Santé Publique France Former Yugoslav Republic of Macedonia Vesna Velikj Stefanovska. University St. Kiril and Metodij Georgia Nana Mebonia. National Centre for Diesease Control Paata Imnadze. National Centre for Diesease Control Greece Angeliki Lambrou. Hellenic Centre for Disease Control and Prevention (KEELPNO) Takis Panagiotopoulos. National School of Public Health, Athens Kosovo* Isme Humolli. National Institute of Public Health. Lebanon Nada Ghosn. Ministry of Health Ghada Abou Mrad. Ministry of Health Moldova Natalia Caterinciuc. National Centre for Public Health Morocco Asmae Khattabi. NFETP Serbia Mitra Drakulovic. Institute of Public Health Spain Adela Castelló Pastor. Instituto de Salud Carlos III Alicia Barrasa Blanco. EPIET Scientific Coordinator. National Centre of Epidemiology Institute of Health Carlos III Ana Mª Pedraza. Instituto de Salud Carlos III Asunción Díaz Franco. Instituto de Salud Carlos III Carmen Varela Martínez. National Centre of Epidemiology Institute of Health Carlos III. Public Health and Epidemiology Biomedical Research Networking Centre (CIBERESP-ISCIII) *This designation is without prejudice to positions on status, and is in line with UNSCR 1244/1999 and the ICJ Opinion on the Kosovo declaration of independence.

47 Abstract reviewers / 47 Diana Gómez Barroso. Public Health and Epidemiology Biomedical Research Networking Centre (CIBERESP). National Centre of Epidemiology Institute of Health Carlos III Isabel Noguer. National Centre of Epidemiology. Institute of Health Carlos III Josefa Masa. National Center of Epidemiology Institute of Health Carlos III. Public Health and Epidemiology Biomedical Research Networking Centre (CIBERESP-ISCIII) Marta Ruiz Alguero. Instituto de Salud Carlos III Nerea Fernández. National Center of Epidemiology. Institute of Health Carlos III -Public Health and Epidemiology Biomedical Research Networking Centre (CIBERESP-ISCIII) Noemí López. Instituto de Salud Carlos III Rebeca Ramis. National Centre for Epidemiology Institute of Health Carlos III. Public Health and Epidemiology Biomedical Research Networking Centre (CIBERESP-ISCIII) Rosa Cano Portero. National Centre for Epidemiology. Institute of Health Carlos III. Public Health and Epidemiology Biomedical Research Networking Centre (CIBERESP-ISCIII) Carmen Varela Santos. European Centre for Disease Prevention and Control Vladimir Prikazsky. European Centre for Disease Prevention and Control Frantiska Hruba. European Centre for Disease Prevention and Control CDC Biagio Pedalino. CDC Country Consultant MediPIET Nikoletta Mavroeidi. Chief Scientific Coordinator. Adela Paez. Scientific Coordinator. Ahmed Zaghloul. Scientific Coordinator. Marie Bélizaire. Scientific Coordinator. Vinciane Sizaire. Black Sea countries Coordinator. Concha Martin de Pando. Liaison Officer. Public Health and Epidemiology BiomedicalResearch Networking Centre (CIBERESP-ISCIII) Silvia Jiménez Jorge. Clinical Research and Clinical Trials Unit. Universitary Hospital Virgen del Rocío, Seville. Public Health and Epidemiology Biomedical Research Networking Centre (CIBERESP-ISCIII) Chesco Nogareda. Epidemiologist - Independent consultant World Health Organisation Eric Bertherat. WHO-HQ ECDC Karl Ekdahl. European Centre for Disease Prevention and Control

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49 Session A Parallel Food & Water Borne Diseases

50 50 / Food & Water Borne Disease 28th November 2017 Session A Parallel Regional contributions and synergies for Global Health Security Abstract 125 Mass food poisoning outbreak in a factory in Tetovo, Macedonia, March 2017 Vladimir Mikik (1,2), G. Kuzmanovska (1,2), K. Stavridis (1,2), D. Kocinski (1,2), L. Balazhi (1,2), S. Subasic (3) G. Boshevska (1), G. Ristovska (1), E. Coneva (1), R. Davidkovski (3), S. Memeti (1,2) 1. Institute of Public Health, Skopje, Macedonia 2. Mediterranean Programme for Intervention Epidemiology Training (MediPIET) 3. Centre for Public Health, Tetovo On March 31 evening and by the following morning, after eating in a nearby factory canteen, 179 workers were admitted to city hospital in Tetovo with symptoms of weakness, nausea and vomiting. We conducted outbreak investigation to identify the cause and mode of transmission and to implement control measures. We conducted retrospective cohort study and interviewed factory workers by telephone. Case was defined as a worker from second and third shift, who developed nausea and vomiting during 31March/01May. We took environmental and food samples from the canteen, restaurant where food was prepared and swab samples from food-handlers. Risk ratio was calculated for each food item served in the canteen, biological samples we investigated in the Centre for Public Health. We contacted 462 of 557 workers, with response rate of 99.6%. From the participants, 29.6% met case definition, attack rate was 9 times higher in the workers from third shift (AR=55.8%) then in second shift (AR=6.2%). Of cases, 45.6% developed symptoms in period of 2-3 hours after eating in the canteen. Relative risk was 31.5 times (95%CI= ) higher among those who ate pasta. A 63.6% (7/11) of environmental samples in the factory canteen were positive for Staphylococcus aureus, also Staphylococcus aureus was isolated in food sample (pasta) served in the canteen and in nasal swabs from cook and food handler in the restaurant. Epidemiological and environmental investigation suggest pasta contaminated with Staphylococcus aureus as main cause of the outbreak. The restaurant and canteen were closed until hygiene standards were met. Mass foodborne outbreaks can have high economic and social impact, but can be prevented with regular education of the food-handlers for food safety and hygiene standards. Abstract 85 Foodborne outbreak of gastroenteritis, among students in the resort Gucevo, Serbia, February 2017 Milunka Milinkovic (1,2), Anita Grgurevic (3,4), Dragana Radojicic (5), Mitra Drakulovic (1,4) 1. Institute of Public Health of Serbia Dr Milan Jovanovic Batut, Belgrade, Serbia. 2. Mediterranean Programme for Intervention Epidemiology Training (MediPIET), fellow. 3. Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Serbia. 4. Mediterranean Programme for Intervention Epidemiology Training (MediPIET), supervisor. 5. Institute of Public Health Šabac On February , the Regional Public Health Institute was notified about thirteen cases of gastrointestinal illness among 45 students that stayed in the resort Gucevo. An investigation was conducted to identify the cause of the outbreak and to implement control measures. The outbreak was described by time, person and place. A case was defined as any person with the following symptoms: vomiting or diarrhea with/without nausea or temperature > 37 C, who had been in the resort Gucevo, after the 24th of February. Based on the results of the descriptive analysis we conducted a retrospective cohort study. Food specific relative risk RR was calculated in univariate analysis and multivariate logistic regression. Leftover food items, row meet, water, environmental samples and swabs from the food handlers hands were collected. Overall attack rate was 51, 3%, 47.8% for males and 50% for females. Main symptoms were nausea (90%), vomiting (85%), abdominal pain (85%), fever (75%) and diarrhea (50%). The epidemic curve was compatible with common point source outbreak, picking on 26th of February. In the univariate logistic regression three food items were significantly associated with disease, whereas stew remained in the multivariate logistic regression analysis (RR= 21.58, 95% CI ). Enterobacteriaceae were detected in the food leftovers and Staphylococcus aureus in the row meat samples. No stool samples had been collected from the cases. In this outbreak, disease occurrence was significantly associated with the consumption of stew. The laboratory results confirmed poor food handling conditions in the resort. We recommended that good food handling practices should be reinforced in the resort. Having foodborne outbreak investigation guidelines developed by PH authorities would increase coordination and efficiency of investigations. KEYWORDS: Foodborne illness, food poisoning, outbreak, Staphylococcus aureus KEYWORDS: outbreak, gastroenteritis, students, resort, Serbia

51 Food & Water Borne Disease 28th November 2017 Session A Parallel / 51 Abstract 132 Outbreak of Foodborne Gastroenteritis in Gaondimoria Village, Kamrup Metro, Assam, India, July 2016 Takujungla Jamir (1), V. Sarma (2), P. Hazarika (3), N. Kumar (1), C. S. Aggarwal (1), S. Venkatesh 1. National Centers for Disease Control, Delhi, India 2. State Surveillance Unit, Assam, India 3. District Surveillance Unit, Kamrup Metro, Assam, India Sonapur block primary health centre reported 105 admitted cases of diarrhoea to State Surveillance Unit, Assam on July 14, Our team started investigation on July 15, 2016 to describe the epidemiological characteristics of outbreak and to determine the associated risk factors. We defined a case as "diarrhoea (> 3 stools in 24 hours) or vomiting in a resident of Gaondimoria village, Kamrup Metro from July 9, 2016 to July 17, 2016". We did a house to house survey for cases and conducted a retrospective cohort study on people who attended or ate from new shop inaugural feast on July 11, We observed exposures of different food items and risk factors involved. We collected three stool samples for testing pathogens, two serum samples for Hepatitis A and five water samples. We identified 138 cases with an attack rate of 10%. Among them, 105 were hospitalised. There were no deaths. Attack rate was highest in age group of 6-15 years (17%). Females (63%) were more affected. Among identified cohort of 168 people, 160 attended the feast and 130 fell ill, eight did not attend but ate food brought home. Risk of gastroenteritis was 5.6 times (95% CI = 2-6) among those who ate raw gram sprouts and 1.6 times (95% CI= 1-2) among those who drank untreated water than those who did not eat or drink. All samples were negative for pathogens. Water samples showed MPN of >5/100 ml. An outbreak of gastroenteritis occurred following feast at village shop having strong association with food item gram sprout. We recommended IEC activities regarding proper cooking and food storage and timely collection of appropriate samples for testing. KEYWORDS: Foodborne, gastroenteritis, outbreak, Gaondimoria, Assam Abstract 163 Increased number of cases of acute enterocolitis in Bogovinje, Tepublic of Macedonia, May-June, 2016 Largime Ballazhi (1,3), V. Velikj-Stefanovska (2,3), G. Kuzmanovska (1,3), D. Kochinski (1,3) V. Mikic (1), A. Zaghloul (3), M. Ballazhi (4), K. Stavridis 1, Sh. Mehmeti (1,3). 1. Institute of Public Health, Skopje, Macedonia 2. Institute of Epidemiology with Statistics and Medical Informatics, Medical Faculty, Skopje, Macedonia 3. Mediterranean Programme for intervention Epidemiology Training (MediPIET) 4. State University of Tetovo, Faculty of Medical Sciences, Tetovo, Macedonia On , the Center for Public Health Tetovo registered increased number of reported cases of acute enterocolitis from the village Bogovinje. The investigation has been applied to assess the situation. The aim of this paper is to present the fieldwork experience, the risk factors and indicated control measures. We conducted a retrospective cohort study. Cases were defined as persons who live in Bogovinje, has diarrhea and nausea/vomiting from Cases were interviewed using a structured questionnaire. We performed descriptive data analysis and calculated food specific attack rates to calculate effect of exposure to food items and water. Chi-square/Fisher exact test were used for assessing significance. We analyzed water samples from the water supply system and stool samples from suspected cases. The total number of reported cases was 69 (60.9% male, 39.1% female). Age ranged from 3 to 84; mean - 29±23 (Median=19). Most affected age group was 5-9 years 18,8%, followed by ,4%. Main symptoms were vomiting (89.8%) and nausea (85.7%). Sixteen cases were hospitalized. We observed highest AR=66.7% for cabbage and iceberg salad AR=57.1%. The OR was highest for water from local supply and cabbage. We found statistical significance for water from local supply OR=9.8 [95% CI ( )]; p= Water and stool samples were negative for common bacterial pathogens. The epidemic curve indicated point source outbreak. Significant rainfall and local floods three days prior may have contaminated the drinking water. Outbreak was not reported by the local epidemiologist. No virology investigations were performed. Following the Protocol for investigation of outbreaks and introducing lab capacities for viral investigation of water samples both on regional and National level is needed. KEYWORDS: Acute enterocolitis, outbreak, R. Macedonia, floods

52 52 / Food & Water Borne Disease 28th November 2017 Session A Parallel Regional contributions and synergies for Global Health Security Abstract 93 Foodborne outbreak, Meknes, Morocco, June 2017: What we Need to learn Touria Essayagh (1,2), A. El Rhaffouli (2), M. Khouchoua (2), S. Essayagh (3), A. Khattabi (1) 1. National School of Public Health, FETP Morocco 2. Prefectural Epidemiology Cell, Ministry of Health, Meknès, Morocco 3. University Hassan Ist, Faculty of Sciences and Techniques, Settat, Morocco Abstract 179 Outbreak of Typhoid Fever in Shaheed Murad Colony of District Jaffarabad, Balochistan, Pakistan July 2015 WA. Lashari (1), GhafoorT (2) Ghafoor, A. Saeed (3) 1. N-Stop Officer FELTP-Pakistan 2. Facuty member FELTP Pakistan 3. Technical Support officer FELTP Pakistan Foodborne outbreaks remain a public health threat in Morocco that require compulsory reporting and epidemiological surveys to halt any risk of epidemics. We report a foodoutbreak that occurred in Meknes on the 10th of June We assessed its extent, determined its source and enforced preventive measures. We performed a retrospective cohort study among the guests of the diner to identify risk factors associated with the illness. Data were analyzed using Epi Info version 7. Association between assumed risk factors and intoxication was estimated using the relative risk (RR) and its 95% confidence interval. Percentages as well as p-values were determined using Fisher's exact test. Among the 15 guests, 9 cases were ill with an attack rate of 60%. The mean age was 39 ± 11.9 years with a male/female sex ratio of The mean incubation period was 3 ± 3h30. The symptoms reported were vomiting (88.9%), dizziness (88.9%), abdominal pain (44.4%), headache (44.4%) and fatigue (33.3%). All cases had a positive outcome. Chicken consumption was associated with the intoxication (p = 0.04). The cook did not respect hand hygiene rules, the chicken was thawed 7 hours at room temperature. Moreover, the dish was more than 12 hours at room temperature before consumption. No wounds or boils were found. Laboratory results were negative. Although laboratory results were negative for microbiological and environmental germs, clinical signs suggest that the probable cause of intoxication are enterotoxins secreted by Staphylococcus aureus commonly found when hygiene is lacking and food storage is deficient. We recommend reinforcing public awareness on the importance of respecting the cold chain and the basic rules of hygiene. On 25th, July 2015, MSDHQ Hospital reported 50 typhoid cases. On the request of Department of Health, a joint FELTP & Health department team visited area on 26th July, 2015 to identify source of outbreak and formulate preventive measures. Case-control study was carried out, from 2nd 8th August Hospital records was checked and Active case finding was done. A case was defined as resident of Shaheed Murad Colony having fever >38oc with one of following symptoms; abdominal discomfort, vomiting, diarrhea and positive Typhoid test between 1st July to 31st July, For each case one age- and sex-matched control was enrolled from neighborhood. 90 cases were identified (over all attack rate = 2.25%), male to female ratio 2:1, with mean age of 28 years (1-70 years). 47% were in age group years followed by years age group; Symptoms were fever 100%(n=90), vomiting 68%(n=76), abdominal pain 61%(n=68) and diarrhea 50%(n=56). No death was reported. 56 %(n=50) serious cases were hospitalized. Spot map showed clustering around 02 water sources, i.e. tape water and ground water.100% positive cases were using tap water and only 5% of cases who were using ground water. OR 6.0, (CL and p value <0.05), showing strong association between tap water and illness. Tap water was contaminated due to damaged water supply lines, it was most probable cause of outbreak. Repair of water lines and proper chlorination of drinking water was recommended. Health department strictly took preventive measures through repair of damaged water supply lines and chlorination of water storage ponds and health education campaigns were also conducted to give awareness to community regarding health and hygiene. KEYWORDS: Foodborne outbreak, enterotoxins, Staphylococcus aureus KEYWORDS: Typhoid fever, water contamination, Jaffarabad, Baluchistan

53 Food & Water Borne Disease 28th November 2017 Session A Parallel / 53 Abstract 139 Outbreak of Gastroenteritis Associated with Contaminated Bore Well Water in Leprosy hospital- Bangalore, Karnataka, India, October, Sree Kalpana Mohankumar (1), Bhavani Gopinath (3), Samir V Sodha (1), Manoj Murrhekar (3), Dr. Prakash Kumar (2), Vidhya Prasad (2), Rajashree Koppad (2), Shilpa Sippy (2), Yasodha Talkad (2), C. S. Agarwal (1), Srinivas Venkatesh (1). 1. National Centers for Disease Control, New Delhi. 2. State Surveillance Unit, Karnataka. 3. National Institute of epidemiology, Chennai. Waterborne infections contribute up to 10% of nosocomial infections. Leprosy hospital in Bangalore, Karnataka state, India, reported clustering of diarrhoeal illnesses among hospital residents including patients on October 8, We investigated to describe the outbreak and identify risk factors. We defined a case as 3 loose stools in 24 hours in a hospital resident between September 20 and October 20, We conducted retrospective cohort study and collected data on demographics, water sources, and behaviours such as hand washing. We tested stool samples for Vibrio cholera from case-patients with active symptoms who did not begin antibiotics. We did environmental survey of water sources, including water testing for faecal contamination. Among 108 residents, including 60 patients, we identified 54 cases (attack rate=50%). Outbreak was during October 2-16 with peak on October 6. Attack rate was higher among patients (72% [43/60]) than other residents of the hospital campus (23% [11/48]). Males (40/63, attack rate=64%) were more affected than females (14/45, attack rate=31%). Drinking bore well water was significantly associated with diarrhoeal illness (Relative Risk: 2.9, 95% Confidence Interval [CI]: ). Using public water (RR: 0.4, CI: ) for drinking, and washing hands with soap after defecation were protective (RR: 0.3, CI: ). All three stool samples were negative for Vibrio cholerae. Bore well water was stored in an underground storage tank without chlorination. All three water samples from bore well were positive for faecal contamination. This diarrhoea outbreak in a hospital was associated with drinking contaminated bore well water. We recommend regular cleaning and chlorination of bore well, use of public water for drinking, and promotion of hand washing practices. Abstract 147 Typhoid outbreak investigation in district of Gabes, Tunisia 2016 Aicha Lahchaichi (1, 2), Lamia Missaoui (1), Hind Bouguerra (1, 2), Souhir Chelly (1), Farah Saffar (1), Amal Cherif (1), Nissaf Ben Alaya Bouafif (1, 2) 1. National Observatory of Emerging Diseases, Public health ministry, Tunisia 2. Mediterranean Programme for Intervention Epidemiology Training (MediPIET) From July 2016 to September 2016, 61 cases of confirmed typhoid fever were reported in Ghannouche, a inhabitants city in Gabes, Tunisia. We initiated an investigation to identify possible source of transmission and risk factors for disease so as to institute control measures. A retrospective cohort study was carried out during August 2016 in Ghannouche city. The information on outbreak was collected and described in time, place and person characteristics. A suspected case was defined as a person who presented clinical signs suggestive of typhoid fever, ie prolonged fever with abatement or torpor, diarrhea or constipation, vomiting and abdominal pain. A confirmed case was a suspected case who had positive result for Salmonella typhi. A probable case was a person having contact with a confirmed case. Food and water samples were also collected for microbiological analysis. Among 628 surveyed subjects, 100-suspected cases, 21 probable cases and 61 confirmed were identified. Attack rate was 2.17 per The main clinical symptoms were fever (99%) and diarrhea (54%). Total of 102 specimens (Stool, serum and blood) were cultured and serotyped for Salmonella typhi. 34 serum samples were reported positive for Widal agglutination test. Salmonella typhi was isolated from 28 blood and 10 stool cultures. Most of the patients were treated with ciprofloxacin for 7-14 days and no complications were reported. 94 water samples were tested for Salmonella typhi (water from government overhead tanks: 50; water well: 18 and softened water: 26). Three softened watersamples were found positive for faecal contamination. Contaminated water from unprotected water sources was the probable source of the outbreak. In Ghannouche City, Authorities must invest in repairing water and sewage systems. KEYWORDS: outbreak, typhoid fever, investigation, Tunisia KEYWORDS: Diarrhoea, India, Hospital, Karnataka

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55 Session B Parallel Zoonoses & Vector Born Diseases

56 56 / Zoonoses & Vector Born Diseases 28th November 2017 Session B Parallel Regional contributions and synergies for Global Health Security Abstract 44 A Pilot Study to Assess the Efficacy of Three- Time Field Spraying of Perythroid Insecticide on The Population Density of Sandfly, The Vector for Cutaneous Leishmaniasis Samer Sawalha (1), A. Ramlawi (2), R. Sansur (3), I. Salem (4), A. Al Jawabreh (5) 1. Environmental Health Department, Ministry of Health, Ramallah, Palestine. 2. Infectious diseases specialist, Ministry of Health, Ramallah, Palestine. 3. Environmental Sciences & Community Health, Palestine. 4. Central Public Health Laboratory, Ministry of Health, Ramallah, Palestine. 5. Leishmaniases Research Unit-Jericho. Pyrethroid insecticides are commonly used to control sandfly population in Palestine and subsequently reduce the incidence cutaneous leishmaniasis (CL) rate. This is based on biannual indoors and outdoors residual spraying during summer. This study aimed to assess the efficacy of field spraying of pyrethroid insecticides at a rate of three times per season on sandfly population density. Two villages in Jenin district were selected for the study. Siletalharthiyyah was selected as a case village with high CL incidence, while Ta anak village was selected as a negative control with zero CL cases. Pyrethroid insecticides were sprayed in the case village in-doors and out-door on three occasions; June, July and August, leaving control village without spraying. Pre and post spraying sandfly density was determined in both villages using CDC light traps. The pre-spraying sandfly density in the case and control village was 184 and 16 sandflies, respectively, showing statistical difference between the two localities (P=0.0001). The number of sandflies collected in-doors in case village in the post-spraying period (n=184) significantly decreased (n=56) compared to pre-spraying period (P=0.0093). Population density of sandflies was significantly higher in control village which did not receive insecticides (n=213) compared to case village (n=56) which received insecticides (P=0.0001). In the out-door trapping, the density of sandfly population was significantly reduced in case village (n=222) relative to control village (n=1368) (P=0.0033). Moreover, in case village sandfly density significantly decreased in the post-spraying period from 162 to 58 sandflies (P= 0.029). Spraying insecticide three times a year has significantly reduced sandfly population density. However, it did not eliminate sandflies which explains appearance of CL cases despite using fieldspraying as a control measure. Abstract 182 Cutaneous Leishmaniasis : Epidemiology, Clinical Feature, Reservoir, vector, and the Strategy of Ministry of Health to Control the Disease in Salfit District, West Bank, Shadi Hilmi Abd Allah Adawi (1) 1. Ministry of Health, Salfit Primary Health Care, Environmental Health Department, Palestinian state. This study was conducted to describe the epidemiology of cutaneous leishmaniasis in Salfit district, Northwestern West Bank. A retrospective study was conducted from 2005 to 2017, including review of all positive cutaneous leishmaniasis (CL) patients at Salfit Primary Health Care Center. A total of 116 CL cases were identified, 62 males and 54 females. CL incidence increased from 0.2 per in 2001 to 4 in Thirteen localities are affected and almost half of the cases (41%) are in Der ballut locality. Most cases live in peripheral of the domestic area (71%). A majority of infections occur during Spring and Autumn. The disease affects both males and females and is most prevalent among those aged 1-month to 25-years (64% of total cases). The most common lesions were single (64%) and nodules (58%) respectively and placed more frequently in face (45%) and limbs (44%). The duration of treatment of CL infection with sodium stibugluconate (Pentostam ) varied between 1 and 40 days. Over the last decade, cutaneous leishmaniasis incidence is increasing and spreading in Salfit district, which has become endemic. The Ministry of Health strategy to improve case detection and management and disease surveillance seems effective. More studies are needed to determine the vectors and reservoirs to help the decision makers fine-tune suitable and more efficient strategies to control the disease. KEYWORDS: Leishmaniasis, Salfit district, Epidemiology, Distribution, MOH, Strategy KEYWORDS: Pyrethroid insecticide, cutanueous leishmaniasis, sandflies, field-spraying

57 Zoonoses & Vector Born Diseases 28th November 2017 Session B Parallel / 57 Abstract 39 Outbreak investigation of cutaneous Anthrax - Midelt City, Morocco, 2015 Samir Mounach (1), M. Lakranbi (1), H. Abdelkhalek (2), A. Rguig (1) 1. Directorate of Epidemiology and Disease Control, Ministry of Health Morocco 2. Regional Health Office of Meknes Tafilelte Region, Ministry of Health, Morocco Cutaneous Anthrax is a zoonosis transmitted to human by contact of affected animals or derived products handling. In Morocco, last five years the mean of notified cases was five cases per year. In August 24th 2015, the Epidemiological unit of Midelt city and local media reported suspected cases in Agdal locality (rural area, livestock activities). An epidemiological investigation was conducted to confirm the episode, define the population under risk and implement response measures. A team of Epidemiologists and medical staff had conducted an investigation. A clinical exam of suspected cases was done, laboratory samples (cutaneous and blood) were taken. Standard case definition was used. An active surveillance system was implemented. Collaboration with veterinarians of agriculture ministry was established. Specific risk communication plan was implemented. Statistical analyses were conducted with Epiinfo 7. Cutaneous Anthraxis Outbreak in Agdal locality was confirmed. Twelve cases were detected (9 during the investigation and 3 by active surveillance). Four confirmed and eight probable cases. Forty four risk exposed persons. Cases evolution was positive. All Cases were males. Average cases age was 43±13 year; all of them had a livestock activity. Bivariate analysis conclude significant associations between case occurrence and participation in slaughtering: Odds Ratio 5,25 (1,23; 22,24) and waste handling: Odds Ratio 4,7 (1,23; 18,30). The disease was confirmed in cattle. A Large vaccination campaign of livestock in the locality was conducted. Risk communication plan informed people of the danger of clandestain slaughter and reported the evolution of the situation to the media. The Episode was under control, the importance of Collaboration with agriculture department was confirmed, since a collaborative surveillance system of Zoonosis risk was implemented. Risk communication plan stopped rumors and participated on reducing clandestain slaughter. Abstract 72 Cutaneous leishmaniasis outbreak, Morocco, 2016 Sofia Azrib (1), S. Redouane (1), D. Daoudi (1), M. Akrim (1), M. A. Tazi (1), A. Khattabi (1) 1. Feild Epidemiology Training Program (FETP)-Morocco, National School of Public Health, Rabat, Morocco. Cutaneous leishmaniasis has emerged as a major public health threat in Morocco. It is an endemic communicable disease in Foum Jemaa district (Azilal province- Morocco). however, in 2016, the district Medical Officer was notified of an unusual increased number of news cases among children in the local surveillance database. Therefore a team, composed of three FETP follows, conduct a risk assessement in Foum Jemaa district to evaluate potential local leishmania transmssion. we defined a case as having a positive parasitology reference test reported to Foum Jemaa district from january 1st to december 31st we conducted an ecological study, combining epidemiological retrospective analysis using data from the distrct surveillance system, and entomological assessements to compare the density of sand flies between five locations using sticky traps. demographic and clinical characteristics of patients were explored. the number of cases reported at Foum Jemaa reached 217 cases. the incidence is 71.2 cases/ inhabitants wich is 4 times higher than that of the age group most affected was children younger than 10 years old (61%), an environemental investigation highlighted the lack of sanitation in the most localities and suspected the role of a dry river bed that cross the district,and wich has become a waste dump, in this outbreak, the results of the entomological survey confirms this hypothesis highlighting a high density of sand flies in the dry river than in the other locations cutaneous leshmaniasis continues to pose a real public health problem in Azilal province. the emergence of severe and resistants forms throughout the world should encourage the strengthening of vector control and prophylactic measures. KEYWORDS: Cutaneous leishmaniasis, outbreak, entomological assessement, Azilal, Morocco KEYWORDS: Cutaneous Anthrax, Zonooses, Midelt City, Morocco

58 58 / Zoonoses & Vector Born Diseases 28th November 2017 Session B Parallel Regional contributions and synergies for Global Health Security Abstract 155 Outbreak Investigation of Dengue Fever in Union Council Shergarh District Mardan, Khyber Pakhtunkhwa, Pakistan Miam Asim Shah (1) 1. Field Epidemiology and Laboratory Training Program (FELTP) Pakistan Dengue fever (DF) is a rapidly spreading vector-borne disease in Khyber Pakhtunkhwa, associated with a significant public health impact. On 28th September 2016, six DF cases were reported in union council Shergarh, District Mardan. Outbreak was investigated to find the associated risk factors and suggest control measures. A case-control study was conducted and data was collected on a pretested structured questionnaire. A case was defined as any resident of Shergarh with acute febrile illness of 2-7 days duration with any of these symptoms headache, myalgia, arthralgia, or hemorrhage/rash from 1st September to 1st December For comparison, age and sex matched controls (n=180) were selected from the area. A total of 82 cases were identified in Shergarh with attack rate (AR) of 25/10000 during the outbreak. The majority of cases were males (n=61, 70%). The median age of the cases was 30 years ranging from 02 to 65 years. The highest cases were observed in the age groups of (AR=0.6%). Students (26.83%) and farmers (24.40%) were the most affected groups. Based on the analysis of risk factors with 95% confidence interval and p-value <0.05, the odds ratio of stagnant water sources in the vicinity was 2.2 (exposure rate in cases=71.95%, controls=53.89%). Odds ratio of uncovered water storage was 2.5 (exposure rate in cases=57.32%, controls=35.00%). The use of mosquito repellents and residual sprays was found protective with odds ratios of 0.46 (95%CI= , p-value=0.008) and 0.38 (95%CI= , p-value=0.008) respectively. Outbreak investigation revealed risk factors like living in the vicinities of stagnant water, uncovered water storage and not using residual sprays & mosquito repellents, which were significantly associated with enhancing the exposure to DF. KEYWORDS: Outbreak, Dengue Fever, Case-Control study, Mardan, Pakistan Abstract 69 Evaluation of malaria surveillance following an outbreak of imported cases Aswan governorate, Egypt from Sara Bakry Mohamed (1), M. Keshk (2), S. Samy (3), S. Refay (4) 1. Aswan health district, Aswan, Egypt. 2. International Emerging Infections Program, Cairo, Egypt. 3. Field epidemiology training program, Cairo, Egypt. 4. Epidemiology and surveillance department, ministry of health, Cairo, Egypt Malaria is a life-threatening disease. Globally 91 countries are having ongoing malaria transmission. African Region carries the highest share of the global malaria with 90% of malaria cases. Egypt is free of local malaria transmission, with the last local case reported in On May 2014, a cluster of imported malaria cases was reported from Aswan governorate at Southern Egypt. The aim is to evaluate the surveillance in Aswan being a border governorate exposed to the illegal Sudanese migrations with the risk of importing malaria. The evaluation was conducted using CDC guidelines for evaluating public health surveillance. Aswan Malaria database was extracted, reviewed and analyzed. A questionnaire was developed for evaluating the surveillance attributes. It was used to interview surveillance team at all levels. Field visits were conducted to evaluate the completeness and timeliness. According to surveillance team, the system was simple as they understand and apply the case definition easily, it is acceptable because filling the form and data entry is performed timely. System was flexible to accommodate outbreaks of imported cases. Completeness of demographic data and reporting was 100%, Completeness of Laboratory testing and results was 82.7%. Timeliness of reporting was unsatisfactory as only 82.7% of cases reported immediately and 81.3% diagnosed within seven days of onset of symptoms. Positive predictive value was 72%. Malaria surveillance system in Aswan is simple, acceptable, and flexible to accommodate outbreaks. Timeliness of case diagnoses and reporting and laboratory data completeness need improvement. It is recommended to improve timeliness and completeness of laboratory testing data for the system to early detect imported Malaria cases for appropriate prevention and control efforts. KEYWORDS: Egypt, Malaria, Outbreak, Public Health Surveillance.

59 Zoonoses & Vector Born Diseases 28th November 2017 Session B Parallel / 59 Abstract 142 Evaluation of the surveillance system for West Nile virus infection, Serbia, Dragana Plavsa (1,2), M. Drakulovic (1,2), A. Grgurevic (1,3) 1. Mediterranean Programme for Intervention Epidemiology Training (MediPIET) 2. Institute of Public Health of Serbia, Belgrade, Serbia 3. Institute of epidemiology, Faculty of Medicine, University of Belgrade Abstract 110 Scabies Outbreak in Irbid- Jordan, 2017 Fatima Zohra Mustafa Zerriouh (1), S. EL-Qasraoui (2), M. Abdallat (3), Y. Khader (4) 1. Field Epidemiology Training Program/ Community Medicine Residency Program, Minstry of Health, Jordan 2. Communicable diseases directorate/ Surveillance department, Ministry of health, Jordan 3. Communicable diseases directorate, Ministry of health, Jordan 4. University of science and Technology, Jordan West Nile fever and neuroinvasive disease cases are under epidemiological surveillance since 2012 in Serbia. The National institute of public health (IPH) is collecting and analyzing the data received from district IPHs and the National arboviruses reference laboratory. This is the first evaluation of WNV infection SS in order to improve the system and control of the disease. A total of 44 case investigation forms (CIFs) and 76 laboratory report forms (LRFs) collected on paper were used. CDC s Updated Guidelines for Evaluating Public Health SS were used to evaluate the system's attributes: simplicity, data quality, timelines, acceptability and stability for the season Jun 2016 May The participation rate of district IPHs was 100%. CIFs and LRFs are easily filled in. The variables included in both forms provide sufficient information for describing the WNV infection by person, place and time. CIFs and LRFs were available for the totality of reported cases. Completeness was 100% for 72 of the 91 existing variables in CIFs. Missing values were mainly related to exposures. Completeness of data was 100% for all variables in the LRFs. The median time between the date of onset and of sampling was 6,5 days (0-26) and 5,5 days (0-21) between the date of sampling and of notification. Trained personnel, application of standard operating procedures and availability of funds ensure the sustainability and stability of the system. Overall the WNV infection SS presents with satisfactory acceptability, sustainability and stability. Timeliness and completeness need to be further improved. Electronic reporting and raising awareness of health professionals with regard to the importance of early reporting for the control of the disease could contribute in that direction. KEYWORDS: WNV infection, evaluation, surveillance system, attributes Globally, Scabies affects more than people at any time. Outbreaks have generally occured in association with conditions of crowding and poor hygiene. This study aimed to determine the extent of a recent scabies outbreak in Hakama, Jordan and make recommendations for control measures. An invetigation was carried out from 28th February to 11th march A special team visited the area on february 28th to confirm and investigate the reported scabies outbreak. The case definition of the suspected case was any person living in Hakama who experience severe itching especially at night, and rash or blisters with the diagnostic linear borrows in the affected body parts from February 1st to 11th March Mobile clinics in schools and house to house active surveillance were coducted to find cases in the entire area (20000 inhabitants, including thousands of syrian refugees). Data were collected using a case investigation form on demograghic data and date of diagnosis. Atotal of 458 cases were captured. The averall attack rate 2.3%, the age range (1 to 85 years). The mean (SD) and median age were 19.0 (17.2) and 12.0 years, respectively. About 54% of cases were males. Of all patients 16.3% were syrian refugees. About 60% of cases were among school children. The attack rate varied significantly in schools from 9.3% among syrian students to 4.0% among jordanians students (p value<0.005). There was a specific clustering in the eastern district of the village (49%). Scabies affected mostly school children and predominantly syrians refugees. Crowding conditions and insufficient water might be some of risk factors. More attention to refugees status is recommended to prevent future outbreaks. KEYWORDS: Scabies, Outbreak, Jordan, Syrian refugees

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61 Session C Parallel Vaccine Preventable Diseases

62 62 / Vaccine Preventable Diseases 29th November 2017 Session C Parallel Regional contributions and synergies for Global Health Security Abstract 60 Note from field, Mumps outbreak among school students of Hebron district in Palestine May 2015 Diaa Hjaija (1), K. Kharouf (1), H. Esaidi (1), A. Ramalawi (2) 1. Preventive Medicine Department. Ministry of Health. West Bank. Palestine 2. Deputy Minister. Ministry of Health. West Bank. Palestine Palestine is classified as an area with low mumps endemecity. The incidence rate per 100,000 population was 2.2, 3.9, and 4.17 in 2012, 2011, 2010 respectively. In 2013 and 2014 the incidence rate per 100,000 increased to 46 and 432 respectively due to a mumps outbreak in Gaza strip. Hebron district where the current outbreak take place the incidence rates per 100,000 population were 0.00, 0.00, 8.78 in 2013,2014 and 2015 respectively. Retrospective cohort study conducted Investigation of cases include case definition, interviews with primary cases, review of medical records and vaccination books, testing mumps Serological and molecular methods were performed. During an outbreak line listing of 761 cases on spreadsheet to ensure complete case investigation, and identification of affected population in Bait kahel in Hebron district. The main affected age group was 9-14 years (669 cases). Analysis of the immunization status revealed that about 60% percent of affected population were vaccinated in single dose of MMR, 10% received 2 doses of MMR, and about 30% whose immunization status was not known. More analysis of the situation was performed to identify the 30% of unknown immunization status showed that age group between years only received one dose in routine EPI and not targeted in any national immunization days (NIDs) or campaigns. The age group of the persons affected by the Bait kahel mumps outbreak (9-14 years) received only a single dose of MMR jeryl lynn vaccine, This outbreak affected a specific group mainly those who received only one dose of MMR vaccine. High vaccine coverage approximately 100% should be maintained for second doses. KEYWORDS: Mumps, Palestine, Hebron district, vaccine, IgM, IgG Abstract 107 Measesles outbreak in Ukraine 2017 R. Rodyna (1) 1. State Institution Public Health Center of Ministry of Health of Ukraine of Ukraine, Kyiv, Ukraine Measles problem remains important throughout the world as one of the causes of infant mortality in developing countries, despite the availability of high-immune vaccines. In , large outbreaks were registered in a number of African and European countries. A particularly worrying situation was in 2012 in Ukraine, when over three months more than 10,000 people fell ill. The last outbreak in Ukraine was registered in The goal of our work was to analyze the epidemic situation in Ukraine and find out the causes of the outbreak of measles in The analysis of measles incidence in Ukraine for the period 2001-beginning of 2017 has been conducted using analytical and epidemiological method. The incidence per population was calculated with statistic methods. Over the past 15 years, 3 epidemic bursts of measles (2001, 2006, and 2012) have been observed in the country, with periodic cycles of 5-6 years. In those years, the incidence increased by tens and hundreds of times. Thus, during the next epidemic recovery in 2012, there were about cases of measles, an intensive index of per population. In 2017 the projected, epidemic recurrence of measles in Ukraine has begun, which is primarily due to the low vaccination coverage among children. In the first half of 2017, there were 736 cases of measles in Ukraine (intensive indicator per 100,000 population - 1.7), 10 cases were registered for the same period last year (incount per 100, ), There is an increase in the incidence of 85 times. The unsatisfactory measles epidemic situation was due to the accumulation of a significant layer of non-immune population. KEYWORDS: measles, outbreak, epidemiological analisys, unsatisfactory epidemic situation.

63 Vaccine Preventable Diseases 29th November 2017 Session C Parallel / 63 Abstract 135 Evaluation of Measles surveillance system in Borno State, North-East Nigeria Batula Bishara Daggash (1), P. Nguku (1), L. Okeke (2) 1. Nigeria Field Epidemiology and Laboratory Training Program 2. National Stop transmission of polio, AFENET, Nigeria Measles cased based surveillance in Nigeria became fully functional in 2006 and was put in place to detect cases and outbreaks of measles. It involves immediate reporting and investigating any suspected case of measles using standard case definition. It aslo predicts outbreaks through identification of geographic areas areas that are at greater rsikand age grpoups that are susceptible. The objectives of the evaluation were to describe the attibutes of thr measles surveillance system in Borno State, to assess wheter the system is meeting its set objectives, to identify gaps in the system aand make appropriate recommendation for improving the system. We conducted the evaluation using the CDC's updated guideline for evaluating public helath surveillance systems, We identified and interviewed stakeholders using a structured questionnaire, reviewed relevant documents and analysed measles data from 2013 to Measles surveillance in Borno State was flexible, simple to use, representative, stable but not sensitive. Annualized Non mealses febrile rash illness rate of 7.5/100,000 in 2016, 8.05/100,000 in 2015, 6.8/100,000 in 2014 & 8.4/100,000 in Predictive value positive was low throughout the period under review (13.5% in 2016, 22.9% in 2015, 36.3% in 2014 & 48.5% in 2013). Data quality was poor (18% complete variables in 2016,60.2% in 2015, 16.5% in 2014 and 21.1% in 2013) The quality of data generated directly affects policies and planning of immunizaton campaigns. Therefore, retraining of stakeholders on correct and complete data entry is neccessary. The sensitivit of the system should be improved. KEYWORDS: Measles, Surveillance evaluation, Borno State, Nigeria Abstract 153 Evaluation of Acute Flaccid Paralysis (AFP) Surveillance System in Khyber Agency Federally Administrated Tribal Areas (FATA) Pakistan M Hakim (1), M Saleem (1) 1. FETP: Pakistan FELTP FATA has set up of AFP surveillance system for immediate case investigation and specimen collection for detecting wild polio virus. The goal is polio eradication. Khyber Agency shares borders with Afghanistan and Peshawar due to which remains a major reservoir of polio virus and has contributed 76 cases in The purpose of this evaluation is to identify the weaknesses and strengths of this system to formulate recommendations. CDC s updated guide lines for evaluation of public health surveillance system were followed and a descriptive study was carried out in May 2015 to evaluate the system s functioning in Literature was studied, records were reviewed in Khyber Agency health department, stakeholders were identified and information was obtained through a designed questionnaire based on system attributes by conducting in depth interviews with the stakeholders. System was found simple; stable and flexible. Representativeness was average. Sensitivity was 100% while predictive value positive was 48.10%.Cases with adequate stools were 128 (81%). Completeness and timeliness of report files were 26 (86.66%).Case investigations within 48 hours of report 156(98.73%). Stool specimens collected within 14 days of paralysis onset 128(81.01%). Percentage of AFP cases with 60 days follow-up by 90 days after onset 58(36.70%). AFP surveillance system in reality is not achieving as envisioned objectives due to the security compromised situation. The system needs improvement in logistics planning, data management, data quality including completeness and analysis. High sensitivity was due to the broad case definition to avoid missing any case. Regular field /desk reviews of system are required. Refresher training for health practitioner and community involvement were recommended. KEYWORDS: Acute flaccid paralysis, Surveillance, Polio, FATA, Pakistan

64 64 / Vaccine Preventable Diseases 29th November 2017 Session C Parallel Regional contributions and synergies for Global Health Security Abstract 157 Evaluation of Acute Flaccid Paralysis (AFP) Surveillance System in District Peshawar, Khyber Pakhtunkhwa, Pakistan Mian Asim Shah (1) 1. Field Epidemiology and Laboratory Training Program (FELTP) Pakistan Acute Flaccid Paralysis (AFP) surveillance is one of the four key strategies to interrupt the transmission of wild poliovirus. AFP surveillance system identifies polio cases through a system that targets any AFP case as a potential case of polio. AFP surveillance system in Khyber Pakhtunkhwa was established in Peshawar remains a major reservoir of polio virus and has contributed 29 cases in The study aimed to evaluate the AFP surveillance system in Peshawar to identify components that require strengthening. CDC s updated guidelines for evaluating public health surveillance system 2001 were followed. Descriptive study was conducted in May Major stakeholders were identified and interviewed through Semi-structured questionnaire. Qualitative & quantitative assessment of AFP surveillance system attributes was based on literature review, reports, analysis of data sets and discussions with stakeholders. System was found simple, flexible, stable and representative. Sensitivity was 100% while predictive value positive was 16.6%. 114 (78%) cases were found with adequate stools and 100 (68%) cases notified within the 07 days of onset of paralysis. Incompleteness of case files, poor data management and analysis at the district level, inadequate logistics and feedback were the major weaknesses. Health care providers lacked basic training regarding early case detection and the reporting. AFP surveillance system met set objectives but needs improvement in logistics planning, data management, data quality including completeness and analysis. High sensitivity was due to the broad case definition to avoid missing any case. Feedback from national and provincial level to the districts needs to be monitored including timely laboratory results. Regular field / desk reviews and trainings for early case detection are required. KEYWORDS: Acute flaccid paralysis, Surveillance, Polio, Peshawar, Pakistan Abstract 94 Evaluation of measles and rubella surveillance system in Republic of Moldova, Alexei Ceban (1,3), V. Bucova (1), N. Caterinciuc (1), V. Gutu (1), A. Zaghloul (2) 1. National Centre for Public Health, Republic of Moldova 2. MediPIET Scientific Coordinator 3. Mediterranean Programme for Intervention Epidemiology Training (MediPIET) To achieve elimination of measles and rubella and to maintain interruption of indigenous transmission, proper vaccination coverage only is not sufficient, but also an efficient surveillance system must to be in place. We performed an evaluation of measles and rubella surveillance system in Republic of Moldova to ensure that data collected meets the proposed objectives of surveillance system. The performance of surveillance was evaluated according to European Centre for Disease Prevention and Control guidelines. We described the system and assessed completeness, representativeness, and timeliness using data from surveillance system and reference documents. For simplicity, flexibility and acceptability we used a standardized questionnaire for personal from local, intermediate and national level. Last reported cases of measles were in 2014 and for rubella last recorded cases in Surveillance system covered the entire domestic population and visitors. The completeness of the system with no missing reporting data fields constituted 97.4%. Timeliness was 71.2% and represented the reports which were transmitted to the upper level in 24 hours. Rate of laboratory investigations for all suspected cases was 100%. Were questioned 172 personal from all levels for qualitative variables, 71% considered the structure and data flow simple, and accepted the format of the surveillance system, but only 49% were flexible to work with new updated case definition, new laboratory diagnosis and an upgraded electronic system. The reporting of cases in the measles and rubella surveillance system is complete, timely and lab results are available. Feedback to the reporting bodies should likewise be disseminated in a timely manner at all levels thereby encouraging participation and involvement for detection improvement with proper public health response and intervention. KEYWORDS: measles, rubella, surveillance system, immunization

65 Vaccine Preventable Diseases 29th November 2017 Session C Parallel / 65

66

67 Session D Parallel Antimicrobial Resistance

68 68 / Antimicrobial Resistance 29th November 2017 Session D Parallel Regional contributions and synergies for Global Health Security Abstract 52 Acute respiratory infections among Schoolchildren: how often do we use the antibiotics Yerevan, ARMENIA 2017 Gennady Palozyan (1) 1. National Center of Diseases Control and Prevention, Ministry of Heath, Yerevan, Armenia Acute respiratory infections in children are mainly (90%) of viral etiology. Over the counter availability of antibiotics in developing countries leads to uncontrolled use by parents. The aim of the study was to identify parent methods of ARI treatment of schoolchildren of different ages. We conducted a random sample survey of parents of 185 schoolchildren (6-17 years) in 9 schools in Yerevan. Respondents were chosen among children who were ill during last month. A standardized questionnaire was developed and distributed to parents. Out of 185 respondents, 72 (39%) did not apply to the doctor. With increasing age, the number of applications decreased from 63% to 52%. 53 (29%) respondents used antibiotics and 17 (32%) of them did not recognize they were antibiotics. Higher the age of children, lower the rate of antibiotic use: 32% in 6-7 years old, 22% in years old. In low-aged schoolchildren penicillins, macrolides and cephalosporins were used more frequently, but in high-aged sulfanilamides. 83 (45%) enrolled persons are not aware that antibiotics have no influence on viral infections, 66 (36%) did not know that antibiotic resistance may occur. 125 (68%) respondents usually take antibiotics as long as prescribed by doctor, 48 (26%) are against getting antibiotics only by medical prescription. This is the first antibiotic use survey in Armenia which showed a high incidence of uncontrolled antibiotic use. Proper education is needed, especially among school and preschool children s parents, about indications of antibiotic use, antibiotic resistance and its outcomes. KEYWORDS: antibiotic overuse, antibiotic resistance, children Abstract 5 Pomegranate Peel Total Extract and Purified Tannin Extract Disinfectant Properties, an Experimental Study, Jordan 2017 Ghazi Sharkas (1), E. Sharkas (2), N. Karablieh (3), Y. Bustanji (4), L. Alolimi (5), R. Ghanem (6), G. Wahdani (6), S. Jabateh (7) 1. Epidemiologist, Director of Planning and Project Management, Ministry of Health, Jordan. 2. The Innovators International Academy, Jordan. 3. Assistant Researcher, Hamdi Mango Center for Scientific Research, University of Jordan. 4. Faculty of Pharmacy, Professor, Director of Hamdi Mango Center for Scientific Research, University of Jordan. 5. Hamdi Mango Center for Scientific Research, University of Jordan. 6. Central Laboratories, Ministry of Health, Jordan. 7. Director of Human Resources Development, Ministry of Health, Jordan. Discovering new substances with antimicrobial properties compensates for the increased antimicrobial resistance, and enhances epidemics control. This experimental study aims to examine Pomegranate Peels (PP), and Tannin extracted from them as natural source materials for hypothesized disinfectant properties. Tannin was extracted from PP using High Performance Liquid Chromatography. After PP extracts were diluted, bacterial strains were prepared from reference cultures, mixed with NaCl solution, and placed in a spectrophotometer to obtain absorbance of each strain. Bacterial steaks were pipetted then spread in agar plates. Four holes were created on the media, labeled and filled with Tannin, PP, Ethanol and water separately. The inhibition zones were measured in mm after 24 hours of incubation. A total of 57 samples (19 bacterial strains, three replicates per strain) were examined for the effect of PP and Tannin. Out of 18 strains, 11 were gram negative (GN), and 8 were gram positive (GP). PP and Tannin have inhibited growth in all experimented GP replicates, and many GN replicates except for Klebsiella-Pneumonia-ATCC ,Moraxella-Catarrhalis,Enterobacter, and Citrobacter. The strains with the largest average inhibition zones after PP in mm were Corynebacterium-diphtheria (29.6), Proteus- mirabilis (19.3), Bacillus-subtilis (17.6), Staphylococcus-aureus-ATCC (17.3), E.coli- ATCC (17.3), and Helicobacter-Pylori (17.3), Whereas, those with the largest average inhibition zones after Tannin were Corynebacterium-diphtheria (29.6), Bacillus-subtilis (18.6), E.coli-ATCC (18), Staphylococcus-aureus-ATCC (16.3), and Proteus-mirabilis (16.3), all in decreasing order. PP and extracted Tannins have demonstrated considerable antibacterial activity against several types of GP and GN bacteria. These substances could serve as natural disinfectants free of the potential side effects of chemical antimicrobials. Large scale experimentation on more bacterial species and other pathogens like fungi and viruses is recommended to consider manufacturing PP and Tannin as antimicrobials. KEYWORDS: Pomegranate peels, Extract, Tannins, Disinfectant, Bacterial Growth

69 Antimicrobial Resistance 29th November 2017 Session D Parallel / 69 Abstract 87 Hospital prophylactic antimicrobial prescribing: Data from the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global -PPS 2015) in Skopje Erjona Shaqiri (4, 5), Sh. Memeti (1), N. Panovski (2), D. Osmani (1), A. Versporten (3), H Goossens (3), G. Boshevska (1), V. Velikj Stefanovska (4, 5), L. Ballazhi (1), Z. Mustafa (1), M. Petrovska 1. The National Institute of Public Health, Skopje, Macedonia. 2. Insitute of Microbiology and Parasitology, Faculty of Medicine, University " St. Kiril and Metodij", Skopje, Macedonia. 3. Laboratory of Medical Microbiology, Vaccine and Infectious Diseases Institute(VAXINFECTIO), Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium. 4. Department of Epidemiology and Biostatistics, Medical Faculty, University "St. Kiril and Metodij", Skopje, Macedonia. 5.Mediterranean Programme for Intervention Epidemiology Training (MediPIET) Antimicrobials are widely used in hospitals for both treatment of infections and prophylactic purposes. Point prevalence surveyes are a good tool for gathering information regarding antimicrobial use in hospitals and setting targets for improved prescribing. The aim of this study was to analyze hospital prophylactic antimicrobial prescribing and to identify targets for improvements. The standardized and validated protocol of Global PPS for antimicrobial consumption and resistance was used for collecting data from 12 clinics with total 1005 beds in Skopje. The study was conducted from March to August Data of patients receiving antimicrobials for prophylactic purposes on the day of survey were analyzed. Out of 527 antimicrobials administered on the day of survey, 49.7% (n=262) were applied for prophylactic purposes; 26% (n=68) for medical prophylaxis-mp and 74% (n=194) for surgical prophylaxis- SP. Third - generation of cephalosporins (59.5%, n=156) were the most frequently prescribed antimicrobials for both MP (23.5%, n=16) and SP (72.2 %, n= 140). Three most used antimicrobials for MP were ciprofloxacin (19.1 %), sulfomethoxazole and trimethoprim (17.6%) and amikacin (13.2%). The three most used antimicrobials for SP were ceftriaxone (66.5%), clindamycin (7.7%) and metronidazole (6.7%). The guideline for surgical prophylaxis were mostly missing; only 20.5 % of drugs prescribed for medical prophylaxis were based on guidelines % (n=185) of antibiotics prescribed for SP were administered for >1 day. The rate of reporting stop/review date for both MP and SP was 100%. The absence of guidelines, prolonged surgical prophylaxis and high use of third- generation cephalosporins for surgical prevention, which can lead to propagation of highly resistance bacteria, were identified targets for intervention. KEYWORDS: Point prevalence survey, antimicrobial consumption, prophylaxis, Macedonia Abstract 154 Antimicrobial Resistance of Klebsiella pneumoniae isolates from surgical hospitals in Kharkiv region, Eastern Ukraine, Tetyana Chumachenko (1), L. S. Makhota (2), T. O. Karlova (2), S. Yu. Pivnenko (2), T. I. Antusheva 1. Department of Epidemiology, Kharkiv National Medical University, Kharkiv, Ukraine. 2. State Institution Kharkiv Oblast Laboratory Center of the Ministry of Health of Ukraine, Kharkiv, Ukraine Klebsiella pneumoniae (KP) is the important cause of healthcare-associated infections. The growth of antibiotic resistance is a severe public health problem. The objective of the study was to research the frequency of isolation of KP strains from surgical hospitals in Kharkiv region, to evaluate antibiotics resistance rate in KP isolates and to assess the changes in the resistance rate in We examined the results of antibiotic resistance tests of 29 bacteriologic laboratories. The samples were collected from 30 surgical healthcare settings in the Kharkiv region for (49,1%) strains of KP were isolated according to CLSI guidelines and tested with disk diffusion method. In the Kharkiv region the frequency of KP isolation in surgical hospitals increased from 3.3% (CI: 2.9; 3.8) in 2013 to 6.7% (CI: 6.0; 7.5) in KP strains were more often isolated from urine than from wounds and blood. Proportion of KP strains among all isolates were 11,0% in 2013, 10,3% in 2014, 6,2% in 2015, 15,8% in We found an increase of the percentages of KP resistance to multiple antibiotics from 46,3% in 2013 to 71,7% in Percentages of resistant isolates to fluoroquinolones raised from 5,6% in 2013 to 12,5% in ,6% and 46,7% of KP strains were sensitive to Ceftriaxone (third-generation cephalosporins) in 2013 and 2016 respectively. Percentages of resistant strains to carbapenems ranged from 76,9% (imipenem) and 31,9% (meropenem) in 2013 to 22,7% (imipenem) and 20,0% (meropenem) in In surgical hospitals of Kharkiv region antibiotic resistance of KP isolates increased in For patient safety it is necessary to implement of effective infection control measures and antibiotic stewardship in hospitals. KEYWORDS: Klebsiella pneumoniae, antibiotic resistance, fluoroquinolones, carbapenems, resistant strain, Ceftriaxone

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71 Session E Parallel Hepatitis B, C &HIV

72 72 / Hepatitis B, C & HIV 29th November 2017 Session E Parallel Regional contributions and synergies for Global Health Security Abstract 43 Evaluation of the Pilot Stage of the National Plan for Hepatitis B Birth-Dose Introduction in the National Immunization Schedule- Egypt, From August to December, Ihab Mohammed Basha (1), S. Azab (1), S. Samy (1), M. Genedy (1), A. Eed (1), A. Kandeel (1) 1. Ministry of health and population Egypt. Egypt introduced Hepatitis B birth dose(hbbd) in September 2014 through nign phases-plan, including pilot phase (eight governorates). HBBD is a main pillar in hepatitis viruses-national elimination plan. The study aimed to estimate HBBD feild coverage, to evaluate HBBD parents' knowledge and to identify non-vaccination causes. A cross-sectional survey using house-hold Non-proportionate stratified cluster technique. Independent monitors interviewed 1760 Parents at eight governorates. The questionnaire covered HBBD vaccination status, HBBD parents' knowledge, non-vaccination causes, mother educational status. We used Excel 2010 in data entry, and Epi- Info7 for analysis. Stratum weight was calculated using annual births. The outcomes were to identify estimated field coverage (EFC) at governorate level, percentage of mothers informed during the antenatal care about the HBBD, and the association between being unvaccinated, and suspected risk factors. Monitors reviewed Vaccination registers and calculated reports' completeness at health units. EFC of HBBD at the eight governorates was 92%(1619/1760), confidence interval (C.I.) (CL95%,87%-95%), 96%(1554/1619) of them were vaccinated at the first 24hours after birth. The administrative coverage (88%) within the C.I. of EFC. Completeness of vaccination registers was 82%(CL95%,75%-86%). The lowest EFC governorate was Alexandria 79%(173/220), while the highest was Elfayoum 95%(209/220). EFC at urban, and rural was 94%, and 96%,respectively. The non-vaccination main cause was parents' HBBD ignorance 74%(104/141). Parents knew HBBD before delivery were 60%(1043/1750). The main source of parents' knowledge was physicians 35%(365/1043). HBBD informed mothers during antenatal-care were 46%(740/1610); (CL95%,39%-54%). Odds of being HBBD non-informed mother was 4.7(CL95%,3-7,P-value <0.01) times higher among unvaccinated than vaccinated babies. HBBD administrative coverage reflects field coverage. Parents' knowledge about HBBD, and educating mothers about HBBD during antenatal care needed to be strengthened. Abstract 104 The Prevalence of Hepatitis B and C among Patients with End Stage Renal Disease Undergoing Hemodialysis- Jordan 2015 Fatima Zohra Mustafa Zerriouh (1), Salem EL-Qaisi (2), Kamel Argoub (3), Haytham AL-Shoqirat (4), Youcef Khader (5) 1. Field Epidemiology Training Program / Community Medicine Residency Program, Ministry of Health, Jordan. 2. Ministry of Health, Jordan. 3. Ministry of Health, Jordan. 4. Ministry of Health, Jordan. 5. University of Science and Technology, Jordan The prevalence of End Stage Renal Disease (ESRD) has almost doubled within the past 2 decades. In Jordan, Age Standardized Incidence Rate of ESRD was 76.2/ population in 2015 with a proportional mortality of 5.6%. Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) are lead causes of morbidity and mortality among hemodialysis patients. This study aimed to determine the prevalence of HBV and HCV infections in patients with ESRD in Jordan, 2015 This study was based on the National Registry of ESRD where records of Hepatitis B and C serology are reported from 75 affiliated dialysis centers in Jordan. This study included all patients who were registred in the ESRD registry and underwent dialysis till Non Jordanians were exluded. Data on hepatitis B and C serology status, age, gender, governorate, were obtained. Atotal of 4690 patients with ESRD were registred in HBV and HCV serology status was known for 4520 (96%) and 4544 (97%) patients, respectively. Male to female ratio was 2:1 for HBV and 1:1 for HCV. The mean (SD) age for patient with HBV and HCV was 56 (16) and 55(17) years, respectively. The prevalence rates of HBV and HCV were 1.2% (95% confidence interval CI: 0.8%- 1.6%) and 8.1% (95% CI: 7.3%-8.9%), respectively. No significant differences were seen between males and females for HBV (1.3% vs 1.0%, respectively) and HCV (7.2% vs 10.0%, respectively). The prevalence rates of HBV and HCV varied significantly between country governorates. HBV and predominantly HCV infections continue to affect a significant number of ESRD patients undergoing hemodialysis. vaccination and infection control are essential to reduce the burden of such infections. KEYWORDS: Hepatitis B, Hepatitis C, End Stage Renal Disease, Prevalence, Jordan. KEYWORDS: Hepatitis B Birth-dose, Egypt, Evaluation

73 Hepatitis B, C & HIV 29th November 2017 Session E Parallel / 73 Abstract 16 Genotype Distribution of Hepatitis C Virus Infection in Palestinian West Bank, 2014-May 2017 Issa Shtayeh (1), A. Fathi (1), N. Fatouni (1), A. Amer (1), H. Alami (1), and F. Salameh (1) 1. Molecular Diagnostic Division, Central Public Health Laboratory - Ministry of Health Hepatitis C virus (HCV) infection is a worldwide concern and it is the major cause of liver disease. There are currently six common genotypes which vary with geographical regions. Genotype identification is important for the prediction of treatment response and clinical outcomes. Therefore, this molecular study was conducted to investigate the prevalence of genotype distribution of HCV in Palestinian West Bank districts. In this cross-sectional study, 127 chronic HCV patients, with detectable HCV RNA serum samples level, during the period 2014 till end of May 2017 were enrolled. Samples were included all districts of Palestinian West Bank. HCV genotypes were determined using a Real-Time PCR based genotyping kit. Frequency of genotypes was assessed according to gender, age and geographical region at the time of sampling. The mean age of the patients was 50.3 ±16.5 years. 52.8% of cases were male and 47.2% were female. Genotyping results demonstrated that genotype 1 (44.1%) was the most prevalent HCV type with the predominant subtypes 1a (30.7 %) and 1b (13.1 %). The second most detected genotype was genotype 4 (41.7%), followed by genotype 3 (11.8%). Genotype 2 was detected only in one patient (0.8%). Two subjects (1.6%) revealed mixed infections by two different genotypes: 1 and 4. Genotype 1 and 4 followed by genotype 3 were found to be the most prevalent HCV genotypes in Palestinian West Bank. This study established the base for HCV molecular epidemiology in Palestine, where it may facilitate treatment options and preventive strategies. Extensive and large scale studies are needed to understand the epidemiology of HCV genotypes, and disease prognosis of those HCV chronic patients. KEYWORDS: Hepatitis C Virus. Genotypes. PCR, Palestine, West Bank Abstract 84 Evaluation of Hepatitis B vaccination status among Health care workers EL-Mahalla El- Kubra General Hospital, Gharbia Governorate, Egypt, June-July 2015 Shereen Elghazaly (1), I. Kabbash (2), S. Refaey (1) 1. Department of Epidemiology and Surveillance, Ministry of Health and population, Egypt 2. Public health, community medicine department, Faculty of medicine, Tanta University, Egypt Hepatitis B is a major universal health problem. Healthcare Workers (HCWs) are at high risk of Hepatitis B Virus (HBV) infection due to repeated exposure. It can be prevented by currently available safe and effective vaccine. This study was done to assess the vaccination status of hepatitis B among Health care Workers in El-Mahalla El-Kubra General hospital, identify the motives difference of vaccination and estimate the percentage of vaccinator and the reasons of refused vaccination. A cross sectional study was conducted among 407 HCWs using stratified cluster random sampling technique. Data were collected using a self-administered questionnaire consisted of 19 questions on socio-demographic characteristics, exposure to blood and/or blood products, hepatitis B vaccine status, complete dosage of hepatitis B vaccination, and reasons for complete vaccination, partially vaccination and not vaccination. Data were entered and analyzed using Microsoft Excel. Of 407 HCWs, 79% were vaccinated with 80% of females and 74% of males were vaccinated. Among vaccinated, 92% were convinced with vaccine importance while 8% considered it a routine procedure. Furthermore, only 20% were partially vaccinated and the main causes of not completing doses were either forget its time (38%) or the vaccine doses were unavailable (25%). However the main cause of being not vaccinated at all was fear from injection (31%). Vaccination status among nursing staff, doctors, and technical staff was 86.7%, 75%, and 70%, respectively. High percentage of Hepatitis B vaccination among Healthcare Workers at EL-Mahalla El-Kubra General Hospital was observed. Providing Hepatitis B vaccine with adequate doses and increasing the awareness of HCWs about the importance of having the vaccine are recommended. KEYWORDS: Hepatitis B, Hepatitis B vaccines, Health care workers, Egypt

74 74 / Hepatitis B, C & HIV 29th November 2017 Session E Parallel Regional contributions and synergies for Global Health Security Abstract 174 Hepatitis B in Tunisia in 2015: Prevalence and risk factors Meriem Ben Hadj (1), K. Talmoudi (1), A. Cherif (1), F. Saffar (1), H. Bouguerra (1,2), S. Chely (1), H. Ben Salah (1), N. Bouafif ép Ben Alaya (1,2) 1. National observatory of new and emerging diseases 2. Mediterranean Programme for Intervention Epidemiology Training (MediPIET) Hepatitis B virus (HBV) infection is a major public health concern. In Tunisia, national prevalence data on markers of HBV infection is needed in the Epidemiological context. The aim of this study was to assess national and regional prevalence of HBV infection in Tunisian population, as well as risk factors associated with HBV in Tunisia. We conducted a cross-sectional HBV prevalence survey in the general population, during the period of Januray 2014 to December The survey booklet included a household questionnaire. Every household member was invited to participate and complete the questionnaire in order to obtain consent and blood samples collected in the nearest healthcare center. Bivariate analysis was based on Khi-squared test. Statistical analysis were done with SPSS 20. Among individuals answered the questionnaire, had blood sample and the serological results reached to Overall prevalence of HBs Ag was 1.7% [ %]. Bivariate analysis revealed that chronic dialysis, traditional circumcision, a relative chronic carrier of HBV infection, use of razor in the hairdresser, history of scarification, past injection, several sexual partners, dental care, surgical intervention, hospitalization, and gender were significantly associated with HBV infection. Based on these results, 9.2% CI95% [2,8%-26,4%] of chronic dialysis individuals were exposed to HBV. Individual whose relatives are chronic carrier of HBV were 4.1% CI95% [3,2%-5,3%] susceptible to HBV infection. The frequency of HBs Ag was significantly higher in men (2,1% against 1,4% in female, p < 10-3). This study offers the possibility to evaluate the epidemiological situation of HBV infection in Tunisia. Although prevention is the most cost-effective method for controlling HBV infection, vaccination remains the best way to control this infection and its complications. Abstract 185 Risk factors of Hepatitis C infection in Tunisia 2015 Hind Bouguerra Hind (1,2), A. Lahchaichi A (1,2), S. Chelly (1), A. Cherif (1), F. Saffar (1), K. Talmoudi (1), A. Bahrini (1), T. Chouki (1), M. Belhadj (1), K. Chahed (1,2), H Ben Salah (1), A. Paez Jimenez A (2), N. Bouafif EpBen Alaya (1,2) 1. National Observatory of New and Emerging Diseases, Tunisia 2. Mediterranean Programme for Intervention Epidemiology Training (MediPIET) With acute and chronic viral hepatitis C (HCV) infection largely asymptomatic, most HCV goes undiagnosed. However, the new curative HCV treatments can both prevent hepatitis C deaths and interrupt transmission. In Tunisia, treatment with direct-acting antiviral drugs is available thanks to the national plan for HCV elimination since Since the appropriate protocol for screening should rely on evidence on current modes of transmission, this study aims to identify risk factors of HCV in the general population of Tunisia. All the subjects (22275) included in the national HCV seroprevalence survey in Tunisia were asked about potential risk factors for HCV transmission including transfusion, history of surgery and hospitalization, intravenous and intranasal drug use, suspected sexual contact, tattooing and scarification, dental procedures, common circumcision rituals and history of abortion. Data were entered in EpiData and analysed with SPSS-20. were adjusted to the 2015 population. In univariate analysis, the risk factors significantly associated with HCV infection were intravenous drug use (OR=28.99; 95%CI [ ]), intranasal drug use (OR=4.01 [ ]), hospitalization (OR=2.8 [ ]), traditional scarification (OR=2.14 [ ]), surgical intervention (OR=2.13 [ ]); dental procedures (OR =2.04 [ ]); history of blood transfusions (OR=1.98 [ ]), multiple sexual partners (OR=1.95 [ ]), traditional circumcision (OR=1.77 [ ]) and medical injections (OR=1.69 [ ]). Multivariate analysis is currently ongoing. Our results suggest main risk factors of HCV transmission in Tunisia are intravenous and intranasal drug use followed by healthcare-related factors and other lifestyle-associated factors. Thus the need to strengthen harm reduction programmes, education as well as standard precautions of hygiene in healthcare settings. Screening programmes among those at risk populations should be highly efficient. KEYWORDS: HBV infection, Risk Factors, Prevalence, Bivariate analysis KEYWORDS: Surveillance, Viral hepatitis C, Risk factor, Tunisia

75 Hepatitis B, C & HIV 29th November 2017 Session E Parallel / 75 Abstract 170 Intelligent multiagent simulation of HIV incidence and prevalence Dmytro Chumachenko (1), T. O. Chumachenko (2) 1. Department of Informatics, National Aerospace University Kharkiv Aviation Institute, Kharkiv, Ukraine 2. Department of Epidemiology, Kharkiv National Medical University, Kharkiv, Ukraine The task of studying the process of incidence spreading is important and the problem of predicting the dynamics of spreading of diseases, the consequences of their uncontrolled growth and the effectiveness of protective measures to prevent a high incidence rate is of particular importance. The aim of the study is to create an optimal algorithm for predicting the dynamics of the spread of HIV infection for a short time, based on the multiagent simulation method. To simulate the dynamics of HIV spreading, an algorithm based on the principles of agent modeling has been developed. The main idea of the method is the principle of decentralization. The behavior of agents is set at local level, and the dynamics of the system is defined as the result of the interaction of multiple agents. The simulation model of HIV spreading has been developed. The model consists of the following assumptions: there is a possibility of interaction between any agents in the system; unit of time is one iteration; countdown starts from zero; the time step is equal to one; all agents are divided into types; system of rules is determined for each type of objects. The software implementation is performed using C# programming language. The result of the program allows building the predicted incidence of HIV infection based on real statistics. The results of simulation show that the spreading of HIV infection is periodic. If the simulation continues for a longer period, we can observe a tendency to decrease the number of new cases in each epidemic period, however, the HIV prevalence tends to increase. KEYWORDS: HIV infection, epidemics, incidence, models, software Abstract 184 Surveillance data analysis of HIV/AIDS in Tunisia from 1985 to 2015 Hamdouni Hayet (1), N. Bouafif (2), S. Mrad (1), Z. Ben Mansour (1), S. Boukhris (1), H. Trabelsi (1) 1. Primary health care directorate 2. National Observatory of New and Emergent diseases Acquired Immunodeficiency Syndrome (AIDS) remains a problem of public health. HIV / AIDS surveillance data analysis in Tunisia was made in order to determine the dynamics and determinants of the epidemic. Most recent epidemiological data were analyzed with cross-reference of the different sources of information (triangulation) as data of notifications, other NAP resources, blood donors data, Bio-behavioral surveys and estimates of UNAIDS. Since the first case in 1985 and until 31 December 2015, a cumulative number of 2193 cases of HIV / AIDS. The prevalence was 0.014%. Despite the overall trend in stabilizing the incidence of HIV / AIDS, there have been three periods of change: : trend to increase to a first peak of 1.05 / 100,000 Inhabitants : downward trend with an incidence of 0.51 / 100,000 Inhabitants in : tendency to increase to 1.4 / 100,000 inhabitants in The proportion of AIDS cases decreased since 2004, sex ratio has been declining. 34% of new infections occurred among people under 30years. The main transmission mode for men was intravenous drug use before 1995 and heterosexual transmission from 1996 to However, for women, heterosexual transmission was usually the main mode. The epidemic was characterized as concentrated, based on three bio-behavioral studies showing an HIV prevalence among MSM greater than 5%. The HIV epidemic in Tunisia is similar to that in Maghreb region and Middle East. It is with low prevalence in general population, concentrated among key populations. Interventions should target the most affected populations and sittings to reach the end of the epidemic as foreseen by OSD. KEYWORDS: HIV/AIDS, Epidemic, Analysis, Tunisia

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77 Session F Parallel Influenza, SARI

78 78 / Influenza, SARI 29th November 2017 Session F Parallel Regional contributions and synergies for Global Health Security Abstract 95 Increasing incidence of pertussis in Republic of Moldova, 2016 Alexei Ceban (1,3), V. Bucova (1), L. Turcan (1), V. Gutu (1), A. Zaghloul (2) 1. National Centre for Public Health, Republic of Moldova 2. MediPIET Scientific Coordinator 3. Mediterranean Programme for Intervention Epidemiology Training (MediPIET) In 2016 were detected an increasing number of pertussis outbreaks in different administrative territories from Republic of Moldova. A study was conducted in order to determine the nature and epidemiological situation of pertussis in Moldova. We reviewed and analyzed pertussis surveillance records, conducted active case finding, and described the pertussis cases from Specific IgM antibodies of patients were investigated by the method of enzyme immunoassay. A total of 210 from 280 cases of pertussis reported in 2016 were analyzed. The incidence rate in 2016 was 7%000, from which 68.1% of cases were aged from 0 to 6 years, 27.1% were school age children and 4.8% were adults. We registered a later uptake of medical care, with an average of 10.5 days after onset of the disease. Also we established a late diagnosis after addressing for medical care, in 42.9%, the diagnosis was established after the second week or later. The bases of the diagnosis of pertussis in 73.1% of cases served laboratory data. Specific IgM antibodies were detected in 77.0% of patients. Among patients <1 year, 14.9% were under the age of vaccination, 34.0% received 1-3 doses of vaccine, 46.7 were not vaccinated, and 5.2% had no data. From children patients who received a full course of vaccination against pertussis, 25.0% had been vaccinated 1-2 years ago and other 25.0% became ill after 3-4 years after immunization. Children <6 years are mainly affected, but also school age children and adults are involved more often in pertussis transmission. Late diagnosis and uptake of medical care contribute to the spread of pertussis. Training of medical staff is need for increasing vigilance and uptake public health measures. KEYWORDS: pertussis, incidence, surveillance, immunization. Abstract 160 Proportion of hospital admissions related to influenza-associated Severe Acute Respiratory Infections (SARI) in five sentinel sites in Lebanon, Majd Saleh (1), L. Bazzi (2), E. Ismail (3), O. Kiwan (4), R. AlAhmad (5), R. Saidy (6), L. Mroueh (7), N. Jammal (7), P. Mrad (8), A. Rady (8), P. Zalloua (7,9), N. Ghosn (1) 1. Mediterranean Programme for Intervention Epidemiology Training (MediPIET), Epidemiological Surveillance Program, Ministry of Public Health. 2. Saida Governmental University Hospital. 3. Rafik Hariri University Hospital. 4. Ain Wazein Hospital. 5. Tripoli Governmental Hospital. 6. Zahleh Governmental Hospital. 7. National Influenza Laboratory, Rafik Hariri University Hospital, Beirut, Lebanon. 8. World Health Organization Lebanon Country Office. 9. Lebanese American University, Beirut, Lebanon In 2014, the Epidemiologic Surveillance Unit (ESU) in Lebanon launched its Severe Acute Respiratory Infection (SARI) sentinel surveillance system. Early findings suggested influenza circulation to be similar to that of neighboring countries with children under 5 years of age at higher risk. With scarcity of burden of influenza estimates in the Eastern Mediterranean, the ESU set out to identify the proportion of influenza associated SARI among all-cause hospital admissions. The study was conducted in five sentinel sites based on representativeness of the Lebanese provinces. Cases had been reported based on WHO s standardized SARI case definition. Data from 1 September 2015 to 31 August 2016 was reviewed and total numbers of allcause hospital admissions were obtained. Nasopharyngeal swabs had been collected and tested using influenza virus RT-PCR panel at the National Influenza Center. Descriptive and bivariate analysis were conducted using STATA 13. A further study to compare severity between two seasons will be conducted after 31 August The total number of reported cases was 1044, of which 98% were sampled and 14% were influenza positive. Influenza B accounted for the majority of positive cases (47%). The overall proportional contribution of influenza-associated SARI to allcause hospital admissions for the five sentinel sites was 0.16% [95%CI: ]. Stratified by sentinel site, highest proportion was shown in a southern province sentinel site specifically in children less two years of age (4.5% [95%CI: ]). Despite the lack of catchment population estimation, this study is the first step in understanding the burden of influenza in Lebanon. The findings can help prevention programs in Lebanon especially for the highest risk population, such as children less than two years of age. KEYWORDS: Influenza, respiratory infections, sentinel surveillance, burden of illness

79 Influenza, SARI 29th November 2017 Session F Parallel / 79 Abstract 166 Implementation of Influenza-Like Illnesses (ILI) Sentinel Surveillance in Lebanon Majd Saleh (1), L. Mroueh (2), N. Jammal (2), P. Mrad (3), A. Rady (3), P. Zalloua (2,4), N. Ghosn (1) 1. Mediterranean Programme for Intervention Epidemiology Training (MediPIET), Epidemiological Surveillance Program, Ministry of Public Health. 2. National Influenza Laboratory, Rafik Hariri University Hospital, Beirut, Lebanon. 3. World Health Organization Lebanon Country Office. 4. Lebanese American University, Beirut, Lebanon. Lebanon has entered its third year of implementing its Severe Acute Respiratory Infection (SARI) surveillance under the Pandemic Influenza Preparedness (PIP) framework. The World Health Organization (WHO) recommends coexistence of both SARI and Influenza-Like Illness (ILI) surveillance, to allow monitoring of patients seeking care in ambulatory facilities. Therefore, the Ministry of Public Health (MOPH) will be initiating ILI sentinel surveillance to complement SARI surveillance in identifying circulating influenza strains, describing influenza cases by time, place, person, and contributing to the global influenza surveillance. Potential medical centers from the eight Lebanese provinces will be visited and assessed based on feasibility, sustainability, and representativeness of the population. Once eight sentinel sites are selected a focal point will be assigned and trained for initiation. Cases will be identified based on WHO s ILI standardized case definition. Nasopharyngeal swabs will be collected for influenza testing at the National Influenza Center. Epidemiological and virological data will be reported through the online District Health Information Software(DHIS2). Potential time for initiating surveillance is October Once surveillance activities commence, generated outputs will include the following: Distribution of ILI cases and influenza positive cases by time, place, and person, tabulation of types of influenza circulating, mapping of cases and influenza types. This data will be shared in the form of bulletins posted on the MOPH website. Having two complementary national surveillance systems identifying influenza circulation is crucial for preventive programs especially among high risk groups. Initiation of ILI sentinel surveillance in Lebanon will be beneficial for understanding better the epidemiology and burden of influenza in the country. Abstract 76 Evaluation of sari sentinel surveillance system in Kosovo, Pranvera Kaçaniku-Gunga (1,3), A. Kalaveshi (1,3), I. Humolli (1,3), N. Ramadani (1), M. Rexhepi (1), A. Zaghloul (2) 1. National Institute of Public Health of Kosova 2. MedIPIET Scientific Coordinator 3. Mediterranean Programme for Intervention Epidemiology Training (MediPIET) Sentinel surveillance of Severe Acute Respiratory Infection (SARI) in Kosovo, is established in 2014 with its 5 sentinel sites in two main regions. Our aim was to identify the gaps of sentinel surveillance system from and provide recommendations for improvement. Datasets was used to assess data quality, completeness and timelines. Questionnaires designed with relevant indicators for representativeness, simplicity, acceptability, flexibility and utility. Categorical variables were expressed as percentage and the data were entered and analyzed in Excel. The scoring scale was 1 (weak), 2 (moderate) and 3 (good performance). We analyzed data from 500 SARI cases during Data quality and completeness with 23/24 variables, obesity as a risk factor missing in all records. All SARI cases had respiratory specimens collected within their first day of hospitalization. The laboratory results were available and given feedback within 1-2 days. The system covers 48,4% of the population. Questionnaire response showed (71%) of the participants perception is simple and easy, 22% answered that system is complicated, 72% responds that they are satisfied with the follow ups, 27% answered that they are very satisfied. The median time they spend in activities for the surveillance system IQR (1-3) hours. External quality assurance program was performed in selected samples with 100% accuracy. SARI sentinel surveillance system provides high data quality and timeliness but there is a need for trainings to improve reporting of risk factors, system should be expanded and include private sector. KEYWORDS: Evaluation, SARI, Sentinel Surveillance System, Kosovo KEYWORDS: Influenza, respiratory infections, sentinel surveillance, influenza-like

80 80 / Influenza, SARI 29th November 2017 Session F Parallel Regional contributions and synergies for Global Health Security Abstract 148 Evaluation of the ILI sentinel surveillance system - R. Macedonia, 2017 Dragan Kochinski (1, 3), G. Kuzmanovska (1, 3), V. Velikj- Stefanovska (2, 3), V. Mikic (1), L. Balazhi (1, 3), G. Boshevska (1), K. Stavridis (1), S. Memeti (1, 3), A. Zaghloul (3) 1. Institute of Public Health, Skopje, R. Macedonia 2. Institute of Epidemiology and Biostatistics with medical Informatics, Medical Faculty Skopje, UKIM, Skopje, R. Macedonia 3. Mediterranean Programme for Intervention Epidemiology Training (MediPIET) Seasonal influenza is an acute respiratory infection caused by influenza viruses. Influenza is a notifiable disease in R. Macedonia from In 2014/2015 season, sentinel surveillance of Influenza like Illnesses (ILI) and Acute Respiratory Infection (ARI) was initiated. The aim of this paper is to evaluate the acceptance and the quality of obtained data of ILI sentinel system in R. Macedonia. The evaluation was conducted according to CDC guide. Data quality, completeness, timeliness and representativeness were analyzed through existing epidemiological and laboratory databases for the seasons 2015/2016 and 2016/2017. Web-based questionnaire for ILI sites, to analyze simplicity, acceptability and stability was created and applied. Quantitative and qualitavie indicators were scored in 3 grades: weak, moderate and good performance. from web-based questionannaire showed that the sentinel system is acceptable in 85.7%. About 70.4% of the total expected data-collection forms were received fully completed but only 66.7% were received timely. 95.1% of ILI cases were sampled with available laboratory results. From the total site stuff, 71.4% find the system easy to work and taking <30 minutes. Each member of the ILI stuff was trained and 57.1% responded that they do not need further traininig. The mean general assessment by ILI sites was 8.3/10. Analysis of the qantitative indicators for data quality showed that 61.5% of the indicators were with good and 17.9% with moderate performance. Moving Epidemic for analyzes used for one season. The sentinel system is well accepted, usefull and flexible. Improving ILI surveillance will require elctronic data collection on timely manner as well as modifications of lab-epi databases for timely assessment of data quality and further analyzes. Abstract 162 Evaluation of sentinel surveillance system of influenza in Republic of Moldova, Dumitru Capmari (1,3), N. Caterinciuc (1,3), S. Gheorghita (2), A. Zaghloul (3), C. Spinu (1), A. Druc (1) 1. National Centre of Public Health from Republic of Moldova 2. World Health Organization, Country Office in Republic of Moldova 3. Mediterranean Programme for Intervention Epidemiology Training (MediPIET) Influenza surveillance in the Republic of Moldova includes routine and sentinel surveillance systems. The routine surveillance system collects cumulative data about cases of influenza, acute respiratory infections (ARI) and severe acute respiratory infections (SARI). Sentinel sites collect specific and non-specific indicators. The objectives are to evaluate the system regarding collection of information for completing reporting forms, data sources for the system, surveillance network, population coverage, geographical coverage, type of reporting. The analysis was done to determine the correctitude regarding the completeness of reporting forms. The determination of the system's timeliness, representativeness, sustainability and utility was performed by analyzing swab forms. The determination of the system's simplicity, accessibility, flexibility, and stability were made by using questionnaire. Between October 2014 and May 2017, 1615 Swab Forms were analyzed.24% had at least one missing variable. Only 87% of SARI diagnosis and 92% of ILI diagnosis corresponded to national case definitions. The sensitivity of the case definition is 84% for SARI, 99% for ILI and 78% for ARI. The Positive Predictive Value is 17% for SARI, 58% for ILI and 24% for ARI. The proportion of specimens that are analyzed and have final results in 72 hours is 91%. The simplicity of key surveillance activities is easy for 70% of sentinel surveillance personnel. Time to complete reporting form by week is one hour (30%), 2-3 hours (38%), 3-4 hours (17%) and >4 hours (15%). Sentinel surveillance system in Moldova has a good performance (85% for quantitative indicators and 80% for qualitative indicators). It needs to improve sections like: completeness of swab form, the number of transmitted samples, use of the case definition by physicians. KEYWORDS: influenza, ILI, sentinel, evaluation, R. Macedonia KEYWORDS: influenza, ARI, SARI, evaluation, sentinel system

81 Influenza, SARI 29th November 2017 Session F Parallel / 81 Abstract 83 Evaluation of SARI surveillance system in Serbia in season 2014/15 Milunka Milinkovic (1,2), Dragana Dimitrijevic (1), Anita Grgurevic (3,4) 1. Institute of Public Health of Serbia Dr Milan Jovanović Batut, Belgrade, Serbia 2. Mediterranean Programme for Intervention Epidemiology Training (MediPIET), fellow 3. Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Serbia 4. Mediterranean Programme for Intervention Epidemiology Training (MediPIET), supervisor The sentinel surveillance for severe acute respiratory infection (SARI) was established in Serbia in Data are collected and analyzed in the National Institute, from designated secondary and tertiary healthcare facilities. We conducted the first evaluation of SARI surveillance, with the aim to improve SARI surveillance. Weekly aggregated SARI reporting forms and case reporting forms of influenza positive SARI cases, from influenza season 2014/15 were used. Data from 2016/17 were used for the evaluation of flexibility. The updated guidelines of the Centers for Disease Prevention Control were followed. System attributes analyzed included: data quality (completeness, validity), timeliness and flexibility. Overall, 125 weekly aggregated reporting forms and 152 case reporting forms of influenza positive SARI cases were analyzed. Timeliness of reporting was confirmed for 87.2% of SARI weekly aggregated data forms. For case based forms, the median time from onset of disease to laboratory confirmation was 6 days (1-18) and from laboratory confirmation to the notification, 1day (0-16). Completeness of aggregated reporting forms was not evaluated in terms of the frequency of blank fields. Instead, we identified that the blank fields were given the value zero irrespectively of the variable. Both, timelines and completeness of data were at 100% after the modification of the system in the 2016/17 season. Completeness of data was 100% for the 92% of the variables included in the case reporting form. Adherence to the case definition was 73%. The SARI surveillance system in Serbia presents with satisfactory completeness, timelines and flexibility. Sari surveillance could be further improved by applying the electronic reporting system and by additional raising awareness activities addressed to the reporting health professionals. Abstract 119 Screening for influenza and other novel viruses among returning Egyptians pilgrims Hajj 2016 Manal Labib Fahim (1), A. Mohsen (2), A. Naguib (1), E. Adly (1), A. Kandeel (1), S. Refaey (1) 1. Department of Surveillance & Epidemiology MOHP-Egypt, 2. National research center -Egypt. The Hajj pilgrimage to Saudi Arabia is the largest pilgrimages in the world, with 3 million participating annually from 180 countries, providing the potential for emerging epidemics. We aimed to assess the risk of influenza virus infection and transmission of new novel viruses among returning Egyptian pilgrims,2016. A cross sectional survey was conducted by Ministry of Health and Population at Cairo International and Borg El Arab Alexandria Airports. Survey was carried out daily on 5 working days in the peak of returning period, Sample size was calculated using the OpenEpi calculator taking into consideration the risk of influenza as 50%, a sample of 765 will provide 95% confidence interval and precision of Sample size was inflated by 20% to give 918. After providing verbal consent, pilgrims were interviewed. Nasopharyngeal and oropharyngeal swabs were collected and sputum was taken from Hajji with productive cough. Specimens were tested by RT-PCR for MERS-CoV and influenza. Data was analyzed using Epi-Info Of 1106 persons surveyed (884 from Cairo and 222 from Borg ElArab Airports),1048 were enrolled (~96%). All specimens tested were negative for MERS-COV. Lab-confirmed influenza was found in 91(9%) of them, from which Influenza A/H3 constituted 67(74%) followed by Influenza B 24(26%). 386(37%) of 1048 Hajj were influenza vaccinated, with no significant difference between lab-confirmed influenza cases and those who tested negative regarding vaccination status (p>0.01). There was significant relationship between having acute respiratory symptoms and influenza positivity (p<0.01). Influenza viruses played a role in the development ofacute respiratorydiseases among Egyptian pilgrims. Pre-travel awareness campaign to enhance compliance to influenza preventive measures is needed. KEYWORDS: Cross Sectional Survey; MERS-CoV; Middle East Respiratory Syndrome Coronavirus KEYWORDS: Evaluation, SARI, Serbia, surveillance

82 82 / Influenza, SARI 29th November 2017 Session F Parallel Regional contributions and synergies for Global Health Security Abstract 112 Epidemiological aspects of influenza, Acute Respiratory Infections and Severe Acute Respiratory Infections Republic of Moldova, Alina Druc (1), C. Spinu(1), S. Gheorghita(1), D. Capmari(1,2), I. Spinu(1), M. Apostol(1) 1. National Center for Public Health, Republic of Moldova. 2. Mediterranean Programme for Intervention Epidemiology Training (MediPIET) The impact of influenza has been recognized for centuries. Acute respiratory infection is a leading cause of mortality worldwide. The National Surveillance System based on Influenza-likeillness (ILI), Acute respiratory infection (ARI) and Severe acute respiratory infection (SARI) morbidity is adjusted to WHO, ECDC and CDC requirements. Epidemiological data were collected through the national surveillance system. Virological data were obtain based on molecular techniques (rrt-pcr) and isolation of influenza strains on MDCK cell culture. A total of 4232 (119.0/100000) cases of ILI were recorded in seasons. 47.3% of ILI cases were in with peak in week 09/2015, 26.0% in season, peak in week 06/2016 and 26.7% in last season, peak in week 51/2016. ARI morbidity in weeks 08-12/2015 was exceeding epidemic threshold (309.96/100000) peaking in week 09/2015 (621.3 by ), in weeks 05-07/2016 was exceeding threshold (313.96/100000) peaking in week 06/2016 (371.6/100000) and in weeks 50/ /2017 was exceeding threshold (311.19/100000) peaking in week 51/2016 (447.5/100000). In all three seasons, the ARI and SARI morbidity affected mainly age group 0-4 years. SARI morbidity was at 637.4/ cases in season to 794.2/ in last season. During , were 45 deaths of influenza-associated SARI in people with preexisting disease, unvaccinated. Influenza virus strains (A(H1N1)pdm09, A(H3N2), B) were isolated in MDCK-siat cell cultures belonging to different species of phylogenetic tree and all were susceptible to oseltamivir. The National Surveillance System makes it possible to monitor the evolution of epidemic process in relation to dominant/codominant influenza strains, antiviral susceptibility, their place in the phylogenetic tree which makes it possible to predict the epidemiological situation and to intervene promptly with response measures in crisis situations. KEYWORDS: influenza, ILI, ARI, SARI

83 Influenza, SARI 29th November 2017 Session F Parallel / 83

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85 Session G Parallel Miscellaneous

86 86 / Miscellaneous 30th November 2017 Session G Parallel Regional contributions and synergies for Global Health Security Abstract 80 Evaluation of Surveillance System for Crimean Congo Hemorrhagic Fever, Kosovo, Fitim Raçi (1, 2), Isme Humolli (1, 2) Ahmed Zaghloul (2) 1. National Institute of Public Health of Kosova 2. Mediterranean Programme for Intervention Epidemiology Training (MediPIET) Crimean-Congo Hemorrhagic Fever (CCHF) surveillance system was launched in Kosova in We performed comprehensive evaluation of the system in order to identify gaps and overlaps and provide recommendations to overcome the constraints identified. This is a descriptive study in accordance with CDC Guidelines for Evaluating Surveillance Systems. We used the CCHF dataset and structured questionnaire to assess system attributes. Health personnel involved in surveillance was identified and interviewed. were expressed in percentage. From , 32 positive cases of CCHF (12,812 tick bites) were notified in Kosova (incidence=1.75/10.000; mortality rate 34.37%). Most affected are farmers (56%), 94% live in rural areas, 87% were male; mean age was 40 (9 74 years). Forms received within 24 hours reach 100%. Data quality and completeness of reporting forms is 81% (2013)-100% (2015): information about risk factors %, infection source known in 62% (53% tick, 9% contact). In 76% of cases ticks were removed at home. Specimens analyzed (100%) with results within target time frame 97.5% (2013)-90.2% (2015). According to our survey among staff, surveillance system is very easy (90%) and 84% of them regularly report tick bites/cchf (16% sometimes); 71% have not enough time to deal with surveillance (29% just enough time ) and 90% of them spend 2-3 hours daily for surveillance activities (during season). Proportion of staff satisfied with follow-ups is 100%. Though system has shown some major strengths, this evaluation identified opportunities for further improvements through raising awareness in rural settings, continuous training and increasing surveillance staff, improve reporting of risk factors, developing refined map for monitoring change in the distribution of CCHF and implementation of electronic reporting system. KEYWORDS: Evaluation of Surveillance System for Crimean Congo Hemorrhagic Fever, Kosovo, Abstract 171 The first cluster of Hantavirus hemorrhagic fever with renal syndrome in R. Macedonia Kristina Stavridis (1,3), V. Mikic (1,3), G. Boshevska (1), D. Kochinski (1,3), L. Ballazhi (1), M. Mela (2), G. Kuzmanovska (1,3) 1. Institute of Public Health of R. Macedonia 2. Public Health Center /Local unit Debar 3. Mediterranean Programme for Intervention Epidemiology Training (MediPIET) Hanta hemorrhagic fever with renal syndrome is a notifiable disease in Macedonia since Since then two sporadic cases were notified in 2009 and in In March 2017, IPH was notified for possible cluster of cases. We launched case investigation in order to identify possible source of the outbreak and to apply control measures and prevention of future cases. We conducted epidemiological investigation for three cluster cases and one sporadic case. Hantan virus serology was performed for laboratory confirmation. Close contacts of cluster cases were also investigated and laboratory tested. The three cases in the cluster are shepherds who were settled in sheepfold, in the same cottage and exposed to excrete of mice. The first case was 24 years old male hospitalized at Clinic for Infectious Diseases with symptoms of fever, high temperature, abdominal pain, diarrhea. Due to the development of acute renal failure, hemodialysis was indicated. The complication at the site of application of the venous catheter, bleeding and surrounding hematoma indicated intensive care treatment. Other two cases, was also hospitalized, developed less severe symptoms of fever, malaise, myalgia, abdominal pain. All three cases were discharged from a hospital in good general condition without consequences. In the same period, fourth case, admitted in severe health condition, but with good outcome was notified from the same hospital but in the different geographical region and could not be connected with previous three. Hanta hemorrhagic fever with renal syndrome is endemic in Macedonia. Identification of risk groups and continuous education of taking control measures are essential. Raising the awareness among health workers of the presence of the Hanta virus in the country is important. KEYWORDS: hemorrhagic fever, renal syndrome, cluster, hemodyalisis

87 Miscellaneous 30th November 2017 Session G Parallel / 87 Abstract 42 Colorectal Cancer in Jordan : Survival rate and its Related Factors Ghazi Sharkas (1), K. Arqoub (2), Y. Khader (3), M. Tarawneh (4), O. Nimri (2), M. Al-zaghal (2), T. Saheb (5), H. Subih (6) 1. Field Epidemiology Training Program, Director of Planning and Project Management, Ministry of Health 2. Cancer Prevention Department, Jordan Cancer Registry, Ministry of Health 3. Department of Public Health, Jordan University of Science & Technology 4. Primary Health Care Administration, Ministry of Health 5. Department of Family Medicine, Ministry of Health 6. Department of Nutrition & Food Technology, Jordan University of Science & Technology In 2012, colorectal cancer (CRC) was estimated to cause about 700,000 deaths worldwide. Survival studies have yielded different findings about the CRC survival rate and prognostic factors between countries. This study was conducted to estimate the survival rate of CRC over ten years, and determine its predictors among Jordanian patients who were diagnosed in the period This study was based on Jordan cancer registry (JCR). All CRC cases among Jordanians who were registered in JCR during the study period were included and analyzed using survival analysis. The last date for follow up was 31 Dec A total of 3005 patients with CRC was diagnosed and registered during The overall 5-year and 10-year survival rates for CRC were 58.2%, and 51.8% respectively. The 5-year survival rate decreased significantly from 60.4% for the age <50 years to 49.3% for the age 70 years (p<0.005). The 5-year survival rate was 72.1% for localized stage, 53.8% for regional stage, and 22.6% for distant metastasis).the multivariate analysis using Cox-regression method showed that the hazard of death increased significantly with increased age being the highest in age 70 years. It was significantly higher for those with poorly differentiated cancer compared to those with well differentiated cancer (HR=1.6). Furthermore, it was much higher for patients whose cancers stage was regional (HR=2.6), and those with distant metastasis (HR=6.0) compared to those with In Situ cancer. The overall 5-year and ten-year survival rates for CRC were 58.2%, and 51.8% respectively. Survival rate decreased significantly with increasing age, poor differentiation and advanced cancer stage. Screening strategies are needed for early detection of colon adenomas and CRC in Jordan. Abstract 67 Outbreaks of nephrocalcinosis due to vitamin D in infants Morocco, Loubna Alj (1, 2), A. Khattabi (1, 2), G. Benabdallah (3), R. Soulaymani Bencheikh (3) 1. Field Epidemiology Training Program (FETP-Morocco). Morocco 2. Ecole Nationale de Santé Publique. Morocco 3. Centre Anti Poison et de Pharmacovigilance du Maroc. Morocco In Morocco, several outbreaks were detected between 2012 and 2016 related to adverse drug reactions ADR due to vitamin D2 in infants. The total number of cases reported is 31 among which 2 were fatal. An investigation was conducted to identify the underlying causes in order to put in place control and prevention measures. The outbreaks have been confirmed by performing the causality assessment of ADR reported. Following the first case of death, a brief reporthas been sent, by the Centre Anti Poison et de Pharmacovigilance du Maroc CAPM to the health authorities. The National Pharmacovigilance Technical Committee has been held to propose recommendations to be implemented. Following the second case of death, the National Pharmacovigilance Commission has been held to implement urgently the proposed actions. The Causality assessment showed a certain link between ADR reported and vitamin D2. The investigation revealed that the recommended dose is three times higher than the one recommended by international standards. The infants were administered adult formulation of vitamin D2 because the pediatric one was not available in the market. The age of infants ranged from 10 days to 6 months. The sex ratio was 3,3. All infants experienced symptoms of vitamin D2 overdose and explorations showed nephrocalcinosis in 67.7 % of the cases. The main measures implemented were the amendment of the dose recommended of vitamin D2and the approval of the marketing authorization of the pediatric formulation of vitamin D2. This outbreak allowed preventing the recurrence of similar cases of serious ADR related to vitamin D2. Reporting of health events, including ADR, should be strengthened to enable early warning and quick response to public health risks. KEYWORDS: Outbreaks, Infants, Nephrocalcinosis, Vitamin D2, Adverse drug reaction KEYWORDS: colorectal cancer; survival analysis; prognostic factors; cancer registry; Jordan

88 88 / Miscellaneous 30th November 2017 Session G Parallel Regional contributions and synergies for Global Health Security Abstract 128 Knowledge, Attitudes and Practices on avian influenza among sellers in live bird markets in high risk governorates in Egypt, 2017 Hend Mohammed Elsheikh (1,2), S. Refay (2,3), M. Labib (2,3), S. Shourbagei (2,3), A. Gad Alla (3) 1. General organization for vetrinay survice,egypt 2. Field Epidemiology Training Program(FETP),Egypt 3. Ministry of Health and Population,Egypt Avian influenza is a global public health threat. Prevention and control depend on awareness and protective behaviors of the general population as well as high risk-groups. Live bird markets are considered the main pathways for disease transmission, and potential reservoir of infection in poultry. Describe the current knowledge, attitudes, and practices (KAP) regarding Avian Influenza (AI) among Live Bird Sellers (LBS) in Egypt Cross sectional survey was conducted in four high risk governorates (2 in Upper and 2 in Lower Egypt), using a structured pretested questionnaire administered in face-to-face interviews with 260 LBS, The questionnaire consisted of demographic data and 30 questions exploring KAP. The total score for each of the KAP was categorized as poor/negative = 0-50%, fair/neutral = 50-70%, and good/positive= %. The respondents mean age was 45 with range (15-65) years old and females represented 53%. Fair knowledge was observed among 63% of respondents. The majority ( 80%) were aware about AI and the ability of sick birds to infect healthy ones and spread infection to human. Only 12% recognized the Egyptian law of banning circulation of live birds between provinces. Negative attitude was found among 43% of participants, yet 70% agreed about correct ways of disposal of dead birds. The practice scores were bad among 62% of LBS. The preventive practice reported by 90% was avoiding buying sick birds even at lower price. KAP were significantly higher among males, high education respondents and participants reporting veterinarians being source of AI information (p<0.05). Implementing health educational programs about AI targeting high-risk workers is essential to enhance their knowledge and improve their compliance with preventive measures. Abstract 15 Food safety practices of restaurant workers in Tulkarm district of Palestine Nader Jalad (1) 1. Head of Environmental Health Division, Tulkarm Health Directorate, Ministry of Health, Palestine Foodborne illness is significant public health issue. Food establishments are the sources of these illnesses and the foodhandlers practices contribute to foodborne illness outbreaks. To improve these practices, we must understand factors linked with these practices. The purpose was to identify factors related to food worker safety practices. We collected observational data on foodhandler (n= 367) hand hygiene practices (hand washing and glove use) in 217 restaurant and observational and interview data on factors related to hygiene behavior, such as worker activity, restaurant characteristics, worker food safety training, and the physical and social environment. Workers washed their hands appropriately in only 17% of work activities, hand washing and glove use were more likely to occur in conjunction with food preparation than with other activities (e.g., handling dirty equipment) and when workers were not busy. Hand washing was more likely to occur in restaurants with more than one hand sink, and with hand sink in the observed worker's sight. Glove use was more likely to occur in chain restaurants and in restaurants with glove supplies in food preparation areas. (38%) of foodhandlers observed changed or washed utensils that were used for raw meat before they used them to chop vegetables. Anumber of factors are related to hand hygiene practices and support suggestions that foodhandler hand hygiene improvement requires more than food safety education. Instead, improvement program must be multidimensional and address factors such as those examined in this study. restaurants should consider reorganizing their activities to reduce the frequency of hand washing required. Periodic medical checkups of foodhandlers, ensuring personal hygiene and enrolling of new foodhandlers in an obligatory training course should be adopted. KEYWORDS: Highly pathogenic avian influenza, Egypt, KAP, LBM KEYWORDS: Food handlers, Restaurant, Appropriate hand washing, outbreaks, Food safety practices, Palestine

89 Miscellaneous 30th November 2017 Session G Parallel / 89 Abstract 117 Knowledge, attitudes, practices of medical staff on vaccination for prevention of seasonal influenza in Republic of Moldova, 2017 Dumitru Capmari (1,3), N. Caterinciuc (1), S. Gheorghita (2), A. Zaghloul (3), A. Druc (1) 1. National Centre of Public Health from Republic of Moldova 2. World Health Organization, Country Office in Republic of Moldova 3. Mediterranean Program for Intervention Epidemiology (MediPIET) In Republic of Moldova, influenza, acute respiratory infections and severe acute respiratory infections are recorded every year, generally representing 2/3 of the total number of infectious diseases recorded during the year. Vaccination against influenza is the most effective method of prevention for influenza reducing the risk by 60%. The research was based on primary quantitative and qualitative data collected from medical staff with a questionnaire conducted in10 administrative territories. The questionnaire addressed knowledge, attitudes and practices of health workers about seasonal influenza and vaccination against it. The data was entered and analyzed using the IBM SPSS. Medical workers are fully/rather informed more than 98% about influenza causes, seasonal influenza symptoms; seasonal influenza consequences; positive effects of seasonal influenza vaccination. 88,4% of health workers know how to reduce the negative consequences of vaccination against seasonal influenza. 75.6% of medical workers participated in training on seasonal influenza and vaccination in the last 3 years. 90,8% need training on seasonal influenza and influenza vaccination. 74,7% consider that they are on the risk to get sick with influenza in their department/institution, and the patients are a source of infection in 73.1%. 24.7% of respondents got sick by influenza in the workplace over the past 3 years. More than 80% were vaccinated in the last 2 seasons. 42,4% of medical workers suffering from chronic diseases and 85,1% of them were vaccinated. Healthcare workers are informed about the influenza, causes and consequences. Not all people with chronic disease are vaccinated. To eliminate these negative things about vaccination, they need regular training and information materials about influenza (etiology, diagnosis, specific and non-specific prophylaxis). KEYWORDS: influenza, KAP study, vaccination, knowledge,attitudes, practices

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91 Session H Plenary Use of surveillance data

92 92 / Use of surveillance data 30th November 2017 Session H Plenary Regional contributions and synergies for Global Health Security Abstract 177 Towards an Early Warning System for Forecasting Human West Nile Virus Incidence in Tunisia : Time Series Modeling Khouloud Talmoudi (1,2), S. Chelly (1), A. Bahrini (1), A. Cherif (1), S. Bougatef (1), and N. Ben Alaya (1) 1. National Observatory of New and Emerging Diseases (ONMNE), Ministry of Public Health, Tunis, Tunisia. 2. National Engineering School of Tunis (ENIT), Tunis El Manar University, Tunis, Tunisia. West Nile Virus (WNV) is an emerging global health threat. In Tunisia, several major outbreaks of WNV infections occurred in 1997, 2003, and Early-warning predictors of mosquito population dynamics would therefore help guide entomological surveillance and thereby facilitate early warnings of transmission risk. The current study aimed to identify risk factors associated with WNV and to assess the epidemic rate. All suspected cases of WNV infection in Tunisia are reported to the national observatory of new and emerging diseases (ONMNE). Epidemiological and clinical data were collected from the paper-based notification form. Weekly data of WNV infection were collected from January 2012 to December Meteorological data including minimum temperature, maximum temperature, and precipitation over the study period were provided by the National Institute of Meteorology. Autoregressive Integrated Moving Average (ARIMA) modeling was used for epidemic time series decomposition and forecasting, and linear mixed models were implemented to examine the relationship betweenwnv incidence and environmental predictors. A total of 1759 WNV cases were reported between January 2012 and December An outbreak of 55 cases was detected in the late 2012 (November 2012). Seasonality during the same epidemiologic year and interval between WNV epidemics were demonstrated. Models showed the mean minimum temperature in January is significantly associated with cases of WNV incidence, and that early precipitation increased total abundance. Finally, precipitation later in the year was associated with a longer season. Climate data collected early in the year can be used to provide early warning of WNV outbreaks. Control measures need to be implemented with implications for prevention of West Nile Virus and other mosquito borne diseases. Abstract 111 Use of Surveillance Data and Descriptive Epidemiology to Guide Response to an Outbreak of Cerebrospinal Meningitis in a Low Resource Setting - Sokoto, Nigeria, 2017 Ramatu Abdu-Aguye (1), M. Dalhat (1,2), G. Mustapha (1), H. Assad (1), A. Kassim (1) 1. Nigeria Field Epidemiology and Laboratory Training Programme NFELTP 2. Africa Field Epidemiology Network AFENET Cerebrospinal meningitis outbreak due to Neisseria meningitides type C was reported in Sokoto in 2014 and 2015 with 756 and 2845 suspected cases respectively. In 2017, largest ever outbreak of NmC was reported in North-Western Nigeria with Sokoto State amongst the worst hit. Sokoto is the poorest state in Nigeria poverty rate 81.2%. Lack of vaccine stockpile to conduct mass immunization implies that the limited vaccines should be effectively utilized to control the outbreak. We report how surveillance data and descriptive epidemiology was used to guide response activities. We used the Integrated Disease surveillance and Response (IDSR) case definition to conduct active case search in all Local Government Areas (LGAs). We calculated weekly attack rates and case fatality rates by LGAs and wards using IDSR guidelines. Wards and LGAs that reached alert and/or epidemic thresholds were prioritized for reactive vaccination, enhanced surveillance and intensified case management. Cerebrospinal Fluid (CSF) samples were collected for Pastorex rapid diagnostic testing, culture and PCR. We documented 4509 suspected cases, 270 deaths (CFR 5.98%) were reported between weeks 2 and 18. Of 180 CSF samples, 51(28.3%) were confirmed NmC. Males were 2613 (57.9%), mean age (standard deviation) was 15.07(10.74) years. A total of 3351 (74.5%) were 20 years. Bodinga, Dange Shuni, Tureta and Rabah LGAs had reached epidemic thresholds at week 12 with ARs of 24.5, 18.9, 12.7 and 12.6/ population. A confirmed outbreak of CSM with NmC was reported. We intensified case management and reactive vaccination with conjugate C vaccine in Bodinga, Dange Shuni, Tureta and Rabah LGAs for ages We recommend use of surveillance data and descriptive epidemiology to guide response in low resource settings. KEYWORDS: Infectious disease, ARIMA Models, Linear Mixed Models, West Nile Virus infection, Tunisia. KEYWORDS: Cerebrospinal Meningitis outbreak, Low resource setting, Surveillance data, descriptive epidemiology

93 Use of surveillance data 30th November 2017 Session H Plenary / 93 Abstract 113 Evaluation of Automated Online Quality Checker Implementation for the National Disease Surveillance Data, Egypt 2016 Ibrahim Saied Eldeyahy (1), E. Ahmed (1), A. Eid (1), S. Refaey (1), A. Kandeel (1) 1. Preventive affairs, Ministry of Health, Egypt. National Egyptian Disease Surveillance System (NEDSS) targeting 40 notifiable diseases and conditions from 584 nominated reporting sites out of 27 governorates. Levels of completeness and timeliness may differ that may influence data quality; these attributes needed to be assessed prior further data manipulation. Completeness of mandatory variables is 100%, while non mandatory variables ranged from 10% to 89%, accordingly Surveillance Online Checker (SOC) was launched In 2016 to facilitate quality check to give feedback about timeliness and completeness to reporting sites. We aimed to measure the effect of Surveillance Online Checker on surveillance data completeness and timeliness after one year of implementation. NEDSS data completeness and timeliness of selected non mandatory variables from the case reporting form were compared before and after one year of launching SOC using Z-test. It is found that completeness of non-mandatory variables increased from 66% to 78%; some variables have significantly increased as; Patient Telephone (38% to 64%, p=0.0002), Final Diagnosis (60% to 85%, p<0.0001), Investigation Form (70% to 87% p=0.0034), National ID (10% to 24%, p=0.0084); while other variables have no significant change as; Address (70% to 76%, p=0.3), Outcome (95% to 98%, p= 0.248), Occupation (89% to 92%, p=0.469). Reporting during predefined Timeliness increased from 76.5% to 81%, with Average Data Reporting Time per Case decreased to 4 days instead of 22 days. The average time to retrieve mentioned calculations shortened from 2 working days /month to just seconds after running SOC. Completeness and timeliness of surveillance system improved after SOC. It is recommended to utilize SOC results by intermediate and peripheral levels after adapting SOC for these levels and adding additional surveillance attributes to SOC. KEYWORDS: Public Health Surveillance, Evaluation,Egypt, Automation Abstract 10 Organization and Evaluation of Performance Indicators of meningitis Program in Meknes, Morocco Touria Essayagh (1,2), A. Elrhaffouli (2) M. Khouchoua (2), S. Essayagh (3), A. Khattabi (1) 1. National School of Public Health, FETP Morocco 2. Prefectural Epidemiology Cell, Ministry of Health, Meknès, Morocco 3. Department of Biology, Faculty of Science and Technology of Settat, Morocco Meningitis is a serious public health problem with 1.2 million annual reports and 135,000 deaths worldwide. In Morocco a meningitis surveillance program was implemented in Nevertheless, in Meknes in 2016, meningitis caused-deaths still increased at 20%. The objective of this study is to evaluate the performance of the meningitis program in place in Meknes to identify its weaknesses and propose measures for its improvement. This retrospective evaluative study was conducted between 2012 and 2016, in Meknes. Several performance indicators of the meningitis program were calculated: the incidence and lethality of meningitis according to the infectious agent, the proportion of lumbar puncture within the first 24 hours of admission performed, time between admissionand and lumbar puncture, time between admission and declaration and the time between declaration and investigation. Data analysis was performed using Epi-info version cases were reported including 60 meningococcal meningitis, 51 probable bacterial meningitis, 17 pneumococcal meningitis and 5 haemophilus meningitis % of meningitis cases were presumptively attributed to bacterial pathogens without final determination of causative organisms. The average incidence of all forms of meningitis was 5 cases per 100,000 population and 1.5 cases per 100,000 population for meningococcal meningitis. The lethality for all forms of meningitis was 16.4% and 9.2% for meningococcal meningitis. Lumbar puncture within the first 24 hours of admission was performed in 72% of cases. The average time between admissionand lumbar puncture was one day and the average time between admission and declaration was 3 days. The investigation was conducted on average on the day of the declaration. The percentage of biological confirmation and serotype determination must be improved to reduce mortality due to meningitis KEYWORDS: Evaluate the performance, meningitis program, Incidence, lethality

94 94 / Use of surveillance data 30th November 2017 Session H Plenary Regional contributions and synergies for Global Health Security Abstract 175 Risk factors for multidrug-resistant tuberculosis in Casablanca-Settat Region, Morocco : multi-center study S, Redwane (1), K. Mansour (2), A. Khattabi (1), M. A. Tazi (1) 1. Field Epidemiology Training Program (FETP)-Morocco, National School of Public Health, Rabat; Morocco. 2. Field epidemiology training program (FETP) graduates, Casablanca- Settat region, Morocco. Name of FETP: Morocco FETP ( ) The aim of this study was to determine the risk factors leading to the emergence of multidrug-resistant tuberculosis (MDR-TB) strains to improve its overall management, in Casablanca-Settat region (Highest declared cases of multidrug-resistant tuberculosis in Morocco : 80 cases, 2015) Morocco. We used a case-control (1 case : 2 controls) design. Both cases included all tuberculosis (TB) patients notified as resistant to rifampicin between January 1st, 2012 and the December 31st, The controls included TB patients treated during the same period in the same center of care as the cases and declared cured at the end of treatment. In which the following factors were analyzed Socio-demographic characteristics, TB contact history, history of TB, comorbidities, history of imprisonment and residence in a care facility, were obtained from clinical records. For each factor, the association with outcome variables was estimated by calculating the odds ratio (OR) together with the 95% confidence interval (95% CI) The sample consisted of 504 cases, 356 men (70,6%) and 148 women (29,4 %). The median age was 35,3 years. Factors associated with significant (p< 0,05) MDR-TB were the failure of retreatment (0R=50.4) (28% cases, 3,6% controls); the relapse tuberculosis (0R=25,1) (48% cases, 2% controls) and the concept of multidrug-resistant tuberculosis in the family (0R=11,6) (27 % cases, 7% controls). The socio-demographic factor significantly associated with MDR-TB status was income (OR = 2.06, 95% CI: ). In Casablanca-Settat, MDR-TB prevalence remains low with 0.5% among new cases and 12% among the restatements but control of this disease is necessary and remains essentially preventive. It is based on real preventive strategies planned according to local and updated regional data. KEYWORDS: Multidrug-resistant tuberculosis, risk factors, Casablanca-Settat region, Morocco Abstract 138 National point prevalence survey of Human Papillomavirus infections in Tunisia, : Genotypes and risk factors Rejaibi Salsabil (1,3,4), Mchala M. (4), Letaief H. (1,3,4), Bahrini A. (1), Ardhaoui M. (2), Enneifer E. (2), Laasili T. (2), Boubaker S. (2), Ben Alaya Bouafif N. (1,3,4) 1. National Observatory of new and emerging diseases, Tunis, Tunisia. 2. Pasteur Institute, Tunis, Tunisia. 3. Mediterranean Programme for Intervention Epidemiology Training (MediPIET). 4. Medical school of Tunis, Tunisia Although the majority of Human Papillomavirus (HPV) infections are asymptomatic, the persistent infection with high-risk HPV genotypes may lead, without treatment, to invasive cervical cancer. This study aims to determine the prevalence of HPV infections, to identify risk factors and main circulating genotypes. National point-prevalence survey, between 2012 and Were eligible for inclusion, women aged between 18 and 65 years, sexually active, who sought medical attention at their primary health care centre, the day of the survey, and who gave written consent. Women having an abnormal genital bleeding or a visible lesion in the cervix were not included. A standardized questionnaire on socio-demographic and behavioral factors was orally administered. Only women with betaglobin positive PCR-test were further analyzed for HPV detection and typing. Data were entered with EpiData 3.0 and analyzed with SPSS Multiple logistic regression modeling was used for the analysis of independent factors associated to HPV infection. A total of 1518 women were included in the survey, among them 1229 were betaglobin positive. The mean age of included women was 40.4±0.9 years. The national prevalence of HPV infection was 7.8% (95% CI [ %]). In multivariate analysis, factors associated to HPV infection were having multiple sexual partners (ORa=5.2; 95% CI [ ]), smoking (ORa=4.7; 95% CI [ ]) and medical history of sexually transmitted infection (ORa=1.9; 95% CI [ ]). The most common genotypes were HPV6 (25.4%; 95%CI [ %]) and HPV16 (14.1%; 95%CI [ %]). Our study is the first national prevalence survey of HPV infection in Tunisia providing important insight into associated factors and main circulating genotypes. However, cost-effectiveness analysis of adding HPV vaccine alongside with screening is necessary. KEYWORDS: Human Papillomavirus, prevalence, genotypes, risk factors, Tunisia

95 Use of surveillance data 30th November 2017 Session H Plenary / 95

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97 Session I Parallel Surveillance Systems

98 98 / Surveillance Systems 30th November 2017 Session I Parallel Regional contributions and synergies for Global Health Security Abstract 164 An example of a decentralized surveillance system in Keserwan-Lebanon: Challenges and suggestions Nadine Haddad (1,2), Nada Ghosn (1,2), Michel Murr (1) 1. Epidemiological Surveillance Program, Ministry of Public Health, Lebanon 2. Mediterranean Programme for Intervention Epidemiology Training (MediPIET) The Epidemiological Surveillance Program at the Lebanese Ministry of Public Health (ESUMOH) is decentralized to 8 provinces that enclose 26 districts. However, several districts lack sufficient human resources, skilled in adequate epidemiological surveillance and investigation. In 2017, a trained epidemiologist was relocated from ESUMOH central level to Keserwan, a district located in Mount Lebanon province and whose population is estimated at 193,993. This abstract aims to present the work undertaken by the epidemiologist to stimulate surveillance performance in Keserwan district. The initial step was to understand the challenges that hindered regular reporting from Keserwan district. Therefore, focal points of the five hospitals were contacted and reminded about reporting systems and forms. In addition, meetings were conducted with representatives of 40 medical centers and dispensaries. Main reported complaints were lack of follow-up from ESUMOH, in addition to the inability of health centers to send weekly forms by fax. Therefore, an alternative reporting method, via Whatsapp messaging, was suggested to enhance reporting. In addition, regular follow-up and monthly meetings are hold with all focal points and representatives. Weekly completeness of zero-reporting from medical centers and dispensaries increased from 30% in January to 90% in May, whereas timeliness reached 80%. As for weekly reporting from hospitals (zero-reporting, laboratory, mortality reporting, and Intensive Care Unit admissions), completeness increased from 50% to 83% in May, whereas timeliness remained below 70%. However, timely reporting on mandatory notifiable diseases increased, which enhanced case-based investigation. Having an epidemiologist at district level definitely improves surveillance indicators and coordination with central level. However, compliance of health centers to reporting via Whatsapp messaging highlights the important role that electronic reporting plays in timely surveillance. Abstract 100 Surveillance of adverse events following immunization Montenegro, Senad Begic (1, 2) 1. Institute for Public Health, Podgorica, Montenegro 2. Mediterranean Programme for Intervention Epidemiology Training (MediPIET), Institute for Public Health, Podgorica, Montenegro Benefits of immunizations have been universally recognized. As the incidence of certain vaccine-preventable diseases has globally declined for more than 99% by increasing coverage with the effective vaccines, adverse events following immunization (AEFI) became more important due to public interest and impact on vaccine coverages. Surveillance, adequate investigation of every AEFI and communication of surveillance results are almost as important as the efficacy of the immunization programs since they are providing basis for maintaining public trust in immunizations. The study reviewed, evaluated and descriptively analysed all AEFI reports submitted by health practitioners to the national health authorities in Montenegro between January 2006 and December During the study period around doses of vaccines were administrated and 251 AEFI reports submitted, with overall AEFI reporting rate of 13/ doses. Most common AEFIs were injection site reactions (54,7%), fever (36,51%) and systemic reactions including allergies (29,76%). Almost two fifths (39,7%) occurred following DTwP vaccine and 18,3% after MMR. Most AEFI occurred within 48 hours, lasted 3 days on average and in 79% did not require any kind of therapy. At the same time 10,71% of cases required hospitalization due to fever and other systematic reactions mainly after DTwP (65,4%). No influence of sex on reporting rates has been observed. The rates of AEFIs identified in the study were lower than the rates stated in summaries of product characteristics, thus indicating underreporting of AEFIs. Therefore, strengthening of AEFI reporting should be implemented as public health impact of sensitive and specific AEFI surveillance system is directly translated in public confidence in immunisation programmes. General public should also be given the possibility to report AEFIs. KEYWORDS: Vaccines, Vaccination, Adverse Drug Event, Immunization Programs, Montenegro KEYWORDS: epidemiology, surveillance, public health

99 Surveillance Systems 30th November 2017 Session I Parallel / 99 Abstract 66 Evaluation of Abortion Surveillance System in Albania, for the period Alba Merdani (1, 2), D. Toçi (1, 2), E. Roshi (1, 3), E. Toçi (1, 3), E. Kakarriqi (1, 3), G. Burazeri (1, 3) 1. National Institute of Public Health, Tirana, Albania 2. Mediterranean Programme for Intervention Epidemiology Training (MediPIET), Ministry of Health Tirana, Albania 3. Faculty of Medicine, University of Medicine, Tirana, Albania Abstract 98 Evaluation of Congenital Malformations Surveillance System in Albania during 2015 Dorina Toçi (1,2), A. Merdani (1,2), E. Kakarriqi (1,3), E. Roshi (1,3), E. Toçi (1,3), G. Burazeri (1,3). 1. National Institute of Public Health, Tirana, Albania 2. Mediterranean Programme for Intervention Epidemiology Training (MediPIET), Ministry of Health, Tirana, Albania 3. Faculty of Medicine, University of Medicine, Tirana, Albania Since 2007, the Albanian Institute of Public Health has established the Abortion Surveillance System (ASS). No systematic evaluation for the ASS had been conducted and published before. Our aim was to evaluate the ASS in Albania during the period in order to improve the surveillance system and to adapt the family planning policies. The evaluation followed the Centers for Disease Control and Prevention guidelines for evaluating public health surveillance systems. The evaluation focused on abortions data from , the latest years for which a data set is available. We assessed the system s usefulness, simplicity, flexibility, data quality, acceptability, representativeness and timeliness. The abortion surveillance provides the overall number and incidence of unwanted pregnancies, by age-groups and by place of residence. The abortion form contains two pages with23 variables in total, easy to modify if needed. All the completed abortion forms are reported every three months from the local to the national level, as foreseen by the surveillance system. Overall, the completeness of the abortion form was 93.2%. Cases notified by the ASS represent 70% of all cases as compared to the total number included in the abortion registers. The private sector does not provide data to the system. The ASS is rather simple, flexible, and provides timely valid data. The information is used both at the local and national level. Representativeness and acceptability by the private sector physicians needs to be improved. Implementing regular trainings and providing regular feedback at both the local level and private sector would allow raising awareness of the health professionals and harmonizing the reporting procedures. KEYWORDS: evaluation, abortion, abortion surveillance system, Albania The Albanian Institute of Public Health (IPH) has established the Congenital Malformations Surveillance System (CMSS) since No systematic evaluation for the CMSS has been conducted and published before. Our aim was to evaluate CMSS in Albania during 2015 in order to improve the detection and prevention of congenital malformations (CMs). The surveillance evaluation process followed the Centers for Disease Control and Prevention guidelines. The evaluation was focused on CMs reported in The assessed attributes included usefulness, simplicity, flexibility, data quality, acceptability, representativeness, timeliness. CMSS is population based and provides information used by the Maternal and Child Health programs and analytical studies. The reporting form has sufficient amount and type of data necessary to establish the type of CM. CMSS can accommodate to new diagnosis, changes in the case definition or technology. CMSS does not need special funding for operating. The main reported characteristics were socio-demographic ones (100%), while risk factors were not reported (0%). 82% of CMs cases were reported to the CMSS. All physicians were trained and all hospitals and physicians in the country participated in the CMSS, and the reporting of CMs is mandatory by state regulations. The number of reported CMs to CMSS is higher compared to official reporting to Ministry of Health. We lack information of CMs among terminated pregnancies and stillbirths. All reported CMs are recieved within the set time limits. The CMSS is simple, accurate, useful, and flexible and provides valid data used at local and national level. There is need to improve reporting of risk factors among all cases and to report all CMs among stillbirths and induced abortions. KEYWORDS: congenital malformations, surveillance, evaluation, Albania

100 100 / Surveillance Systems 30th November 2017 Session I Parallel Regional contributions and synergies for Global Health Security Abstract 47 Neonatal Tetanus Surveillance Evaluation - Aswan, Egypt, 2015 Ihab Mohammed Basha (1), S. Samy (1), M. Genedy (1), A. Eed (1), A. Kandeel (1) 1. Ministry of health and population Egypt Egypt eliminated neonatal tetanus (NT) in Keeping this achievement through strengthening NT surveillance is very important. Objective of NT surveillance system is to insure that all districts don't exceed the elimination rate (one NT confirmed case/1000 live birth). The objective of the study is to evaluate the NT surveillance, detect any gaps and recommend improvement actions. NT Suspected case is defined as any neonatal death between three and 28 days of age in which the cause of death is unknown (WHO). Data sources were NT surveillance registries & questionnaire. Sensitivity of NT surveillance was evaluated through reviewing all neonatal deaths reported of unknown cause at Aswan, NT data quality were evaluated through revision of zero reports and cases notification timeliness (reports arrived on time) and completeness (total number of reports arrived) in We reviewed flow chart of the NT surveillance system (high level & detailed). Simplicity, flexibility, and acceptability were evaluated quantitatively through conducting questionnaire targeting NT surveillance officers at governorate, and district level. Each question is given a weight. Questions were grouped according to attribute it reflects. Low score of any question reflects the defects in the attribute it measures. At 2015: No NT missed cases; Timeliness and completeness of zero reports were 78% and 82%, respectively; Simplicity of the system is 81%, 83% at governorate, and district level, respectively; The system is flexible on both governorate, and district level; Acceptability of the system is 74%, 71 % at governorate, district level, respectively. The NT surveillance is simple, highly sensitive, and data of high quality. Acceptability will be strengthened through training program, and advocacy meetings with physician at reporting sites. Abstract 97 Implementation of Environmental Surveillance system (ES) in Lebanon 2016 Hala Abou Naja (1,2), N. Ghosn (1,2), R. Louis (1), Z. Farah (1,2), A. Fares (1), N. Homsy (3), H. Asghar (4), M. Karasneh (5) 1. Ministry of Public Health- Epidemiological Surveillance Program, Lebanon 2. Mediterranean Program for Intervention Epidemiology Training (MediPIET) 3. Local WHO office in Lebanon 4. Regional WHO office in Jordan 5. Jordanian National Polio Laboratory (JNPL) Poliovirus remains endemic in three countries imposing threats to polio-free countries. In , poliovirus returned to the region striking Syria and Iraq, whereby it was considered public health emergency of international concern. Poliovirus spreads via fecaloral route where <1% of infected children show paralysis. Hence, poliovirus can circulate silently in community without being picked by acute flaccid paralysis surveillance (AFP) system. In this regard, ES has proven its importance in detecting poliovirus circulation. In Lebanon, it's thus crucial to implement ES to ensure absence of poliovirus circulation as it hosts the largest Syrian community. Sampling site selection was done via risk assessment. A scoring matrix was used including many criteria: catchment area of sewage system, rapid household surveys data, areas with large high risk populations, areas with low-performance surveillance indicators, and areas of AFP cases with zero doses. Sampling plan was prepared in coordination with concerned partners. One liter of sewage specimen per site is collected monthly and shipped to WHO accredited laboratory in Jordan for poliovirus culturing. Between Oct 2016 and May 2017, 2 sites are routinely sampled: Ghadir station covering parts of Beirut and its south suburbs and Jib Janine station covering parts of Bekaa and some Syrian informal tented settlements. Fourteen samples were collected and results were: 50% Sabin-Like (1 and/or 3), 29% non-polio enterovirus, and 21% negative. No wild poliovirus, neither vaccine derived poliovirus type 2 (VDPV2) was isolated. ES is an important tool for confirming absence of poliovirus circulation to ensure polio-free status of the country. An extension plan is prepared to increase the ES site network for better national coverage, in particular with the 2017 VDPV2 outbreak in Syria. KEYWORDS: Neonatal tetanus, Aswan, Egypt, Surveillance, Evaluation KEYWORDS: Environmental surveillance, poliovirus, Syrian refugees, sewage plant site, Lebanon, AFP surveillance system, polio-free countries

101 Surveillance Systems 30th November 2017 Session I Parallel / 101 Abstract 158 Hospital mortality surveillance among Syrians in the Bekaa and Baalback/Hermel provinces - Lebanon, Zeina Farah (1,2), K. Haidar Ahmad (1), N. Ghosn (1,2) 1. Epidemiological Surveillance Program, Ministry of Public Health, Lebanon 2. Mediterranean Programme for Intervention Epidemiology Training (MediPIET) The Bekaa and Baalback/Hermel provinces host the largest number of Syrians in Lebanon. The epidemiological surveillance program at the Ministry of Public Health uses the hospital-based mortality surveillance system to collect data on causes of death among Syrians in Lebanon. The objectives are: 1) to detect any epidemiological alert, 2) and to measure proportional mortality among Syrians in hospital settings in the two provinces. Sources of data are hospitals in public and private sectors. A standard anonymous form is used to collect demographic data and causes of death including direct cause, intermediate and primary causes, in addition to comorbidities. Causes are coded using ICD-10 and underlying causes are selected. Data entry and analysis are performed using Epidata (3.1), EpiInfo (6.04) and SPSS (18). From January 2014 till December 2016, the total number of reported hospital deaths among Syrians was All hospitals in the two provinces did participate and the weekly completeness of reports was 85%. Fifty six percent of cases were under 5 years and 61% were males. The top underlying causes of death were: conditions originated in the perinatal period (37%), external causes (14%), diseases of the circulatory system (10%) and congenital malformations (6%). As alerts, 4 meningitis cases, 5 maternal mortalities and 13 intestinal infections were reported. All alerts were investigated. Mortality data can guide priority health interventions; our data show that efforts are needed to enhance maternal and perinatal care among Syrians in Lebanon. In addition, alternative methods are needed to collect data on mortalities occurring outside the hospital to be able to compute mortality rates, since the data presented above represent proportional mortality. Abstract 172 Risk Factors of Hepatitis A Main Findings of National Survey in Tunisia Farah Saffar (1), A. Cherif (1), H. Bouguirra (1,2), S. Chelly (1), A. Lahchaichi (1,2), S. Rejaibi (1,2), K. Talmoudi (1), T. Chouki (1), A. Bahrini (1), M. Belhadj (1), O. bahri (1), H. Ben Salah (1), N. Bouafif ép ben alaya (1,2) 1. Tunisian National Observatory of new and emerging diseases 2. Mediterranean Programme for Intervention Epidemiology Training (MediPIET) Viral Hepatitis (VH) is one of the remaining communicable diseases which constitutes a major public health problem in Tunisia during the last decade. Despite the decline of the number of VHA reported cases, VHA outbreaks occur in some regions of the country attesting the translational burden of the diseases. A National survey on Viral Hepatitis seroprevalence was conducted in to give an overall view of the situation in the country. Our Study aims to identify the main risk factors of VHA in Tunisia to recommend the relevant preventive strategy tackling the occurrence of outbreaks. A cross-sectional household-based VHA seroprevalence nationwide study was conducted using stratified sampling design. A total of 6200 peoples were enrolled. A standardized questionnaire was used to collect related variables to the VHA transmission (age, sex, location, water consumption, sanitation, animal shelters, personal hygiene ) Overall prevalence (anti VHA antibodies) was 79%. Among the under 30 years old, seroprevalence was only 42%. The HVA seroprevalence was significantly higher in rural areas (10-3). The other main risk factors linked to the VHA seroprevalence were the sharing toothbrush (OR= 2.3), the tank water supply (OR = 1.8) and the presence of animal shelters (OR=1.6). HVA occurrence seems to be linked to the rural area, personal hygiene behavior (toothbrush using) and sanitation conditions. A huge school health education program and an environmental health and sanitation strategy in the rural areas should be implemented. KEYWORDS: Viral Hepatitis, Hepatitis A, Risk Factor, Public Hygiene, Personal Hygiene, Prevention KEYWORDS: Lebanon, surveillance, hospital mortality, Syria, perinatal mortality

102

103 Poster Session 29.1 Influenza, Acute Respiratory Infections & Tuberculosis

104 104 / Influenza, Acute Respiratory Infections & Tuberculosis 29th November 2017 Poster Session 29.1 Regional contributions and synergies for Global Health Security Abstract 53 Virological monitoring in the system of epidemiological surveillance for influenza and acute respiratory diseases in epidemic seasons of 2015/2016 and 2016/2017 in Dnipropetrovsk Oblast, Ukraine Oleksandr Shtepa (1), M. Bredykhina (1), V. Rezvykh (1), I. Pokhmurko (1), I. Gernets (1), I. Kolesnikova (2), D. Stepanskyi (3), G. Daragan (3) 1. State Institution «Dnepropetrovsk Oblast Laboratory Center of the Ministry of Health of Ukraine», Dnipro, Ukraine 2. Bogomolets National Medical University, Kiev, Ukraine 3. State Establishment «Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine», Dnipro, Ukraine Acute respiratory infections (ARI) are a special group of diseases, which ranks among the top in the morbidity patterns for human infectious pathologies. The research objective was to determine the etiologic spectrum of ARI in Dnipropetrovsk oblast during the epidemic seasons of 2015/2016 and 2016/2017. The method of polymerase chain reaction with reverse transcription (RT-PCR) was applied using kits that allow detecting seven infectious pathogens of human ARI. The results of monitoring indicate a circulation in the 2015/2016 of the virus A(H1N1)pdm09. According to the examination results of hospital patients with flu-like symptoms, its share was 21,6±1,5%. The basis of etiologic spectrum of other ARI pathogens was: rhinoviruses 31,7±5,7%, metapneumoviruses 27,2±5,4%, adenoviruses 18,2±4,7%, bocavirus 9,1±3,5%. Virus of parainfluenza, coronavirus and respiratory syncytial virus were defined in rare cases. During the epidemic season 2016/2017 was circulated of influenza virus A (H3N2). The proportion of persons with identified RNA of influenza virus A(N3N2), influenza virus B was 26,2±1,9%.The basis of etiologic spectrum of other ARI pathogens was: rhinoviruses 34,2±7,4%, metapneumoviruses 29,3±7,0%, adenoviruses 14,6±4,7%, bocaviruses 12,2±5,1%, parainfluenza viruses 4,9± 3,4%, coronaviruses and respiratory syncytial viruses at 2,4±2,3%. The results of monitoring of ARI pathogens during the 2015/2016 and 2016/2017 indicate the dominant role of influenza viruses like as A(H1N1)pdm09 and A(N3N2). Also, the most active circulation of viruses was: rhinoviruses, metapneumoviruses, adenoviruses, bocaviruses. All this ARI pathogens have a great revalence in population disease level in Dnipropetrovsk oblast. Abstract 7 Sentinel Surveillance of Severe Acute Respiratory Infections in Serbia in Influenza Season Dragana Dimitrijevic (1), L Stankovic (1), S Mitov Scekic (1) 1 Institute of Public Health of Serbia '' Dr Milan Jovanovic Batut'' Sentinel surveillance of severe acute respiratory infections (SARI) was implemented in Serbia in November sentinel hospitals in 4 cities participated in the SARI surveillance system. Intensive care units (ICUs), infectious disease, paediatric and respiratory disease wards were all represented. The aim of this study is to provide a review of sentinel surveillance of SARI in Serbia in influenza season. During October 2016 to May both epidemiological and virological data were collected and analyzed on a national level and weekly basis. For laboratory confirmation of influenza, Real time polymerase chain reaction (RT-PCR) was used. Start of influenza season was registered in week 49/2016. Influenza activity peaked between weeks 50/2016 and 3/2017, with the positivity rate higher than the >50%. A total of 730 SARI cases were reported. Among these cases, 507 (69.5%) respiratory specimens were collected. The number of positive samples was 228 (45%). The highest proportion of laboratory-confirmed influenza cases was 68.4% in week 50/2016. All three viruses were confirmed: A(H3), A(H1)pdm09 and B. A viruses predominated, accounting for 99.6% of all sentinel SARI detections. Of those subtyped, 72.7% were A(H3). In total, 13 deaths among sentinel SARI laboratory-confirmed influenza cases have been reported. All of them were from ICUs. Of all fatal cases, 13 (100%) were due to influenza A with 11 (85%) of those subtyped being A(H3) viruses. In Serbia, influenza activity started earlier than usual with predomination of influenza virus A(H3). Integration of laboratory surveillance with epidemiological surveillance highlights the importance of maintaining and improving national influenza surveillance capacity. KEYWORDS: influenza, surveillance, severe acute respiratory infections, Serbia KEYWORDS: Influenza viruses, respiratory infections, rhinovirus, adenoviruses, parainfluenza

105 Influenza, Acute Respiratory Infections & Tuberculosis 29th November 2017 Poster Session 29.1 / 105 Abstract 35 The mortality from influenza in epidemic season in Ukraine Oksana Artemchuk (1), Tetiana Dykhanovska (1), Iryna Demchichina (1) 1. Center of influenza and ARVI of State Institution Ukrainian Center for diseases control and monitoring Ministry of Health of Ukraine The mortality rate from complications of influenza in the epidemic season was in 7 times higher than the background which shows the severity of this season. The study used a retrospective and descriptive methods and statistical processing of materials. In the epidemic season revealed 733 cases of severe acute respiratory infection (SARI), of which 391 deaths, including 5 children under the age of 17. The maximum increase took place on the 3rd and 4th weeks of 2016, when recorded 76 and 80 deaths respectively. Centre of influenza and ARVI received 206 sectional samples. PCR diagnosis of influenza was confirmed in 177 (85.6 %) cases, of which 164 (92.7 %) identified as influenza type A(H1)pdm09 and 13 (7,3 %) influenza virus untyped. Also isolated 29 (14,1 %) strains of influenza virus type A(H1)pdm09, which is confirmed and sent for further study to reference laboratory WHO. Among the dead adults most cases were in age group years 83,9 %, gender composition among the dead adults: men %, women %, of them 2 pregnant. Among the dead from complications of influenza 62.9% were individuals from risk groups: 52.4 % people with cardiovascular disease, 10.0 % obesity, 5.9 % diabetes. Among 924 medical workers who have had respiratory infections, recorded 3 fatal cases. The analysis of deaths showed that all the dead had not vaccination against influenza. Season had the largest number of deaths. The dominant virus was influenza A(H1N1)pdm09. The greatest attention require individuals of risk groups. The main measure preventing influenza is vaccination KEYWORDS: Morbidity, mortality, dominant virus, severity Abstract 173 Epidemiological profile of tuberculosis, in Fida-Mers Sultan prefecture, Casablanca city, Morocco S. Redwane (1), K. Mansour (2), A. Khattabi (1), M. A. Tazi (1) 1. Field Epidemiology Training Program (FETP)-Morocco, National School of Public Health, Rabat; Morocco. 2. Field epidemiology training program (FETP) graduates, Casablanca-Settat region, Morocco. Name of FETP: Morocco FETP ( ) Tuberculosis is a major public health problem in Morocco, The national incidence in 2015 was 89 cases / inhabitants, with 52% extrapulmonary tuberculosis. The objective of this study is to determine the incidence rate and epidemiological characteristics of extrapulmonary tuberculosis cases in the prefecture of Fida-Mers Sultan, Casablanca Morocco. We conducted a retrospective study that used records of extrapulmonary tuberculosis patients were reported in the single diagnostic center for tuberculosis, in the prefecture between January 1, 2013 and December 31, The variables analyzed were the site of Disease, confirmation rate, history of pulmonary tuberculosis, BCG Vaccination, presence of HIV infection, diabetes, progression under treatment and high-risk neighborhoods. the analysis was performed using Epi-Info A total of 640 cases of extrapulmonary tuberculosis were reported with an average annual incidence rate of 57 cases / 100,000 population. The mean age was 31 ± 17 years and sex ratio (M / F) was 0.8. The most frequent sites of extrapulmonary tuberculosis were lymph nodes (60%), pleural (17%), osteo-articular and genito-urinary (4%). histological examination had contributed in diagnosis of 73% of cases. Nearly 37.5% of cases had no history of tuberculosis, ninety-six percent had a BCG scar. Infection with HIV, diabetes, pulmonary tuberculosis was found to be 2.6%, 1.6% and 1.2%, respectively. A good result was observed in the majority of the cases treated, and relapses were observed in 3.3% of the cases. The burden of extrapulmonary tuberculosis in the prefecture is among young women and the main sites are the lymph nodes. It is necessary to focus on extrapulmonary tuberculosis, to identify risk factors, confirmation modalities, treatment strategies KEYWORDS: profile, site, extrapulmonary tuberculosis, prefecture, Casablanca, Morocco

106

107 Poster Session 29.2 Zoonoses& Vector Borne Diseases

108 108 / Zoonoses & Vector Borne Diseases 29th November 2017 Poster Session 29.2 Regional contributions and synergies for Global Health Security Abstract 57 Human Granulocytic Anaplasmosis - Relevant Tick-borne Infection in Ukraine ( ) Iryna Ben (1), Ihor Lozynskyi (1) 1. SI "Lviv Research Institute of Epidemiology and Hygiene Ministry of Health of Ukraine", Lviv, Ukrane The influence of climatic factors and the formation of anthropurgic foci natural focal infections leads to the emergence of new tick-borne zoonosis. Relevance is little known in Ukraine disease human granulocytic anaplasmosis (HGA), thanks to the growth in the number of ticks-vectors, sintropic rodents reservoirs and registration HGA cases in the neighboring countries of Ukraine. The first case of HGA in Ukraine was verified in The goal of the paper was to determine the prevalence and main clinical characteristics of HGA in the Western region of Ukraine. During years were examined 516 patients with suspected tick-borne infections for the presence of Ig G antibodies to A. phagocytophilum by enzyme-linked immunosorbent assay (ELISA). For the detection of tick-borne mixed infection the patients were examined simultaneously on Lyme disease (326 htrsons) and tick-borne encephalitis (208 persons). Among persons with suspected tick-borne infection anaplasmosis has been laboratory confirment 60 cases - the HGA monoinfection in 46.7%, mixed infection HGA-LD were in 50% and HGA-LD-TBE were in 3.3%. The monoinfection HGA was dominated by manifestation of flu-like symptoms (85.7%), enlargement of the liver (46.4%), subicteric skin and eyes (25%), increase bilirubine level and transaminase levels (39.3%). Patients with mixed infection HGA-LD often showed erythema (78.3%). The symptoms of three infections were in the patient with HGA- LD-TBE. HGA cases were laboratory confirmed in the Western region of Ukraine in mono- and mixed infection. Identification of HGA main clinical manifestation and implementation of methods of differential diagnosis of patients with tick bite in the history of the whole range of tick-borne diseases will allow to verify cases of mixed infection. KEYWORDS: anaplasmosis, morbidity, Western region of Ukraine Abstract 27 Epidemiological investigation of natural foci of arboviral infections in Armenia. Hasmik Hovhannisyan (1), L. Hovhannisyan (2) 1. Yerevan State Medical University after M. Heratsi, Department of Epidemiology,2 Koryun str. 0025, Armenia. 2. Yerevan State Medical University after M. Heratsi, Department of Therapy,2 Koryun str. 0025, Armenia. The arboviruses belong to the ecological group of viruses characterized by natural nidality. The transmission of this group of infections is realized by vector-borne mechanism: trough the blood sucking vectors such as mosquitoes, ticks and etc. There are known more than 500 types of arboviruses, but approximately 100 of them are considered pathogenic for human. Epidemiological scientific researchers have been carried out in Armenia for detection of natural foci of arboviral infections and main vectors in the whole territory of country. Epidemiological, entomological, virological and statistic methods have been used. Totally, mosquitoes and ticks have been collected from different regions. After the entomological identification they were sorted according to the types and preserved in the liquid nitrogen under the -196oC before starting virological investigation. The virological analyses were conducted on mice at the age of 1-2 days. The virus identification was realized by the complement-fixing reaction and immunoenzymatic analysis. Verification of arboviruses was carried out by the IFA method. 126 strains of causative agents of arboviral infections were discovered and identified. These strains are belonged to 10 types of viruses: Batai, Sindbis, Tyaginya, WNF (West Nile Fever), TBE (tick-born encephalitis), Dhori, Geta, Bhanja, Tamdi and CCHF (Crimean-Congo hemorrhagic fever). One strain of causative agents of arboviral infection (TBE) was isolated from the patient suffering from hemorrhagic meningoencephalitis. The above listed arboviruses were isolated from mosquitoes and ticks. 60 natural foci of Batai, Sindbis, Geta, WNF, TBE, Tyaginya, Dhori, Bhanja, Tamdi and CCHF have been detected out of 118 investigated regions of Armenia equaling to 50,8%. Therefore, the conducted research findings demonstrate that the arboviruses are widely disseminated and circulated in different geoclaimatic regions of Armenia. KEYWORDS: Key words: arboviruses, vector-borne, natural nidality, foci.

109 Zoonoses & Vector Borne Diseases 29th November 2017 Poster Session 29.2 / 109 Abstract 152 Description of dynamics of West Nile epidemic in Tunisia from 2012 to 2016 Chelly Souhir (1), Bouguerra Hind (1.2), Bahrini Asma (1), Lahchaichi Aicha (1.2), Cherif Amel (1), Bougatef Souha (1), Ben Alaya Nissaf (1.2) 1. National observatory of new and emergent diseases, Tunis, Tunisia 2. Mediterranean Programme for intervention Epidemiology Training (Medi- PIET). Ministry of public Health. Tunisia West Nile virus (WNV) is a mosquito-borne neurotropic pathogen that presents a major public health concern. In Tunisia, several outbreaks of human West Nile virus (WNV) infection were reported during the last two decades. But the Information on WNV prevalence and circulation remains insufficient. The aim of this study was to describe the epidemiological profile of WNV infection during these 5 years. This is a prospective longitudinal descriptive study. A passive surveillance system based on the reporting of suspected cases of neuroinvasive infection by the public and private health care. If viral activity is detected, this passive surveillance is enhanced. Data collected from the notification of cases that reach to the National Observatory of New and Emerging Diseases. Data were entered and analyzed with SPSS A total of 1759 suspected cases were notified. Most are aged from 1 to 10 years (23.9%) with a male predominance. Mahdia is the governorate most affected by the West Nile virus. The main clinical symptoms of the probable (n=196) and confirmed (n=62) cases were meningitis (28.7%), meningoencephalitis (14%) and fever with non neurological signs (12.4%). Highest incidence rate is in the Center East with This region is the most affected during these 5 years: 54/176 in 2012, 8/13 in 2013, 17/20 in 2014, 13/33 in 2015 and 7/12 in 2016 between 18 and 50th week. After the cases notified during these last 5 years, we can say that there was an epidemic of West Nile in 2012 or that there has been a loosening of the surveillance system in Tunisia. An evaluation of this system is mandatory. Abstract 50 Medical care of four human rabies cases in the health region of Tunis K zitoun (1), A. Gzara Zargouni (2), R. Tej Dellagi (2), H. Kharmachi (3), S. Khoufi (3) 1. Tunis Regional Health Authority 2. Ministry of Health 3. Institut Pasteur of Tunis Rabies is a real public health problem. Tunisia is exposed to this risk since the average number of human rabies cases ranges from 2 to 3 per yea. Description of the clinical and epidemiological investigation related to the medical care of four cases of human rabies entrusted to the health region of Tunis in Retrospective descriptive survey of 4 clinical observations as well as the study of the regional-report data of basic health care for the region of Tunis in cases of human rabies entrusted to the Tunis region; 3 patients who are rural residents; no notion of exposure for one patient; for the 4 patients, the post-exposure treatment was either absent or with a large gap to the recommended protocol; notion of a wound stitching without anti-rabies serum local infiltration in advance; 4 furious forms; a single diagnosis established ante mortem. The response included the establishment of a regional monitoring unit, an information program aimed at the health professionals involved and the public opinion, the provision of a reserve stock of anti-rabies serum in major emergency hospitals in the region and launching a campaign to vaccinate animals. The analysis of 4 cases shows the main problems for rabies, i.e. the delay in diagnosis and the failure of management. The mobilization of professionals (health, agriculture and interior departments) has revealed the difficulties to control the dog population and proven that the vaccination campaign of dogs is unsatisfactory. The information and public education are essential components to prevent diseases. The killing of stray dogs and the mass vaccination of the dog populations must be maintained and even reinforced. KEYWORDS: West Nile Virus, surveillance, epidemiologiy, Tunisia KEYWORDS: Rabies - Epidemiological situation - Tunisia

110 110 / Zoonoses & Vector Borne Diseases 29th November 2017 Poster Session 29.2 Regional contributions and synergies for Global Health Security Abstract 134 Anthrax in Albania during the period Time to detect time to response. Luljeta Alla (1) 1. Institute of Public Health, Tirana, Albania. Control of Infectious Diseases Department, Anthrax in Albania remains the principal zoonosis with a significant impact in public health and economy. Anthrax as part of Disease Mandatory Reporting System is routinely reported by local health authorities. The aim of this study was to evaluation of epidemiological surveys, detecting the disease and responding in time in function of the action of control and prevention of zoonoses. Data were collected and analyzed from the Major Surveillance System Based on Diseases, according to person-place-time. The time to detect and time to response, detailed case history is obtained from the individual reporting form. During the period cases of the Anthrax were reported. Cases belong to the cutaneous form. About 62.2% of the cases were confirmed by laboratory, with direct microscopy whereas 37.4% of the total reported cases were classified clinically. The most affected areas were in the south of the country. The incidence varied from 1.1 in 2014 to 1.8 cases/105 population. The mean age of patients was 40.3year (range 2-73). The mean time from symptom onset to hospitalization was 4.6 (±3.36) days and median 4 days. The mean time from symptom onset to laboratory diagnosis was 5.1 (±3.97) days and median 3 days. The mean time from hospitalization to laboratory confirmation was 1.5 (±0.1), median 0.5 days. In cases of outbreak the mean time from detection to response was 1.5 days with a range from 24 h to 2 days. Anthrax is an endemic diseases in Albania. There is a need to strengthen the formal coordination to detect and response to zoonoses across public health and veterinary sector to implement as early the measures of control and prevention. Abstract 81 Impact of mosquito larval integrated biological and physical control in human population during 2015 in Albania Elton Rogozi (1), Enkelejda V. (1), Perparim K. (1), Viola J. (1), Gjergji S. (1), Juliana N. (1), Klajdi T. (1), Silva B. (1) 1. Control of Infectious Diseases Department, Institute of Public Health, Rr. Aleksander Moisiu, No. 80, Tirana, Albania. As infectious diseases transmitted by mosquitoes are persisting to be a serious problem in human health worldwide; their control continues to be an important tool on the prevention and control of these infectious diseases. During the period May October 2015 a program on the integrated biological mosquito larval control was performed in the costal and urban areas. Bacillus thuringiensis israelensisandbacillus sphaericusin granular and water dispersible granules formulations were used as biological agents for larval control only; the monomolecular film was used as physical control A total of 3000 hectares were totally treated, with a two weeks period in twelve treatments. Eight different techniques were used following a different protocol formulary varying once in two or three weeks. We conducted a randomized questionnaire to the human population, as well as tourists and personnel. As a result, 61% of the population answered that they did not have any concern by mosquitoes, meanwhile 39% had had a concern. 82% answered that there had been a low density of mosquitoes; meanwhile 18% answered there had been a high or similar density. 85% of the population is satisfied with the program; meanwhile 15% of them are not satisfied. 98% of the population would like the program to be carried out the followed years; meanwhile 2% did not like. 91% of the population thought that even the community themselves affect the mosquito control process, and 9% of them did not think so. As a conclusion, the process of mosquito control has a positive impact in increasing the life quality of population in the treated areas, and is strongly suggested to follow up as a continuous program. KEYWORDS: Zoonosis, Leptospirosis, Anthrax, Albania. KEYWORDS: Mosquito, larval control, Bacillus thuringenis islaelensis, impact, human.

111 Zoonoses & Vector Borne Diseases 29th November 2017 Poster Session 29.2 / 111

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113 Poster Session 29.3 Non Communicable Diseases

114 114 / Non Communicable Diseases 29th November 2017 Poster Session 29.3 Regional contributions and synergies for Global Health Security Abstract 99 Epidemiology of Colo-rectal Cancer in Jordan, from Fatima Zohra Mustafa Zerriouh (1), A. Abu slaih (2), M. Zaghal (2), I. Iblan (2), A. Dheneibet (2) 1. Field Epidemiology training program, Ministry of Health, Jordan / Community Medicine Residency Program 2. Ministry of Health, Jordan Colo-rectal cancer (CRC) is an important public health problem. Wordwide there are nearly one million new cases of CRC diagnosed each year and half a million deaths. Regionnally it is the fourth most common cancer. In Jordan it ranked the second among all new cancers in males and females. This study aimed to explore the epidemiology and describe the trend of CRC in Jordan over the ten years period in order to provide update information. This is a descriptive study, all jordanian cases registred in Jordan Cancer Registry (JCR) in were included, data on age, sex, primary site, morphology, grade and stage were collected and filtred, analysis was done using SPSS software version 17, graghs and frequency distribution tables demonstrated the various epidemiological variables, officiel approval was taken from the registry. Total number of CRC in Jordan registred in JCR from was 3299 cases among both genders, 1833 in males (55.6%) and 1466 cases (44.4%) in females. In 2003, there were 357 cases (10.3%) of all newly diagnosed cancers among Jordanians compared with 567 (11.3%) in Male to female ratio was (1.4:1) in 2003 compared to (0.9:1) in The median age at diagnosis was 51 years for both genders in 2003 ; in 2012 it increased to 61. The averall Age Standardized Incidence Rate (ASIR) increased fom 11/100,000 in 2003 to 16.3/100,000 in Colorectal cancer has an increasing trend in Jordan. This rising trend may be partially due to improvement in cancer regisry system. Targeted prevention and early detection by establishing screening programs is recommended KEYWORDS: Colo-rectal cancer, Epidemiology, Jordan Cancer Registry Abstract 108 Prevalence of Common Mental Disorders among Undergraduate and its Associated Factors and its relation to Quality of Life in Public University, Cairo, Egypt 2016 Mohamed Elghazaly (1), M. Gadallah (2), M. Rady 1. Ministry of Health and Population, Cairo, Egypt 2. Faculty of Medicine Ain Shams University, Cairo, Egypt Common mental disorders (CMD) (anxiety, depressive and stress disorders), have symptoms such as fatigue, insomnia, forgetfulness, and difficulty in concentrating. CMDs is a serious public health problem among students because it may progress over time to cause great biopsychic and social impact, and because of its impact on academic performance and quality of life. The prevalence of CMDs varies between countries ranging between 16% to 64% in Egypt. The aim of this study was to determine the prevalence of CMDs among undergraduate students, identify its associated factors, and its effects on quality of life An institution based cross-sectional study conducted among 800 undergraduate students in a public university in Cairo, Egypt. A systematic random sample was used to select the participants. Data were collected using a pretested and structured self-administered questionnaire. Quality of life was assessed using World Health Organization Quality of Life - BREF. Bivariate and multivariate logistic regression model was fitted to identify factors associated with CMD The prevalence of CMDs was 50.8%. Multivariable analysis showed that interrupted sleeping (OR: 2.98, 95% CI ), not owning a car (OR: 5.88, 95% CI ), low economic status(or: 2.76, 95% CI ) were significantly associated with increased odds of CMDs. Meeting with friend frequently (OR: 0.48, 95% CI ) was associated with lower likelihood of having CMDs. CMDs was significantly associated with poor quality of life (p= <.001). Half of undergraduate students in Cairo's Public universities have CMDs. Preventive measures should be implemented such as psych pedagogical support services for students and lecturers, development courses for the teaching staff, and a healthier environment to improve interpersonal relationships KEYWORDS: Common mental disorders, Prevalence, risk factors, quality of life

115 Non Communicable Diseases 29th November 2017 Poster Session 29.3 / 115 Abstract 14 Factors Affecting Survival of Women Diagnosed with Breast Cancer in Georgia Zhizhilashvili S. (1), Mebonia N. (1,2), Vashakidze N. (1), Kereselidze M. (2), Mchedlishvili I. (1), Gambashidze K. (2) 1. Tbilisi State Medical University, Georgia 2. National Center for Disease Control and Public Health of Georgia (NCDC), Tbilisi Breast cancer was the most common cancer overall, with an estimated 2.4 million incident cases in In Georgia survivalrates for breastcanceris lower than in many developing countries. The goal of the study was to identify predictors for low survival of disease. Data from population-based cancer registry was used in order to estimate 1-year and 5-years relative survival rates for breast cancer. To identify predictors for low survival time, bivariate statistical analysis was performed, that looked at correlations between possible predictors and survival period. 190 breast cancer cases from the population-based cancer registry database, who have been diagnosed histologically and died in 2015, were included in an analysis. In 2015 according to the population-based cancer registry database 1838 breast cancer new cases were detected in the country, incidence rate composed 94.7 per women. Based on 190 breast cancer patients data one-year and 5-year survival rates composed 69% and 26% in accordance. The results of bivariate analysis, show that late stage at diagnosis (OR=1.89, 95%CI= ), a young age of patients at diagnosis (OR=1.89, 95%CI= ), highly differentiated histological grade (OR=1.21, 95%CI= ), is positively correlated with low survival period (less than 5 years), while having mastectomy (OR=0.52, 95%CI= ), adjuvant chemotherapy (OR=0.38, 95%CI= ), and a radiotherapy (OR=0.62, 95%CI= ), have statistically significant positive association with high (more than 5 years) survival period. Modifiable factors that are predictors for low survival of breast cancer in Georgia are stage of disease at diagnosis and inappropriate treatment. Survival time of Breast Cancer could be increased by early detection and implementation of standardized approaches to management of diseases. Abstract 141 Time to manage acute coronary syndrome: Associated epidemiological factors Rejaibi salsabil (1,2,5), Osman M. (1), Dhaouadi S. (1), Ben Ahmed I. (1), Mrabet A. (1,5), Ben Alaya Bouafif N. (1,2, 3,5), Ben Romdhane H. (5) 1. Medical school of Tunis, Tunisia 2. Mediterranean Programme for Intervention Epidemiology Training (MediPIET) 3. National Observatory of new and emerging diseases, Tunis, Tunisia 4. Pasteur Institute of Tunis, Tunisia 5. Epidemiology of cardiovascular diseases department, medical school of Tunis, Tunisia The delay in the management of acute coronary syndrome (ACS) is admitted to be a key factor attributable to higher mortality rates. The aim of this study was to identify the epidemiological factors influencing the "latency-patient" delay, which is the delay between the onset of symptoms and the first medical contact. Prospective, multicentric study conducted betweenjuly 2009 and June 2010 in cardiology departments in all teaching hospitals of Tunis. Our study population was a subgroup of the study "TEPS-ACS", carried out by the epidemiology department of cardiovascular diseases of the Faculty of Medicine of Tunis. Were included patients admitted for (ACS) with a diagnosis made within the first 24 hours of onset of symptoms. Patients with (ACS) who were initially treated in a primary health facility were not included. Data on socio-demographic characteristics and medical history were collected using a questionnaire administered by external investigators. Data were analyzed with SPSS software version 11.5 with a significance threshold of 5%. A total of 445 patients were included in our study, with a median age of 60±1.2 years and a sex ratio M/F equal to3.7. The mean "latency-patient" delay was 4 hours and 15 minutes. In univariate analysis, age, gender, marital status, history of myocardial infarction, smoking, diabetes, and dyslipidemia were significant factors influencing the latency-patient delay. In multivariate analysis, the only independent factor significantly associated with the prolongation of this delay was the female gender with an adjusted Odds ratio equal to 1.87; p = To decrease mortality attributable to (ACS) and to guarantee better results after revascularization, increasing awareness in general population regarding the onset signs of myocardial infarction is necessary. KEYWORDS: Breast cancer, survival period, risk factors KEYWORDS: acute coronary symdrome

116 116 / Non Communicable Diseases 29th November 2017 Poster Session 29.3 Regional contributions and synergies for Global Health Security Abstract 151 Poor Glycemic Control in Diabetic Patients Attending Primary Health Care Kenitra, Morocco, Ahmed Idrissi National School of Public Health Diabetes is a real public health problem in Morocco; its prevalence is increasing as all over the world. Diabetic patients are estimated at two million people in the country, one-third of them are cared in public primary health care facilities. Inadequate glycemic control in diabetic patients contributes to increased rates of macrovascular and microvascular complications. The objective of the study was to determine the factors associated with poorly controlled diabetic patients. We conduct a cross-sectional study using a pretested questionnaire administered to a sample of diabetic patients, randomly selected from diabetic patients attending 24 health centers in Kenitra province, in Biological parameters and patient characteristics were collected. Data were analyzed using Stata, version In the total 777 patients, the mean HbA1c was 9% ± 2.2, 82.6% had HbA1c 7%, indicating poor glycemic control. In the multivariate model, being unemployed (OR = 1.6, 95% CI ), without medical coverage (OR = 1.4, 95% CI ) and diagnosed as diabetic patients over five years (OR = 1.8, 95% CI ) were more likely to present poor glycemic control. There was no difference in glycemic control related to sex or type of therapy. Even though 77.6% of diabetic patients reported dieting and exercising, it does not seem to improve their glycemic control. This study indicated that glycemic control in diabetic patients was very poor. Long duration of diabetes and some social characteristics of patients, such as lack of employment and medical coverage were independent predictors of poor glycemic control. Interventional strategies should focus on promoting social determinants and education programs in order to enhance glycemic control and to reduce long-term complications. KEYWORDS: Glycemic Control, Diabetes, Primary Health Care, Morocco

117 Non Communicable Diseases 29th November 2017 Poster Session 29.3 / 117

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119 Poster Session 29.4 Hepatitis Virus B & C

120 120 / Hepatitis Virus B & C 29th November 2017 Poster Session 29.4 Regional contributions and synergies for Global Health Security Abstract 146 National Plan for the Elimination of Viral Hepatitis C, Tunisia Aicha Lachaichi (3), Farah Saffar (1), Amal Cherif (1), Hind Bouguerra (1,3), Souhir Chelly (1), Dhekra Zehi (1), Souad Dziri (1), Najla Besbes (1), Naila Hannachi (2), Nissaf Ben Alaya Bouafif (1,3) 1. National Observatory of Emerging Diseases, Public health ministry, Tunisia 2. Laboratoire de microbiologie, Hôpital Farhat Hachad, Sousse, Tunisia 3. Mediterranean Programme for Intervention Epidemiology Training (MediPIET) Viral hepatitis C (VHC) is an international public health problem with a heavy burden on the health system worldwide. However, the management of VHC has undergone a therapeutic revolution thanks to the availability of direct-acting antivirals. Tunisia is considered as a country with low endemicity of VHC but there is great heterogeneity in the distribution of the disease with high-risk areas. In this context, a national plan to eliminate VHC has been developed in Tunisia for period. The goal was to eliminate VHC by reducing the incidence of chronic VHC, the complications and deaths attributable to it. The objectives of the national plan are achievable with the following actions: the treatment of people with chronic hepatitis C through new treatment regimens, a targeted screening of areas and populations at risk, the prevention and control of risk factors, and the therapeutic monitoring of tolerance and effectiveness of the treatment by measuring the viral load at the 4th week and then at the end of treatment. Up to now, 2009 patients have been included in the plan of which 1324 have completed their treatment. The predominant genotype was 1B in 85.69%. The median initial viral load was six log. 31% of patients included were cirrhotic. The majority of patients were treated with Ledivir. The kinetics of the viral load between S0 and S4 has passed from 5.9 log ± 0.9 to 2.7 log ± 0 8. At S12 the viral load is only detectable in 1.1%. In addition to the measures taken to eradicate VHC, there is a need to expand the control program for all viral hepatitis, strengthen vaccination against hepatitis B virus. Abstract 121 Sentinel Sites surveillance of acute Viral Hepatitis - Egypt, January May 2017 Hanaa Abu El-Sood (1), S. Refaey (1), F. Shahat (1), A. Elgohary (1), R. Hamad (1), A. Eid (1), A. Kandeel (1) 1. Preventive sector, Ministry of Health and population (MOHP), Egypt : Acute viral hepatitis (AVH) is a major health problem in Egypt. According to Demographic Health Survey (DHS), 2015, prevalence of HBV of population (aged 1-59years) was 1%, while of HCV was 4.4%. Sentinel Surveillance for acute viral hepatitis was implemented to describe the trend of the disease and to identify possible risk factors ology: Sentinel surveillance of AVH was established in 5 hospitals geographically distributed around the country. Data was completed for patients meeting the case definition of AVH. Patients were interviewed with a standard questionnaire and they provide a serum sample for ELISA testing for all known types of viral hepatitis (A, B, C and E) after verbal consent, data were analyzed using EpiInfo7 : Overall, 9255 enrolled cases of suspected AVH were identified from January, 2014 to May, Median age was 9 years, 5299(59%) were males, 8313(90%) tested positive for one or more serotype of AVH including 7572(84%) HAV, 228(2.5%) HBV, 250(2.8%) HCV and 30 (0.3%) HEV, 942(10%) undifferentiated hepatitis. The most affected age group in HAV was 5-15 years (48%), years in HBV (37%), years in HCV (22 %) and years in HEV (23%), sharing needles, illegal injectable drugs, incarceration and exposure to blood outside health care facilities. hospital admission during the last 6 months were identified as possible risk factors for HBV and HCV. Conclusion Sentinel AVH surveillance identified HAV as the main cause of AVH in Egypt, while HBV and HCV represent small percentage. Possible risk factors for HBV and HCV pointed to community in addition to the healthcare associated exposures, it describes efficiently the changing epidemiology of AVH in Egypt. KEYWORDS: Chronic hepatitis c, eradication, viral load, Tunisia KEYWORDS: Sentinel sites, Surveillance, Hepatitis A-B- C- E, Egypt.

121 Hepatitis Virus B & C 29th November 2017 Poster Session 29.4 / 121 Abstract 6 Hepatitis B and C infection-related knowledge, attitude and practices of dentists practicing in Yerevan: a cross sectional survey Mnatsakanyan BMS, MPH (1), A. Demirchyan, MD, MPH (1), V. Khachadourian, MD, MPH (2) 1. Jerald and Patricia Turpanjian School of Public Health, American University of Armenia 2. Fielding School of Public Health, University of California, Los Angeles (UCLA), USA Globally, there are 400 million people living with Hepatitis B and/or C infection. In Armenia, the prevalence of Hepatitis B and C is 2% and 4% respectively. Evidence suggests that dental treatment is associated with elevated risk of Hepatitis B and C infections. This study was the first to investigate the Hepatitis B and C related knowledge, attitude and practices (KAP) of dentists practicing in Yerevan. A cross-sectional survey with multistage cluster sampling of dentists was applied. Firstly, dental clinics were randomly selected from the list of all dental clinics in Yerevan. Then dentists were randomly selected from the lists of dentists practicing in the selected clinics. Overall, 120 dentists participated in the survey. A validated KAP-measuring questionnaire was administered through phone interviews. The majority of study participants were males (67.5%), the mean age of the participants was 37 years old. The mean working experience of dentists was 13 years. The mean knowledge score was 63.7% (SD=12.1), attitude score 56.9% (SD=23.9), and practice score 69.7% (SD=9.7). The cumulative KAP score was 63.4%. Only a quarter of dentists (25.8%) were vaccinated against Hepatitis B. Multivariable linear regression analysis identified significant association between KAP score and dentist s weekly workload: B=0.07, 95% CI 0.31, Attitude score was also positively associated with weekly workload (B=0.05, 95% CI 0.28, 2.9) while knowledge score negatively with participant s age (B=-0.04, p=0.029, 95% CI -0.24, -2.22). Educational programs on Hepatitis B and C control should be organized for dentists. Their vaccination against HBV should be mandatory. Further studies could be conducted in Armenia to understand the factors associated with infection control practices among dentists. Abstract 180 Screening of Pregnant Cases for HCV and the Barriers Faced By Positive Cases in Their Management at District Jaffarabad (Balochistan, Pakistan) WA LAshari 1, H Qureshi 2, SNkhalid3 1.N-stop Officer FELTP 2. Executive direcor Pakistan medical researech Council Islamabad 3. Associate professor Institute of Public Health Islamabad Study was conducted to find out reasons why Health Care Providers recommend for HCV screening at district health care facility to pregnant woman and to identify the stigma faced by HCV positive pregnant cases in health care facility, home and in society after diagnosis. Study was conducted on HCV positive pregnant cases visiting hospital and health care providers. Mix method was used and separate questionnaires for HCPs and cases were developed. In Qualitative part IDIs ofhcps to know their knowledge of HCV screening for HCV pregnant cases and their behavior and practices regarding treating/ handling such cases. In qualitative part IDIs of 21 HCPs (7 specialists/doctors, 9staff nurses and 5 Dais) were done. Out of 78 cases 30% were between the age 26 and 30 years. 48% respondents were from rural areas. 74% of respondents were illiterate, 35% were diagnosed in their first ante-natal visit. 53%respondents felt very bad after diagnosed with Hepatitis C virus. Behavior of Husbands of 30% of the respondents and in-laws with respondent was bad and 15% respondent said they are ignored by HCPs after diagnosis of HCV.80% HCPs thought that HCV screening is recommended during pregnancy which is against the international guidelines for screening of HCV in pregnancy. Majority of the HCPs were sure that HCV transmits from mother to child during pregnancy and delivery. About 90% assume that HCV can t be treated during pregnancy and lactation. Majority didn t take risk to handle/treat positive pregnant women. Screening for HCV in every pregnant woman shouldn t be done. Safe procedures and equipment to be used while handling infected pregnant cases. Awareness about HCV transmission & treatment among health care providers should be raised. KEYWORDS: Hepatitis C, Pregnancy, Jaffarabad, Balochistan KEYWORDS: Infection control, blood borne pathogens, KAP, hepatitis, Armenia, dentistry

122 122 / Hepatitis Virus B & C 29th November 2017 Poster Session 29.4 Regional contributions and synergies for Global Health Security Abstract 123 Evaluation of hepatitis C awareness among public health workers - Georgia, 2016 Ana Tatulashvili (1), K. Zakhashvili (1), M. Butsashvili (2,3), G. Kamkamidze (2,3) 1. National Center for Disease Control and Public Health, Tbilisi, Georgia 2. Health Research Union, Tbilisi, Georgia 3. Clinic NeoLab, Tbilisi, Georgia Abstract 130 Factors associated with anti-hcv treatment outcomes in 1629 patient s data Georgia, 2017 Levan Bakuradze (1), M. Gelovani (1), M. Butsashvili (2,3), G. Kamkamidze (2,3). 1. National Center for Disease Control and Public Health, Tbilisi, Georgia 2. Health Research Union, Tbilisi, Georgia 3. Clinic NeoLab, Tbilisi, Georgia Hepatitis C is highly prevalent in Georgia (7.1% of adult population has antibodies to HCV). Form April, 2015 the country launched HCV elimination program with the support of international partners: US CDC, Gilead etc. The assessment of education and stigma in public health workers is important, as they are primary source of information for general population. The survey was conducted to evaluate the level of knowledge of public health workers about hepatitis C. Cross-sectional study was conducted among PH workers in different regions of Georgia by evaluating pre-posttest during the short-term training program on HCV infection. 109 PH workers participated in the study. Data were entered and analysed using statistical software SPSS-20. Pre-test: Out of 109 interviewed, 70.6% new that HCV is blood-borne pathogen, 92.7% responded that the virus is transmitted by sexual contacts, 9.2% believed that household contact is the route of HCV transmission. Alarmingly, 18% considers intravenous drug use as the reason of treatment refusal by health care workers. Post-test: The knowledge on HCV blood-borne transmission increased to 97.1% after the training. Even though the stigma related to intravenous drug use still remained considerably high (9.7%), the proportion of PH workers who thinks people who inject drugs should not be treated markedly decreased after the training. HCV awareness among Georgian public health workers is very low. The educational intervention had positive outcome increasing overall awareness from 43.7% to 78.4%. Stigma related with injection drug use is very important in Georgia, even among public health workers, which needs to be addressed to achieve HCV elimination goal in the country, given the highest prevalence of HCV infection among people who inject drugs. The purpose of this study was to evaluate predictive factors for sustained viral response (SVR) among patients treated with direct acting antivirals (DAA) within HCV elimination program in Georgia. Data were extracted from clinic Neolab database, one of the major clinical sites providing HCV care and treatment. For all patients, pretreatment sociodemographic and clinical data, treatment regimen, adherence and monitoring data were collected. Treatment was provided by sofosbuvir/ribavirin (SOF/RBV) with or without interferon (IFN) and sofosbuvir/ledipasvir (LDV) with or without RBV. Treatment outcomes were analyzed by demographic and clinical data, including the degree of liver fibrosis and treatment regimen. Multivariate analysis using logistic regression was conducted. SVR data were available for 1629 patients by the time of data analysis. Factors significantly associated with SVR were treatment regimen (92% cure rate for SOF/RBV/IFN, 77.1% - for SOF/RBV 24-week and 99.4% for SOF/LDV or SOF/LDV/RBV regimen), genotype (with genotype 3 having highest cure rate of 95.4% compared to 91.8% and 91.7% for genotype 1 and 2, respectively), liver fibrosis stage (99.9% SVR among patients with low fibrosis level compared to 87.8% among patients with advanced fibrosis), age (99.2% for age<35 with 92.7% for older patients), gender (96.6% for females and 92.7% for males), platelet count (6.2% for >= and 21.2% for <100000), ALT, AST and weight. Multivariate analysis showed significant association of SVR with genotype, fibrosis stage, treatment regimen and platelet count. The presented study showed that genotype, fibrosis stage, treatment regimen and platelet count were independent predictors of the treatment outcome. KEYWORDS: Awareness, Hepatitis C, Public Health Workers, Stigma, Injection Drug Use KEYWORDS: Hepatitis C, SVR, Treatment, Outcome,Genotype, Fibrosis.

123 Hepatitis Virus B & C 29th November 2017 Poster Session 29.4 / 123

124

125 Poster Session 29.5 Knowledge, Attitudes and Practices

126 126 / Knowledge, Attitudes and Practices 29th November 2017 Poster Session 29.5 Regional contributions and synergies for Global Health Security Abstract 54 Evaluation of Knowledge, Attitude and Practices towards Prevention of Communicable Diseases among Junior High School students - Kafr al sheikh governorate, Egypt 2017 Ali Mohammed Alqony (1.2), A. Yacoob (1), M. Genedy (1), A. Eid (1), A. Kandeel (1) 1. Ministry of Health and Population, Egypt 2. Feild Epidemiology Training Program(FETP), Egypt Schools is an ideal places for the spread of communicable diseases because of large nomber of students in close contact with each others, Implementation of appropriate preventive measures in schools along with good knowledge and safe practices among students are important factors to minimize transmision of infection not only within the school but also to wider community. This study evaluated knowledge,attitude and practices (KAP) towards prevention of communicable diseases among junior high school students and also assessed school environment. Descriptive cross sectional study comprised of 720 students who were assessed using semi structured questionnaire, participants were grade 7 students in Egypt, Kafr Al sheikh governorate(northern Egypt); both urban and rural. the issues of personal hygiene, hand wash, immunization, food habits in addition to school toilet, class denisty, food source were assessed. Epi info 7.2 used for data analysis. Overall, 45% had adequate knowldge for prevention of communicable diseaes. Although most of students (90%) reported hand washing using soap only (16%) of school toilets contains soap.(57.4%) of students reported to ask parents if having health queries while (33%) reported to ask school doctor/nurse. Adequate knowledge students were more likly to be of adequate attitude(or 1.57, CI , P 0.003) and good practices(or 1.6, CI , P ). Female students tend to have more positive attitude and practice(or 2, CI , P>0.0001),(OR 1.31, CI , P 0.04). knowledge is weak amonge all students; urban and rural, Classroom denisty accepted but urgent need to improve toilet hygiene. Recommendations: develop a health education message to students, involvement of parents and school doctor/nurse in the intervention program, improvement of health environment in schools. Abstract 68 Knowledge and practice of the Egyptian pilgrims regarding the possible health hazards during the Hajj, Saudi Arabia 2016 Mahmoud Taha (1), Mahmoud Hassan (1), Amira Mohsen (2), Fatma Shahat (1), Manar Keshk (1), Samir Refaay (1) 1. Ministry of Health and Population, Egypt 2. National Research center, Egypt About Egyptian pilgrims visit Mecca, Saudi Arabia for pilgrimage every year, gathering with more than three million pilgrims from 180 countries worldwide to perform Hajj. The over crowdedness and mass movement over small area may aggravate the risk of infectious diseases and injuries. Our objective is to assess the level of knowledge and practice among Egyptian pilgrims regarding health hazard during pilgrimage. In this cross sectional study, convenient sampling approach was used. Egyptian pilgrims were interviewed by trained health care workers in Mecca and Medina during the annual Hajj pilgrimage, 2016 using a predesigned questionnaire. The questionnaire consisted of demographic data, health knowledge (17 questions), and health practices (23 questions). The total scores for knowledge and practice were categorized into satisfactory and unsatisfactory based on 60% cutoff point out of the total expected score for each. One hundred eighty six pilgrims participated in the study, of whom 47% were males, and the median age was 55 years. The median knowledge score was 29% (IQR 24%-38%). Food preservation, hand wash, using umbrella, avoid crowding and Hajj vaccination showed the highest scores. The median practice score was 72% with IQR (64% - 78%). Wearing mask, nose coverage, using wipes and food wash showed the highest scores. Males, age group less than 40 years, urban residency and high education attainment were significantly associated with satisfactory knowledge (P<0.05) whereas practice level showed no significant relation with any variable. There was weak correlation between level of knowledge and practice (correlation coefficient= 0.16, P= 0.029). Pre-travel educational strategy to raise knowledge regarding health hazards and improve health practices among pilgrims is needed with specific health messages for different targeted groups. KEYWORDS: Prevention, Communicable diseases, High school, Egypt KEYWORDS: Piligrim, infectious diseases, mass gathering,

127 Knowledge, Attitudes and Practices 29th November 2017 Poster Session 29.5 / 127 Abstract 114 Body image perception and body image satisfaction among a sample of university students in Cairo, Egypt 2016 Manar Keshk (1), Sahar Mahmoud (1), Mohamed Genedy (1), Amr Kandeel (1), Hoda Fahim (2), Dina nabih (2), Azza Hassan (2) 1. Ministry of health and Population 2. Faculty of Medicine, Ain Shams University Body image (BI) perception hasphysical, psychological and socio-cultural factors. Once BIis distorted or dissatisfying,strict diet and low self-esteem may occur, especially among university students. This study aimed to assess BI perception, factors affecting it, and consequencesof distorted BI amonga sample of university students in Cairo. A cross-sectional study was conductedon 400 students selected randomly from Ain Shams and MUST universities. Weight and height were measured for each participant and Body Mass Index was calculated (BMI). A self-administered questionnaire was used to collect information on socio-demographic characteristics, physical activity and eating habits. BI was assessed by standard body figure matching scale Stunkard scale. Participants were asked to choose a figure of their current status,ideal bodyfigures for both sexes. Individual BMI was translated into anactualfigure number. Body status estimation was calculated by (feel figure minus actual figure inconsistency). BI dissatisfaction was assessed by feel figure minus ideal inconsistency. Self-esteem was assessed by the Rosenberg standard scale of self-esteem. A total of 254 females aged 20.5 ±2.2 years and 146 males aged 20.9±2.4 years were included. Nearly half of participants (49.5%) had normal weight status. Overweight/obese participants were more likely to underestimate their body status than normal weight subjects (p<0.001). Females significantly overestimated their body size than males (p=0.00) and had significantly higher desire to get thinner than males (p= 0.01). BI dissatisfaction was significantly associated with the following diet(p<0.1), but not significantly associated with self-esteem in both sexes and all weight status categories (p>0.05). BI perception and satisfactionis associated with following diet, butnot associated with low self-esteem in university students in Cairo. KEYWORDS: Body image perception, body image satisfaction, self-esteem, Cairo, Egypt, University students Abstract 56 Awareness and attitudes towards passive smoking, Georgia 2015 Natia Kakutia (1); N. Mebonia (1,2); M. Topurirdze (1); M. Shishniashvili (1) 1. National Center for Disease Control and Public Health of Georgia (NCDC) 2. Tbilisi State Medical University Second-hand smoke (SHS) is an important public health problem worldwide responsible for about deaths per year and 1% of the global burden of disease. In Georgia, SHS is a principal source of indoor air pollution causes about 3000 death per year. We assessed the second hand smoking-related findings of the Tobacco and other behavioral risk factor knowledge, attitudes and practices survey, Georgia A cross-sectional study was conducted. Participants across Georgia were selected using a multi-stage, random cluster sampling method. Data about sociodemographic and smoking pattern, awareness and SHS exposure were collected through face-to-face interviews individuals aged years (63% women) were involved in the study. The prevalence of SHS exposure was 40%. Half of all agreed that SHS is a harmful while 23% of smokers were not sure. 62%, 40% and 47%, were aware that secondhand smoke causes lung cancer and heart diseases in adults and lung disease in children respectively. Nonsmokers were more aware about hazards of passive smoking while second-hand smoke personal risks were recognized by smokers (PR=1.3; 95%CI= ). 80% of those exposed to SHS daily had no thought about personal risks of passive smoking during past month. 28% and 10% reported complete ban on smoking in home and private car while 54% had no intention to restrict smoking in their places. There is low awareness and poor practices on SHS among Georgian population. In Georgia while they are in support of adopting public smoke-free policies tobacco control advocates and policy makers should take steps to enforce the law. An educational approach is recommended to increase public awareness of SHS exposure harm and the smoke-free environments benefits. KEYWORDS: Second-hand smoking, Health hazards, Risk perception, Awareness

128 128 / Knowledge, Attitudes and Practices 29th November 2017 Poster Session 29.5 Regional contributions and synergies for Global Health Security Abstract 88 Oral health knowledge, attitude, and practice among first grade preparatory school children Belbeis district, Sharkia governorate, Egypt 2016 Reham Kamel (1), H. Abu El-Sood (1), S. Samy (2), M. El-Housinie (3), A. Kandeel (1), S. Refaey (1) 1. Ministry of Health and Population (MoHP), Egypt 2. Field Epidemiology Training Program (FETP), Egypt 3. Department of community medicine, Ain Shams University, Egypt Abstract 105 Effects of Increasing Daily Walking in Adult Patients with Type 2 Diabetes Mellitus Attending the Debre Tabor General Hospital, Northwest Ethiopia, A Randomized Controlled Trial Achenef Asmamaw Muche (1), Edward Gregg (2) 1. Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia. 2. Epidemiology and Statistics Branch, Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA 30341,USA Some oral diseases are associated with life style. In Egypt, 70% of children had dental caries while 80% had periodontitis. Tooth decay burden for 12-year olds is highest in middle income countries. This study aimed at describing oral health knowledge, attitude, and practice (KAP) among first grade preparatory school children in government schools of Belbeis and comparing their knowledge with the corresponding practice. A cross sectional study was conducted on 1607 first grade preparatory school students from 14 rural and urban government schools using multistage stratified random sample. KAP of students were assessed using self-administered questionnaire. A pilot study was conducted on 29 students. KAP scores were measured based on true answers to questions related to each variable. Data were analyzed using SPSS 20. Of all students, 69.5% and 30.5% had medium and poor knowledge, respectively while 86.4% had a positive attitude and 86% had a medium practice. Females had higher KAP scores than males (P<0.001). Urban students had higher knowledge score (P<0.001) and lower attitude and practice scores than rural students (P=0.009). The higher the parental education and job levels the higher the knowledge and practice scores (P<0.001). Although 78.5% of students were aware of regular dental visits importance, only 10.8% visit the dentist regularly. Moreover, 35.3%, 49.2%, and 84.7% know that chips, soft drinks, and sweets, respectively cause tooth decay. The main causes for not cleaning teeth were forgetting (31%) and lack of time (20%). There was a significant weak positive correlation (r=0.101, r=0.218) between knowledge with attitude and practice, respectively. Oral health KAP among study participants were medium to good. Oral health educational programs for both children and their parents are recommended. Diabetes mellitus is major public health problems with rapidly increasing its prevalence worldwide. Regular physical activity is one of the cornerstones of life style modification in the prevention and management of diabetes mellitus. This study aimed to assess the effects of increasing daily walking on glycaemic control in adult patients with type 2 diabetes mellitus attending in Debre Tabor general hospital, Northwest Ethiopia. Randomized control intervention design was conducted for three months among 60 adult patients with type 2 diabetes mellitus using consecutive sampling method. Intervention participants were asked to increase their daily walking levels to 10,000 steps (measured by a pedometer), while control group participants were asked to maintain their current levels. Data relevant to glycemic control and other parameters of health were collected at study weeks 1 and 13. Statistical analyses included descriptive statistics, x2 tests, t-test, Pearson s correlation, and linear regression. Mean baseline HbA1c% was 6.85% in intervention and 6.72% in control participants (P=0.058). Post-intervention mean HbA1c was significantly lower in the intervention group (6.41%± 0.28) than in the control group (7.02%± 0.33) (P<0.001). There was a significant negative correlation between the average step count in week 9-12 (P<0.001), the average change in step count at week 9-12 from baseline (P<0.001), average week 12 step count (P<0.001) and baseline HbA1c (P<0.001) with the change in HbA1c. Finally, there was a significant change in the weight (P<0.0001), BMI (P<0.0001), and waist circumference (P<0.0001). A 10,000 step count recommendation positively affected glycaemic control among adult patients with type 2 diabetes mellitus. We recommended intervening on sedentary lifestyles and increasing physical activity to improved glycaemic control in type 2 diabetes patients. KEYWORDS: Knowledge, attitude, practice, oral health, Egypt, children KEYWORDS: Randomized Control Trial, Diabetes mellitus, daily walking, glycaemic control, Ethiopia

129 Knowledge, Attitudes and Practices 29th November 2017 Poster Session 29.5 / 129 Abstract 59 Epidemiologic telephone conference -EpiTel a new method of communication in public health system in Albania 2017 Elona Kureta (1,3) Nadine Zeitlmann(2), Silvia Bino (1) 1.Epidemiology and Control of Infectious Diseases Department, Institute of Public Health, Tirana, Albania 2.Surveillance Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin German 3.Mediterranean Programme for Intervention Epidemiology Training (MediPIET) Epidemiologic telephone conference -Epitel is a new method of communication for discussing and sharing information related to infectious diseases (ID) events in real-time. It is based In German teleconference (EpiLag) which is conducted between Robert Koch Institute (RKI) and all 16 regional public health authorities weekly since It started as an international assignment at RKI In July 2016 by an Albanian Mediterranean Programme for Intervention Epidemiology Training fellow. During this assignment a country-specific concept for EpiTel developed. This concept includes standard operating procedures for national, prefectural and district level. The first EpiTel was held on 10 May It takes place every Wednesday involving epidemiologists of the Institute Public Health (IPH) and from the 12 Public Health Directorates. They discuss the current ID events detected locally, nationally as well international events notified to the IPH. Skype is the current way of communication. Until second week of June all of 12 district epidemiologists participated. During two teleconferences participated some district epidemiologist as well. Written minutes of each EpiTel are shared with all levels. A Mini-EpiTel it is held every Monday between each prefecture and its respective district health directorates in order to collect the events for reporting in EpiTel. EpiTel is an effective way in exchanging epidemiological information and experiences between all levels of the albanian public health system. It illustrates how a new epidemiological tool can be implementated succesfully. Its implementation is planned for other countries in the South-Eastern-European region during next year. KEYWORDS: Albania, events epidemiologic teleconference, communication

130

131 Poster Session 30.1 Outbreak Investigation

132 132 / Outbreak Investigation 30th November 2017 Poster Session 30.1 Regional contributions and synergies for Global Health Security Abstract 168 Collective outbreak of food poisoning - Agadir, Morocco, June 2017 Abdellah Lotfy (1), F. Guezzar (2), H. Farouk (2), FZ. Meski (3) 1. Field Epidemiology Training program - FETP. Ecole nationale de santé publique, Rabat. Morocco 2. Epidemiological surveillance unit of the regional direction of health of Souss-Massa, Ministry of health, Morocco 3. Ecole nationale de santé publique, Rabat. Morocco On 11 June 2017, several cases of gastro-enteritis have been admitted to the emergency service of the regional hospital Hassan II of Agadir. The signal was reported to the epidemiological surveillance unit of the regional direction of health of Souss-Massa, Morocco. All cases came from the same district and had taken a single common meal on 9 June A collective outbreak of food poisoning was suspected. We conduct an epidemiological investigation to confirm and describe the outbreak, to suspect causal food and to prevent the propagation of disease by applying preventive measures. We collected information from all people how had taken the common dinner on 9 June 2017 and we conducted a case-control study to identify the suspected food. On the 63 exposed people, 48 had presented clinical signs after ingestion of the meal (attack rate 76.2%). Symptoms were dominated by abdominal pain (87.5%), diarrhea (83.3%) and fever (58.3%). We recorded 14 hospitalizations including 7 children. The average age was 34 years (2.5 to 85 years). 25% of cases had less than 15 years. The sex-ratio was 0.4. The duration of incubation varied from 4 to 48 hours. The aspect of the epidemic curve was in favor of a double contamination. The case-control study showed a statistically significant relation between the outbreak and the consumption of chicken with an Odds Ratio of 5.7 (IC: ). This relation was even more obvious by including suspected food in a logistic regression model which showed an Odds ratio of chicken of 9.6(IC: ). Our investigation contributed to describe a collective outbreak of food poisoning, to suspect the origin of the contamination and undertake the preventive measures. Abstract 24 The overview of trichinellosis outbreak in Cajetina, Serbia, 2016 Aleksandra Andric (1), M. Baralic (1), D. Dimitrijevic (2), S. Pavic (3) 1. Institute of Public Health of Uzice, Serbia 2. Institute of Public Health of Serbia Dr Milan Jovanovic Batut, Belgrade, Serbia 3. The General Hospital of Uzice, Serbia Trichinellosis belongs to the group of zoonoses. Trichinellosis outbreak in Cajetina was discovered on 22/01/2016 when a hunter from Cajetina was hospitalized at the infectious department of the General Hospital in Uzice under suspicion of trichinellosis. The patient had consumed dried wild boar meat in late December During the outbreak, 300 people consumed infected meat, sausages, and ham from two wild boars and a deer. For the analysis of the outbreak, the descriptive epidemiological method was applied. We described the basic clinical and epidemiological characteristics of the patients as well as the most important results of the epidemiological-epizootiological research of this outbreak. The survey instrument was an epidemiological questionnaire. In Uzice General Hospital, since the detection of the outbreak, 273 persons had been examined and 114 of them were reported as infected. In Uzice General Hospital there were 19 hospitalized patients (14 adults and 5 children). The mean age of the patients was 32.3 years, ranging from 3 to 64 years. Male to female ratio of cases was 1.75:1. The diagnosis was based on the epidemiological data, clinical and laboratory findings. Trichinella britovi was identified using the multiplex PCR method at the National Laboratory for parasites. The way of transmission in this outbreak was eating sausages and hams originating from wild pork infected by trichinellosis britovi. Trichinoscopic examination (digestion method) of each slaughtered boar's meat and the underlying thermal processing of meat and meat products prevents the infection. For the prevention of similar outbreaks, it is highly important to improve knowledge of people working on the preparation food about the risk of food-borne diseases. KEYWORDS: outbreak, food poisoning, epidemiology, investigation KEYWORDS: Trichinellosis, zoonoses, outbreak, wild boars, Cajetina

133 Outbreak Investigation 30th November 2017 Poster Session 30.1 / 133 Abstract 116 Contribution of networking in detection and investigation of Salmonellosis outbreak during an international cycling race in Morocco, Bouchaib Benbakhta (1), Ahmed Rguig (1), Chichaoui Smaine (2), Carmen V. Martinez (3,4) 1. Directorate of Epidemiology and Disease Control, 71, avenue Ibn Sina, Agdal, Rabat, Maroc 2. Heath Regional Directorate, BP57, Errachidia 3. Centro Nacional de Epidemiología Instituto de Salud Carlos III Av da Monforte de Lemos, Madrid 4. Centre for Bio-medical Research Network in Epidemiology and Publik Health-CIBERESP - ISCIII On 05 may 2017, the Moroccan health authority was informed via Epidemic intelligence Information System, Food and Waterborne Disease (EPIS-FWD) that an outbreak of acute gastroenteritis occurred between 30 April and 5 May affecting more than 100 participants during an international cycling race that took place at Erfoud city in Morocco. On April 29th, around 675 participants accommodated in the same Hotel where they had lunch and dinner at the buffet. Spanish health authority collected information from medical team of the race via telephone interview. A case was any participant with diarrhea and ate at the buffet. Moroccan heath authority undertook the investigation, collected environmental and stool samples. Medical team of the race reported that 105 cases had symptoms with diarrhea (100%), fever (42%) and abdominal cramps (11%). The first participant developed symptoms at about 1 pm on April30th. The onset of symptoms of most of the cases was between April30th- May4th. stool samples confirmed that three cases was positive for Salmonella hadar. The microbiological investigation continued in the hotel restaurant, foods and stool samples were taken for analysis. Salmonella hadar was detected in samples taken from both raw and cooked chicken and was isolated from 06 of 15 food handlers. Since the chicken was well cooked, the food contamination likely occurred after cooking. Poor hygienic conditions found in the restaurant, together with inappropriate food-handling practices may have contributed to spread the contamination to other foods. Abstract 181 Preliminary results of an outbreak brucellosis investigation in south Morocco, June 2017 Majidi H. (1), Laakabi F. (1), Benfouila Fz. (1), Tazi Ma. (1), Akrim M. (1), Meski Fz. (1), Khattabi A. (1), Rguig A. (2), Cherkaoui I. (2), Ezzine H. (2), Maaroufi A. (2) 1. Field Epidemiology Training Program (FETP-Morocco), National school of Public Health (ENSP), Morocco 2. Directorate of Epidemiology and Disease Control (DELM), MoH, Morocco Brucellosis is a zoonotic disease of worldwide distribution especially in the Mediterranean Region. Human and animal brucellosis is endemic in Morocco with major outbreaks occurring in some regions. On 2 June 2017, the Directorate of Epidemiology and Disease Control (DELM) was notified an outbreak of 24 human cases of brucellosis in the province of Laayoune located in south of Morocco where human brucellosis is common due to eating behavior of the population. A study was conducted to determine risk factors associated with this brucellosis outbreak. Cases of brucellosis reported to the Ministry of Public Health were investigated, and for each case 2 controls were recruited. The questionnaire included demographic information, clinical symptoms and exposure to possible risk factors for up to six months before symptom onset for cases. Twenty three cases were diagnosed with acute brucellosis and one case with a subacute form. Fever, Arthralgia, and sweat were the most consistent clinical manifestations. Two cases have been confirmed positive for Brucella Bovis Abortis. Consumption of unpasteurized camel milk was a significant risk factor for contracting brucellosis (OR=14,07, P= 0,0016). Cases were concentrated in two neighborhoods where camel milk providers are located. Education of the population to minimize exposure by boiling milk before drinking was indicated and carried but was hampered by established local customs. This network collaboration contribute to investigate and response to food disease outbreaks and develop enhanced microbiological surveillance around participants countries. This investigation was an opportunity to aware food handlers to prevent such outbreaks in the future. KEYWORDS: Brucellosis, Outbreak, Risk factors, South Morocco KEYWORDS: Network, outbreaks, salmonellosis, Morocco

134 134 / Outbreak Investigation 30th November 2017 Poster Session 30.1 Regional contributions and synergies for Global Health Security Abstract 178 An outbreak of varicella in an orphanage in Casablanca - Morocco, July 2016 S, Redwane (1), K. Mansour (2), A. Khattabi (1), M. A. Tazi (1) 1. Field Epidemiology Training Program (FETP)-Morocco, National School of Public Health, Rabat; Morocco. 2. Field epidemiology training program (FETP) graduates, Casablanca-Settat region, Morocco. Name of FETP: Morocco FETP ( ) An outbreak investigation was initiated to determine the characteristics of the outbreak, identify factors contributing to the high rate of transmission and to assess the effectiveness of control measures. A varicella case was defined as onset of a generalized, vesicular pruritic rash lasting more than 4 days in a child at the orphanage during April 8-July 27, We reviewed records kept by the orphanage doctors. We described the identified cases by place, time and person and calculated the overall attack rate of this outbreak. During April 8-July 27, 2016, of 150 children, 107 had varicella (attack rate 71,3%), this caused 3 bacterial infections of the skin and 3 hospitalizations. the median age was 2 years (2months-6years), the category of age most affected was 6-36 months (attack rate 92%), 69 were male (F:M ratio 0,55).the index case was reported on 4th April Control measures were applied (isolation of cases, prohibition of visits, information of staff and voluntaries). There is an urgent need to establish the vaccination in unvaccinated individuals at risk as orphanage. Also, there is a need for regular training programs of health workers in such institutions so that highly contagious communicable diseases can be picked up in time and such outbreaks can be prevented. These findings are important in countries where varicella vaccination is not part of the routine vaccination program as Morocco KEYWORDS: varicella, outbreak, orphanage, investigation, Morocco Abstract 167 Outbreak of measles -Banja Luka, Bosnia and Hercegovina, Vesna Lučić Samardžija (1,5), J. Bojanić (2), E. Ademović (4), M. Kasabašić (1) 1. Health Centre Banja Luka 2. Institute of public health Republic of Srpska, Banja Luka, B&H 3. Department of Epidemiology, Faculty of Medicine, University of Banja Luka, B&H 4. Department of Epidemilogy and Biostatistic, Faculty of Medicine, University of Sarajevo, B&H 5. MediPiet, External participant, B&H Inections in health care sistem affect patients and workers in health care facilities; therefor effective infection control program should be implemented daily by work safe procedure for nursin staff, pshysicians and other health care workers. An outbrake of viral respiratory diseases in genaeral population presents a hihg risk for transmission of pathogensto health care workers in their workplace. During the outbrake of measles in Republik of Srpska in 2014/15, an active epidemiological and virusology surveillance was established on the territory of the City of Banja Luka. The incidence of the measles before epidemic period was 0,3 and during the outbreak was 174/ The objective of this paper is to analyze the outbreak for the purpose od assessing the effectiveness og infection control measure. The data colected was from an active suirvelliace and it was performed descriptive study. For laboratory confirmation IgM antibodyes levels were used. The overall numberof registered cases in general population was 964, with incidence 482/ In most cases the patients were unvacctinated, males, average age 25,5 years. Amongst health care workers we registered 15 cases, 6 were doctors, 5 were nurses, and 4 were non-medical staff, average 40,6 years. All of them were in contact with patiens diagnosed with measles. Five of them were laboratory comfirmed. After infection control measures were implemented in the 16 th week, no new cases were registered amongst health care workers The abscense of new cases can support the assertion that the workers were exposed to the virusat their workplace and not outside of it. KEYWORDS: infection control measures, health care workers, measles

135 Outbreak Investigation 30th November 2017 Poster Session 30.1 / 135

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137 Poster Session 30.2 Anti Microbial Resistance

138 138 / Anti Microbial Resistance 30th November 2017 Poster Session 30.2 Regional contributions and synergies for Global Health Security Abstract 71 Knowledge, Attitude and Practice of population regarding antibiotic use in the Republic of Moldova Violeta Munteanu (1), C. Rimis (1,2) 1. School of Public Health Management, State University of Medicine and Pharmacy Nicolae Testemitanu, Chisinau, Republic of Moldova 2. MediPIET national team of the Republic of Moldova Antimicrobial resistance is a major challenge that threatens global public health response to the infectious diseases. Knowledge, attitudes and practice of population influence the antibiotic use. A cross-sectional survey was performed using a pretested self-administered questionnaire on a sample of 393 randomly selected patients visiting the Family Doctor s Centers in Chisinau during the winter season of About 59% of respondents have used antibiotics during the past year, including 43% who received antibiotics over the past 6 months. Most of people (85%) mentioned that antibiotics they took were prescribed by the doctor. The study has shown that knowledge about the prudent use of antibiotics, including how and when antibiotics are administered, are confused. Approximately 23% of respondents consider that it is acceptable to use the same antibiotics that were administered to a friend or family member as long as they were used to treat the same disease. About 36% feel that it is acceptable to buy the same antibiotics or to ask them from the doctor if they are ill and that antibiotics have helped them feel better when they had the same symptoms previously. Moreover, about 19% of respondents think they should stop taking antibiotics when they feel better, not when they have finished the indicated treatment. Many respondents believe that cold and flu (46%), throat ache (46%) and fever itself (24%) can be treated with antibiotics. These results provide quantitative baseline data on knowledge, attitudes and practice regarding the use of antibiotic in the Republic of Moldova. These findings will aid to provide the adequate educational campaigns to promote specific messages to the prudent use of antibiotics to prevent antibiotic resistance. Abstract 21 Antibiotics use among Albanian adults Herion Muja (1), G. Qirjako (1), A. Bregu (1,2), G. Burazeri (1,2) 1. Institute of Public Health, Tirana, Albania 2. Mediterranean Programme for Intervention Epidemiology Training (Medi- PIET), Institute of Public Health, Tirana, Albania Inappropriate use of antibiotics is a well-known phenomenon in many countries worldwide. Our aim was to assess the level of knowledge and attitudes of the Albanian adult population regarding the use of antibiotics. A cross-sectional study was conducted in several districts of Albania in October 2016 including a representative sample of 1123 adult primary health care users (53.3% females and 46.7% males, with an overall mean age of 45.3±18.2 years). All participants were asked about their level of knowledge and attitudes about antibiotics. Overall, 61% of participants answered (correctly) that the full course of antibiotics should be taken as directed. Conversely, about 33% reported that antibiotics may be stopped when they feel better. There was a positive association of proper knowledge about use of antibiotics (that is interruption of use only after taking all the antibiotics as directed) with older age, a higher educational attainment and urban residence of survey participants. This is one of the first reports informing about the level of knowledge and attitudes of the Albanian adult population regarding the use of antibiotics. The current survey provides a snapshot of current public awareness related to antibiotics use in a former communist country such as Albania which is undergoing a rapid transition associated with deep reforms including also the health care sector. Nevertheless, further studies should be conducted in Albania including nationwide population-representative samples of adults in order to confirm and replicate the findings of the current survey. KEYWORDS: Albania, antibiotics, attitudes, knowledge KEYWORDS: Knowledge, Attitudes, Practice; Antibiotic use, Anti-Microbial Resistance, Republic of Moldova

139 Anti Microbial Resistance 30th November 2017 Poster Session 30.2 / 139 Abstract 19 Knowledge about anti-microbial resistance Albania, 2016 Iris Mone (1), E. Toçi (2,3), A. Bregu (2,3), G. Burazeri (2,3) 1. University Hospital Center Mother Teresa, Tirana, Albania 2. Institute of Public Health, Tirana, Albania 3. Mediterranean Programme for Intervention Epidemiology Training (Medi- PIET), Institute of Public Health, Tirana, Albania Currently, antibiotic resistance is one of the biggest threats to global health. Over-prescribing by health workers and the easiness of taking antibiotics in drugstores are a well-known phenomenon in many countries. Our aim was to assess the knowledge, attitude and practices of the Albanian adult population regarding the antibiotic resistance. We carried out a cross-sectional study in several districts of Albania in October 2016 including a representative sample of 1123 adult primary health care users (653 [53.3%] females and 570 [46.7%] males; overall mean age: 45.3±18.2 years; overall response rate: 94%). The WHO questionnaire administered in the multi-country public awareness survey (published in 2015) was used. Participants were asked about the level of knowledge about and the understanding of the issue of antibiotic resistance. Overall, 67% of participants had heard about antibiotic resistance ; 63% had heard about the term drug resistance ; 59% had heard about antibiotic-resistant bacteria ; and 46% had heard about antimicrobial resistance. Only 39% had heard about superbugs, whereas 21% of individuals included in this survey had not heard any of the aforementioned terms. A significantly lower proportion of younger participants, those with a lower educational attainment and respondents from suburban and rural areas had heard about the abovementioned terms related to antibiotic resistance. Findings of this survey may help health professionals, policymakers and decision-makers in Albania to design appropriate and cost-effective strategies and interventions for the control and prevention of antibiotic resistance in the general population. Nonetheless, the Albanian government must play a central role in providing stewardship and coordination in this process. Abstract 101 Consumer Knowledge Attitude and Practice of antibiotic use -Tbilisi and Kutaisi, Georgia, 2014 Zaal Merabishvili (1), T. Chachava (1) 1. National Center for Disease Control and Public Health Antimicrobial resistance is a threat to global health security. Studies conducted on antibiotic resistance in Georgia have confirmed the presence of antibiotic-resistant pathogens and lack of information on the magnitude and causes of misuse. We conducted a cross-sectional study in two most populous cities of Georgia (Tbilisi and Kutaisi), using a two-stage, household cluster sampling, proportional to population. We interviewed one respondent (>18 years old) per household about knowledge, attitudes and recent practices regarding antibiotic use. Bivariate analysis was used to identify potential risk factors and calculate prevalence rate ratios. We interviewed 980 adults: 677 (69%) females and 303 (31%) males. Sixty percent of the participants reported antibiotic purchase without physician s prescription at least once in the past; 35% reported lack of prescription for their most recent antibiotic use (defined as misuse ). Antibiotic misuse was associated with: purchase of antibiotics without prescription (PRR 8.6, 95%CI ), and with two attitude variables: usage without consultation (PRR 1.8, 95%CI ) and antibiotics should be available in pharmacies without prescription (PRR 1.3, 95%CI ). These two attitudes are associated with knowledge about antibiotics (RR 1.4, 95%CI ) and (RR 1.3, 95%CI ) respectively. Knowledge about antibiotics is correlated with high university education (PRR 3.3, 95%CI ) and having family members with medical or biological occupation (RR 2.2, 95%CI ). Antibiotic misuse is caused by the common practice to buy antibiotics without prescription and by the belief that antibiotics can be used without any consultation. We recommend prohibiting antibiotic sales without doctor s prescription and to increase knowledge of population regarding outcomes of antibiotic misuse to reduce self-treatment. KEYWORDS: Albania, anti-microbial resistance, attitudes, knowledge KEYWORDS: Antibiotic, Antimicrobial resistance, Prevention

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141 Poster Session 30.3 Surveillance of Non- Communicable Diseases

142 142 / Surveillance of Non-Communicable Diseases 30th November 2017 Poster Session 30.3 Regional contributions and synergies for Global Health Security Abstract 131 Childhood obesity in Macedonia - urban versus rural prevalence Igor Spiroski (1, 2) 1. Institute of Public Health of the Republic of Macedonia, Skopje, Republic of Macedonia 2. Faculty of Medicine, University Ss. Cyril and ius, Skopje, Republic of Macedonia Regular measurements of height and weight may indicate if the progress of children s growth is following recommended patterns. The aim of our study was to compare the prevalence of obesity of urban versus rural children in two rounds of anthropometric data collection. Children attending second grade of primary school were measured. Children were measured for their height and weight in school years 2010/2011 and 2015/2016. Measurements were done in the same schools in both rounds. WHO s growth references were used to assess the nutritional status of measured children. Overweight and obesity were defined through BMI-for-age index. 42.2% of urban boys and 33.4% of urban girls were overweight or obese in % and 14.2% were obese, respectively. In 2016, 41.6% of urban boys and 33.6% of urban girls were overweight or obese, 22.3% and 15.2% were obese, respectively. For the rural children, 27.8% of boys and 26.8% of girls were overweight or obese in % and 10.6% were obese, respectively. In 2016, 33% of rural boys and 30.7% of rural girls were overweight or obese, 15.5% and 15.1% were obese, respectively. Overweight and obesity in Macedonia is more prevalent among boys than among girls and among urban children compared to the rural ones. The prevalence is similar among urban children when 2010 and 2016 rounds are compared but it has increased in rural children. The disparities between the growth of rural versus urban obesity need to be further more thorowly investigated in order to draw conclusions about the reasons for that phenomenon. The obesity surveillance should continue in the following period as the trends for longer period are needed when interventions are planned. KEYWORDS: Childhood, Obesity, Urban, Rural, Macedonia Abstract 156 Evaluation of Diabetes Surveillance System in the province of Kenitra Morocco, Nadia Lahrimi (1), M. Lacheheb (2), M. Harrag (2), A. Khattabi (1), M. Akrim (1) 1. Field Epidemiology Training Program (FETP)-Morocco, National School of Public Health, Rabat; Morocco 2. Provincial Cell of Epidemiology, Medical Delegation of Health, Kenitra; Morocco Diabetes is a chronic disease causing serious complications. In 2015, in the Middle East and North Africa, approximately 9.1% of adults aged 20 to 79 lived with diabetes. In Kenitra province, prevalence of diabetes detected by the Diabetes Surveillance System (DSS) in 2015 (2.28%) was far from national prevalence of this disease (6.6%). We aimed to evaluate the DSS in Kenitra province in order to give recommendations for improvement. A descriptive study was conducted in November 2016 to assess seven surveillance system attributes using the CDC s updated Guidelines for Evaluating Public Health Surveillance Systems, Diabetes database of 2015 was analyzed. Stakeholders were interviewed using a structured questionnaire. System was found relatively complicated due to the high number of basic supports and their poor organization. Due to the high time required for data collection, DSS was unacceptable by 55% of staff. The Representativeness of system was limited because of the non-coverage of private and military sectors and public hospital. Reporting from 48.6% health facilities were incomplete and 89.1% of reports included data errors limiting data quality. 72.9% reports were received in time. System was found Unstable and little flexible due to interruption of supply of surveillance resources and lack of training of staff on the information system. Inadequate basic supports, failure of reference and counter-reference system and lack of feedback from the Regional Directorate for Health were identified as major weaknesses. Much lower levels of DSS were found. In order to its improvement in this province, we recommend to move from paper to an electronic form, to train staff involved in epidemiological surveillance of diabetes and to coordinate with private, military and public hospital sectors. KEYWORDS: Diabetes, evaluation, surveillance system, Kenitra, Morocco

143 Surveillance of Non-Communicable Diseases 30th November 2017 Poster Session 30.3 / 143 Abstract 37 Assessment of oral hygiene practices among Minya university students, a cross sectional survey- Minya, Egypt, 2017 Mustafa Mahran (1), I. Saied (1), S. Elshourbagy (1), S. Refaey (1), A. Kandeel (1) 1. Ministry of Health & Population, Egypt Abstract 159 Epidemiological Profile of Diabetes in Kenitra province Morocco, Nadia Lahrimi (1), M. Lacheheb (2), M. Harrag (2), M. Akrim (1) 1. Field Epidemiology Training Program (FETP)-Morocco, National School of Public Health, Rabat; Morocco 2. Provincial Cell of Epidemiology, Medical Delegation of Health, Kenitra; Morocco Oral diseases rank with most common diseases of humankind, however receive minimal attention in most countries with weak health care systems. In spite of their high socio-economic burden, oral diseases are a neglected topic of international health. A cross sectional survey using an online version of the WHO standard scored questionnaire assessing Oral Hygiene Practices. Minya university students electively filled the online questionnaire to measure self-perception, oral hygiene practice and Food as well as tobacco consumption. This cross -sectional study included all respondents to the online request during a period of fourteen days (14th 28th Feb, 2017). Statistical analysis was done using Epi Info version (7.2). A total of 561 valid responses were collected. Most respondents aged 22 or less (81.3%), (63.1%) were females and (85%) were medical students. Many have lost one or more teeth (28.88%) and more than (50%) suffered toothache during last year. Majority perceived their teeth & gum condition to be good (63%, 58.2%) respectively. More than (90%) reported use of a toothbrush with or without a toothpaste. However, only (51.9%) reported proper tooth brushing. Visits to the dentist where due to pain (41.2%) while only (28.34%) had regular checkups. Food consumption score was fair in (55.8%) of respondents and 11.6% were regular smokers. Chi square test was done between oral hygiene practice score & influencing factors which showed high significance in Sex (P value<0.001), Residence (P value<0.001). Oral health practices of the respondents were unsatisfactory although the majority were medical students including dental, the results indicate lack of knowledge in this highly educated population. Although reported problems where frequent, however not severe, access to dental services is questionable. Diabetes is a chronic disease causing serious complications. In 2015, in the Middle East and North Africa, approximately 9.1% of adults aged 20 to 79 lived with diabetes. To describe the epidemiological characteristics of diabetes among the population of the province of Kenitra allows to monitor the trends of its prevalence and to guide the activities of diabetes control. We conducted a retrospective descriptive study including cases of diabetes reported to the Province of Kenitra in Morocco from 2011 to Data were retrieved from the aggregated database at the Provincial Epidemiology Unit in the Delegation of the Ministry of Health. Diabetics were described according to characteristics of age, gender, Area of residence, comorbidity, complications related to diabetes and antidiabetic treatment used. Prevalence of diabetes and number of cases detected annually were also measured. The prevalence of diabetes in the Basic Health Care Facilities in province of Kenitra increased from 1.4% in 2011 to 2.3% in Among the diabetics registered, 66.2% (15183) lived in urban areas and 62% (14235) were women. People aged 40 to 59 were the most affected (49.4% of all diabetics). Every year, 2313 diabetics were diagnosed. 8.5% (1943) of diabetics were hypertensive, 1.1% (263) had diabetic retinopathy and 0.9% (195) developed diabetic nephropathy. 32.3% of diabetics treated with drugs used insulin and 67.8% used oral antidiabetics. Despite limitations due to the single data source, the prevalence of diabetes in the province of Kenitra increases every year, however, it remains far from national (6.6%) and regional (9.1%) prevalence. Strengthening of screening activities and improving data collection on diabetics monitored in the private sector are needed to improve disease control activities. KEYWORDS: Oral Health, Oral Hygiene Practice, Evaluation, Minya, Egypt, WHO KEYWORDS: Diabetes, epidemiological profile, Kenitra, Morocco

144 144 / Surveillance of Non-Communicable Diseases 30th November 2017 Poster Session 30.3 Regional contributions and synergies for Global Health Security Abstract 3 Diabetes Education Program for People with Type 2 Diabetes:An International Perspective Osama Abdulkareem Abdulrahman Rashed (1), H, Al Sabbah (2), M, Younis (3) 1. Ministry of Health, Tulkarm, Palestine 2. Public Health Nutrition Department, Zayed University, Dubai, United Arab Emarates 3. Zirve University, Gazianteap, Turkey In the Palestinian community, Life style changes, rapid urbanization and socioeconomic development, stress, smoking, and changes in food habits has increased the risk of non-communicable diseases especially diabetes mellitus.diabetes complications can be prevented if the glycemic status of patients with diabetes is maintained within a nearly normal range.therefore, patient education is critical in controlling blood glucose levels within the normal range. A short duration observational study involving pre-and post -test educational intevention program was carreied out on a relativly small number of type 2 diabetes patients at Diabetic Clinic in Tulkarm Directorate of Health. In total,215 patients attended a group based 4h educatioanal intervention session.the program included explaining diabetes symptoms,risk factors,treatment and complications and main aspects of self-careof the disease,- diaetary manegment,weight reduction,smoking cessation investigations,home monitoring and physiacl activity.knowledge evaluation questionair were evaluated pre and post study.anthropometric measurements and lab tests were measured boyh at the begining and at the end of the study.significance of the results was assessed by paired t-test at 95% confedance interval. The maen weight before educational intervention was kg that decreased to after eduactional intervention.the BMI decreased significantly after educational intervention.the mean FBS was before intervention that decreased to =66.1 after intervention.the mean HbA1c was before intervention that decreased to after intervention. The mean score of knowledge questionnair before intervention was /65 that increased to =13.4 afte intervention Diabetes education was found to be effective on BMI,FBG,HbA- 1c,Chol,Tg and knowledge. Abstract 12 Assessment of the causal factors of the pedestrian's injuries in Georgia Tamar Chachava (1), N. Mebonia (1), Z. Merabishvili (1) 1. National Center for Diseases Control and Public Health of Georgia Road traffic injuries cause an estimated 700 to 1,000 people to die every day. Among the total road traffic fatalities, more than (22%) are pedestrians. Road traffic accidents (RTA) and pedestrian road injuries are a devastating burden for Georgia, annually, about 600 people are killed and 9,000 are injured. This study investigates the incidence and causal factors in fatal and non-fatal injured pedestrians for prevention and reduces the burden of road injuries among this group. A retrospective review of medical records of injured pedestrian from RTA for 2015 was done in several hospitals in three cities of Georgia, Tbilisi, Batumi and Rustavi to provide a cross-sectional profile of the non-fatal injury burden. The medical records were collected, by the following ICD-10-AM codes: S00 T98 & V01 to V89 and additional information was obtained using a questionnaire. A total of 374 cases of the hospitalized injured pedestrians was observed, 54% of them were 40 of age. The case fatality rate was 4.8%. Risky behavior of pedestrians and drivers were revealed in 32% and 30% respectively. Children 7 of age are the most likely to be a risky maneuver (PRR=3.1 95%CI= ), than other age categories. The risk of fatal outcome is higher among hospitalized pedestrians who injured in due to excessive speed of the vehicle, compared to other injured pedestrians (PRR=3.7 95%CI= ). This study identified some key factors associated with pedestrian collisions. There is overwhelming evidence that speed and some behavioral risk factors (risky maneuver, drunk) of pedestrians and drivers have a great impact on pedestrian safety and play a role in injury severity. These results will be used to develop national road safety strategies. KEYWORDS: Road traffic accident, injury, pedestrian, speed; KEYWORDS: Chronic Diseases,Diabetes Educational Intervention, International Health, Middle eastern Countries, Type 2 Diabetes

145 Surveillance of Non-Communicable Diseases 30th November 2017 Poster Session 30.3 / 145 Abstract 79 Differences in age at menopause- Tirana, Albania 2016 Miranda Hajdini (1), V. Osmani (2) 1. The National Institute of Public Health, Tirana, Albania 2. Faculty of Public Health, Tirana, Albania The goal of this study was to determine differences in age at menopause in women taking into consideration the influence of socio-demographic factors. As a country in transition, Albania will have a growing-aged population in need to be informed and treated efficiently by understanding the influence of various factors in age at menopause, an important indicator of aging. A population based cross-sectional study was conducted during 2016 in urban and rural Tirana. Sample included 1207 women aged years old and as a measure instrument was used a specific self-administered questionnaire. Variables like age, marital status, residence, educational level and ethinicity were examined for potential associations with age at menopause. Data was analyzed using SPPSS version 21. Mean age at menopause resulted years. There was a significant relationship between age at menopause and marital status (x=6.48, p=0.011), where married women have a later menopause compared to the unmarried group. When examining the relationship between age at menopause and birth cohorts (x=22.18, p=0.000) and age at menopause vs. residence (x=4.414,p=0.035), it can be noted that women living in the city report early menopause more often than those living in rural areas and younger birth cohorts reported an early menopause more frequently. Some socio-demographic factors influence age at menopause and are by this matter an important start to understading the menopause phenomenon. The fact of being married suggests a later arrival of the non-reproductive period by leaving space for research in the future. Also, it is important to examine carefully the major modern life influencers that may be contributing to an early menopause in women of younger generations. Abstract 103 Micronutrients deficiency in Georgia Rusudan Kvanchakhadze (1), R.Tsiklauri (2) 1. National Center for Disease Control and Public Health of Georgia 2. National Center for Disease Control and Public Health of Georgia In spite of several assessments of nutritional status have been done in the recent past in Georgia, until 2015 there was not any effective surveillance system in Georgia, which could provide with reliable data for developing national strategy of micronutrient deficiency elimination and improving the nutritional status of population. With the support of US CDC, in 2015, NCDC of Georgia launched collaborative project - strengthening of micronutrient deficiency surveillance in Georgia. For nutrition surveillance system (GNMSS) had been used sentinel surveillance approach (8 sentinels in 4 regions). Iron deficiency was studded in pregnant and months old children (toddlers) and folate deficiency in pregnant. Iron deficiency was measured using ferritin concentration in plasma with cut-off points of <12 µg/l in toddlers, and <15 µg/l in pregnant. Below 3.0 ng/ml was considered as a cut-off point of Folate (in plasma) deficiency in pregnant (1st trimester). The study showed 6.3% prevalence of anemia in 1680 pregnant enrolled in study. Blood testing of 243 pregnant resulted in 67.4% of Iron deficiency, and 31% prevalence of folate deficiency. The study in toddlers showed 33.7% prevalence of anemia in 516 children, and 84.4% prevalence of iron deficiency in 238 children. Severe anemia cases were not identified, not in toddlers and not in pregnant women. According to the results of the project, Georgia has the problems with iron deficiency in children and folate deficiency in pregnant, which means, that additional nutritional intervention is necessary for combating the deficiencies, effectively (food fortification, etc). KEYWORDS: Micronutrient, deficiency, Iron, folate, anemia KEYWORDS: menopause, aging, marital status, population

146

147 Poster Session 30.4 Human Inmunodeficiency Virus & Sexual Transmitted Infections

148 148 / Human Inmunodeficiency Virus & Sexual Transmitted Infections 30th November 2017 Poster Session 30.4 Regional contributions and synergies for Global Health Security Abstract 20 Epidemiologic profile of HIV incidence cases in Albania in 2016 Iris Mone (1), SH. Qyrra (2), E. Tomini (2,3), E. Toçi (2,3), A. Bregu (2,3) 1. University Hospital Center Mother Teresa, Tirana, Albania 2. Institute of Public Health, Tirana, Albania 3. Mediterranean Programme for Intervention Epidemiology Training (MediPIET) Albania is a low HIV prevalence country with 883 cumulative cases diagnosed and confirmed until However, there is need for continuous assessment of HIV situation. In this context, our aim was to assess the incidence of HIV in Albania in 2016 and describe the profile of newly diagnosed HIV cases. Information about newly confirmed HIV cases was retrieved from the Institute of Public Health (IPH) in Tirana. All positive and/or reactive blood samples from all blood testing centers (blood banks, voluntary counselling and treatment centers, private clinics and hospitals) are referred to IPH for definitive HIV diagnosis via Western-Blot test. To calculate the incidence of HIV, the 2016 estimation of the Albanian population was used ( inhabitants). In 2016, a total of 126 blood samples tested positive for HIV, yielding an incidence rate of 4.38 new HIV cases per population, whereas ten individuals died of HIV/AIDS. About 58.0% of all cases were referred from health clinics, 17.5% were volunteers, 12.7% of positive samples came from blood banks and the remaining 11.9% were tracked from epidemiological follow-up. About 79% of incidence cases were males and the infection was transmitted sexually in 100% of the cases. More than half (54.78) of incidence cases were Tirana residents. The most affected age-group was years, accounting for 61.1% of all incidence cases, followed by persons aged >40 years old (38.1%) and those aged years (0.8%). HIV incidence in Albania in 2016 was low and epidemiologic profile of HIV incidence cases in Albania is similar to literature reports. Additional efforts are needed in order to increase the awareness about the sexual route of HIV transmission. Abstract 13 HIV / AIDS knowledge among youth in Kosovo schools during the training activities, 2016 Luljeta Gashi (1), N. Ramadani (1), D. Gexha (1), A. Kalaveshi (1,2) 1. National institute of Public Health of Kosova 2.Mediterranean Programme for Intervention Epidemiology Training (MediPIET) Based on classification of UNAIDS system, Kosovo is categorized as low level of HIV epidemic, with the infection rate below 1 % in the general population and below 5 % key populations. The aim of the study was to see impact of trainings in raising awareness about HIV and AIDS among young people in schools. The survey was conducted among 249 students in 9 schools in Kosovo using self - administered questionnaire for pre and post training. The primary statistical parameters were analyzed, arithmetic average, standard deviation, correlation tests, and Significance by T test. Before training 95% of young people knew about HIV and AIDS. After training 99%. Correct HIV transmission knowledge based on a composite of correctly responding to HIV knowledge Five Questions, pre training 52.3%, post training 65.4% of young people have knowledge about HIV transmission. Only 80% answered that people can protect themselves with condoms during sexual intercourse. After training 94%. Before training 25% responded that don t know if mosquito bites can transmit HIV, after training 10%. Before training 66% responded can be protected from HIV by only one uninfected and faithful partner, after training 84%. Before training 48% responded that a person can be infected by sharing food with a person with HIV, after training 81%. A person can be infected with HIV by using syringes that were used before from someone else 83% said before training, after 94%. This research confirms that need more health education of young people and shows that training has considerable effect by providing opportunities for increasing knowledge. KEYWORDS: Albania, diagnosis, epidemiology, HIV, incidence KEYWORDS: HIV, knowledge, young people, training

149 Human Inmunodeficiency Virus & Sexual Transmitted Infections 30th November 2017 Poster Session 30.4 / 149 Abstract 48 HIV infection trend in TB patients in Libya Mohamed Furjani (1), M. Shelli (1), S. Hawadi (1), N. Abuamer (1,2,3) 1. National Center for Disease Control, LIBYA 2. Medipiet corresponcance 3. ECDC correspondance in Libya Globally, the relationship between HIV and TB disease is well known. HIV epidemic continues to stimulate the global TB epidemic and vice versa. The latest national Seroprevalence study among general population was done in 2004 and revealed0.13%hiv prevalence (2). We aimed in this study to describe a nine years period trend of HIV incident infections among patients newly diagnosed with Tuberculosis disease in Libya. This retrospective study used data of registries and annual reports of National Tuberculosis and Leprosy Control Programme (TBP) at the National Center for Disease Control (NCDC). The study covered the period starting from January 2007 to December Data entered and analyzed using excel programme. The rate of HIV coinfection in TB diagnosed individuals between the years 2007 and 2015 is shown in figure 1. HIV/TB coinfection rate was 8.6% in 2007 and increased to 9.9% in 2008 but decreased again in year 2009 (7.1%). HIV infection has increased again to 8.9% in year 2010 and from then rates have continued to fall to finally reach 2.2% in A downward trend in HIV infection rates in TB cases has been noticed during the studied 9 years period. In 2010, the National HIV Programme has introduced and promoted for HIV testing and counseling (HTC) and hotline programme for HIV education and information. Raising awareness campaigns were also launched since then aiming at improving early diagnosis rates and retention to ART treatment. Hence the better chance of control of opportunistic infections like TB among PLHIV in the country. New assessment of HIV/TB case notification system is highly recommended. KEYWORDS: HIV, Tuberculosis, Trend, Libya Abstract 92 Opportunistic infections and CD4 cell correlates among HIV-infected cases at antiretroviral health care center of Ibn Zohr Hospital, Marrakesh, Morocco, 2015 A Cross-sectional Study. Noureddine Sakhri (1), L. Aajly (2), A. Khattabi (1), F. Z. Meski (1) 1. National School of Public Health (ENSP), Rabat, Morocco 2. Health care center of Ibn Zohr Hospital, Marrakesh, Morocco Morbidity and mortality in HIV disease is due to immunosuppression leading to life-threatening opportunistic infections (OIs) during the natural course of the disease. In 2015, the HIV prevalence is low in general population and Concentrated among key populations. This study aimed to assess the prevalence and CD4 correlates of OIs among adult HIV-infected patients attending at antiretroviral health care center of Ibn Zohr Hospital, Marrakesh during We conducted a cross-sectional study among all adult HIV-infected patients for admitted in the health care center during 2015, who had acquired infection disease. Patients opportunistic infection status was determined through clinical diagnosis and laboratory investigations. CD4 count was determined using flow cytometry technique. The clinical stage of HIV was identified by the classification of CDC. We collected Socio-demographic and clinical data from patients medical records. We performed statistical analysis by using Epi-Info software. The appropriate test was applied, bivariate analysis was made and the differences were significant when p< HIV-infected cases were included; 62.9% were males. The most represented age group was years (40.2%). The mean age of the cases was 35.4 ± The prevalence of OIs was 55.1%. Oral candidiasis 14.2% and tuberculosis 11.0% were the most frequently observed OIs. OIs were more prevalent among cases when the CD4 count was less than 200/mm3 (p<0.0001) and among cases who had a CDC clinical stage C (p<0.0001). Oral candidiasis and tuberculosis were the leading OIs, encountered by HIV-infected cases. CD4 count less than 200/mm3 and advanced CDC clinical stages of the disease were found to be predictors of OIs. Preventive measures and early treatment of HIV associated to OIs are crucial. KEYWORDS: Opportunistic infections, CD4 correlates, HIVinfected cases, AIDS, CDC clinical stage

150 150 / Human Inmunodeficiency Virus & Sexual Transmitted Infections 30th November 2017 Poster Session 30.4 Regional contributions and synergies for Global Health Security Abstract 129 Sentinel surveillance system for sexually transmitted infections in Albania, 2016 Adela Vasili (1), A. Xhaferi (1), Dh. Torba (1) 1. Institute of Public Health, Tirana, Albania Increases in STIs have been reported from the United State an Europe. Since 2009, only syphilis and HIV are notifiable in Albania. A sentinel surveillance system has been set up to assess the occurrence and trends of STIs and identify risk groups. Through the sentinel system data are collected from local Health Offices, hospital and private laboratory. For every newly diagnosed laboratory confirmed infection of gonorrhea, chlamydia, syphilis, gardenella vaginalis, mycoplasma hominis, ureplasma or trichomoniasis, physicians complete a standardized questionnaire regarding diagnosis, source of infection, and demographic information. Characteristics of sentinel patients were compared with those reported through the HIV and syphilis national notification system. 5 local Health Offices, 7 hospital and 15 private laboratory (55,5%) from all Albania participated in the study. From March 2019-December 2016, a total of 9580 STIs have been reported, among them 12 chlamydia, 507 syphilis (100% of notified syphilis), 68 gonorrhea, 1323 gardenella vaginalis, 253 mycoplasma hominis, 637 ureplasma and 377 trichomoniasis (97%) of the patients were female, the median age was 27 years. Our sentinel system will provide a base for detection of STIs trends in Albania. In addition, information about sexual risk behaviour will enable us to target prevention at those most at risk for STIs. KEYWORDS: surveillance, sexually transmitted infections, syphilis, sentinel Abstract 22 HIV testing in Albania in 2016 Tana Bregu (1), SH. Qyrra (2), E. Toçi (2,3), E. Tomini (2,3), G. Burazeri (2,3) 1. Health Center Number 9, Tirana, Albania 2. Institute of Public Health, Tirana, Albania 3. Mediterranean Programme for Intervention Epidemiology Training (Medi- PIET), Institute of Public Health, Tirana, Albania HIV testing is essential for monitoring HIV situation in a country, reducing HIV transmission and enabling affected individuals to access proper treatment. Voluntary testing is an important aspect of HIV testing. In this context, the aim of this study was to assess the proportion of voluntary HIV testing among persons tested for HIV in Albania. We collected information from all sources providing HIV testing in Albania during 2016, and namely: blood banks, voluntary counselling and testing (VCT) centers, university hospital center Mother Teresa in Tirana, Institute of Public Health (IPH) and private laboratories. The information on whether the testing was voluntary or prescribed or carried outroutinely as part of the normal procedures, for example in blood banks, was recorded and used to calculate the proportion of voluntary HIV testing. In 2016 a total of HIV test were carried out in Albania. Among these, 83.7% occurred in blood banks across the country, 14.1% in VCTs and the remaining 2.2% in IPH. In total, only 1336 cases or 3% of all HIV tests were carried out on voluntary basis. Among 7219 tests outside of blood banks (not eligible for voluntary testing), 18.5% of them were on voluntary basis. There was huge variation in voluntary testing rates across regions of the country. The lowest rate was recorded in Tirana (2.9% of all HIV testing is on voluntary basis) and the highest rate in Kukes and Fier regions (all testing is voluntary). Voluntary HIV testing is an extremely uncommon procedure in Albania, especially in Tirana, the capital of Albania. There is a need to find ways and opportunities to enhance voluntary HIV testing in Albania. KEYWORDS: Albania, HIV, testing, voluntary testing, VCT

151 Human Inmunodeficiency Virus & Sexual Transmitted Infections 30th November 2017 Poster Session 30.4 / 151

152

153 Poster Session 30.5 Surveillance

154 154 / Surveillance 30th November 2017 Poster Session 30.5 Regional contributions and synergies for Global Health Security Abstract 136 Epidemiological characteristics of maternal mortality in Kenitra Province, Morocco, from 2010 to 2015 Driss Daoudi (1), M.A Tazi (1), M. Harrag (2), M.El Rhouli (2), A. Khattabi (1) 1. National Public Health School, Ministry of Health, Rabat, Morocco. 2. Delegation of Health of Kenitra Province, Ministry of Health, Kenitra, Morocco. Maternal deaths are very serious public health problem worldwide. In Morocco, maternal mortality rate reduction is a national priority. It decreased of 49% from 227 to 112 deaths per new births between 2004 and 2011but remains insufficient to reach a MMR lower than 50 deaths per new births. The aim of our study is to determine trends and epidemiological characteristics of maternal mortality (MM) in Kenitra Province from 2010 to We conducted a descriptive analysis of data collected in the provincial register of MM over a period of 6 years. Study population was represented by women living in Kenitra Province and giving birth during the study period. We used the WHO definition of MM. We calculated proportionate mortality ratios and 95% confidence intervals for associations between causes of death categories. The MMR was 63.0 deaths per living births over 6 years (95% CI [ ]).This MMR is 54% higher among rural women with 71.2 deaths per living births. The mean maternal age at death was 30 years ± 6.7 years and 72.7% of women were under 35 years old. The leading causes of death were eclampsia (36.4%-95% CI [26.5% %]) and hemorrhage (33.8%-95% CI [24.2% %]). Out of the 79 deaths reported from 2010 to 2015, 56 (70.8%) had a parity less than 4, and 84.8% had no antenatal care. Even if the MMR in Kenitra Province is much lower than the national MMR reported in 2011, maternal mortality is still an important health problem that seems to affect more rural mothers and those with no antenatal care. KEYWORDS: Maternal death, epidemilogocal profile, retrospective study, Province of Kenitra-Morocco. Abstract 122 Antiretroviral Adverse Drug Reactions Pharmacovigilance in Harare City, Zimbabwe, 2017 Hamufare D. Mugauri (1), O. Mugurungi (2), M. Tshimanga (1), N. Gombe (1), T. Juru (1), G. Shambira (1) 1. Department of Community Medicine, University of Zimbabwe 2. Ministry of Health and Child Care, Zimbabwe Key to pharmacovigilance is spontaneously reporting all Adverse Drug Reactions (ADR) during post-market-surveillance. This facilitates identification and evaluation of previously unreported ADR s, acknowledging the trade-off between benefits and potential harm of medications. Only 41% ADR s documented in Harare city clinical records, January to December 2016 were reported to Medicines Control Authority of Zimbabwe (MCAZ). We investigated reasons contributing to underreporting of ADR s in Harare city. Descriptive cross-sectional study usingcenters for Disease Control (CDC) guided surveillance evaluation was conducted. Seventeen health facilities, 52 health workers were randomly selected. Interviewer-administered questionnaires, key informant interviews and WHO pharmacovigilance checklists were used to collect data. Likert scales were applied to draw inferences and Epi-info-7 used to analyse data. Of 52 participants, 32 (61.5%) distinguished the ADR defining criteria. Twenty-nine (55.8%) knew system s purpose whilst 28 (53.8%) knew reporting process. Knowledge scored average on a 5-point-likert scale. Thirty-eight (73.1%) participants identified ADR s following client complaints and nine (1.3%) enquired clients medication response. Forty-six (88.5%) cited non-feedback from MCAZ for underreporting. Inadequate ADR identification skills were cited by 21 (40.4%) participants. Reporting forms were available in five (26.3%) facilities and reports generated from hospitals only. Forty-two (90.6%) clinicians made therapeutic decisions from ADR s. Averaged usefulness was 4, on the 5-point-likert scale. All 642 generated signals were committed to Vigiflow, reflecting case detection rate of 4/ Data quality was (WHO), all reports were causally assessed. Pharmacovigilance system was useful, simple, and acceptable but unstable, not representative and not sensitive. It was threatened by suboptimal health worker knowledge, weak detection strategies and referral policy. Revisiting local policy, advocacy, communication and health worker orientation improved pharmacovigilance performance in Harare city. KEYWORDS: Pharmacovigilance, Postmarketing Product Surveillance, Adverse drug reaction, Antiretroviral agents

155 Surveillance 30th November 2017 Poster Session 30.5 / 155 Abstract 25 The urgency of legionnaires disease in Ukraine Nataliia Rodyna (1), R. Rodyna (2) 1. State Institution Kyiv Regional Laboratory Center of the Ministry of Health of Ukraine, Kyiv, Ukraine 2. State Institution Public Health Center of the Ministry of Health of Ukraine, Kyiv, Ukraine Legionnaires disease surveillance is extremely important for countries around the world. The study of legionellosis pathogens circulation in the environment by microbiological laboratory methods has proved the existence of this problem for Ukraine. The accession of Ukraine to the European network of surveillance of legionellosis EPIS ELDSNet in 2016 was important for our country. The goal of our research was risk assessment of possible legionella infection among people living in Ukrainian hotels using laboratory studies of environmental objects (EO). We analyzed notifications received from the European Center for Disease Control (ECDC). We studied 66 samples of EO which were selected in 7 hotels in Ukraine, including: water samples 22, swabs from shower nozzles and grids cranes We investigated samples in real-time PCR («AmpliSens Legionella pneumophila-fl», Russia) and by bacteriological method (medium "Legionellabakahar"). Ukraine has received 10 notifications ECDC about confirmed cases of legionellosis among foreigners which lived in 9 different hotels in Ukraine during years. One of the cases ended fatally ((10,0 ± 1,9)%). During the risk assessment of pathogens legionellosis in these hotels were detected L. pneumophila in 21 samples of EO ((31,82 ± 2,67)%) using laboratory methods. Positive results were obtained in 5 water samples ((22,72 ± 3,28)% of the total examined samples of water) and in 16 samples of swabs ((36,36 ± 3,99)% of the total number of surveyed washings plumbing equipment). The L. pneumophila strain has been isolated from swab by bacteriological method and was confirmed by RT-PCR. The problem of possible infection with L. pneumophila in the hotels is a huge challenge in public health in Ukraine. KEYWORDS: legionnaires disease, risk assessment, Legionella pneumophila, PCR. Abstract 74 Campylobacteriosis in the population of Belgrade, Serbia, Slavica Maris (1), S. Šipetić-Grujičić (2), J. Maksimović (2), J. Marinković (3), Z. Vidaković (4) 1. Institute of Public Health of Belgrade 2. Institute of Epidemiology, Faculty of Medicine, University of Belgrade 3. Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade 4. Primary health care center "Dr Milutin Ivković" Palilula Campylobacteriosis is a diarrhoeal disease caused by Campylobacter bacteria. The incidence and prevalence of campylobacteriosis have increased worlwilde, particularly in North America, Europe and Australia. Campylobacter is one of leading cause od bacterial gastroenteritis in Belgrade. Objective: This study analyzes the epidemiological features of campylobacteriosis in Belgrade for the period The incidence of campylobacteriosis were analyzed in this descriptive study. In analyzing the data, the crude and age-specific and standardized incidence rates were used. To assess trends in incidence joinpoint regression analysis was used (Joinpoint Regression Program, Version May 2013). In total, 1,214 cases (696-male, 518-female) of campylobacteriosis were recorded during the observed time period. The highest average age-specific incidence rates in the age group <4 years were registered (98.4/100,000 men and 76.4/100,000 women). The average crude incidence rate was 6.9 per 100,000 inhabitans and average standardized incidence rate was 14.4 per 100,000 inhabitans. In the opserved period there was an increase in the annual standardized incidence rate in the overall popilation of +1.6% (95% CI: -3.9 to 7.5%, p=0.5, joinpoint=0), in the men +2.4% (95% CI: -3.2 to 8.4%, p=0.5, joinpoint=0), in the women of +0.3% (95% CI: -7.4 to 8.6%, p=0.5, joinpoit=0). The average standardized incidence rate for urban municipalities (10.9/100,000 inhabitans) was higher than for rural (7.5/100,000 inhabitans). Peak occurrence of campylobacteriosis was from September to October (23.4%). The highest average age-specific incidence rates in the youngest age group was registered. There was no statistically significant change of trend in the incidence of campylobacteriosis for any age group by gender. There is a need for enhanced prevention of campylobacteriosis with focus on identified risk groups such as children. KEYWORDS: campylobacteriosis, incidence, trend, Belgrade

156 156 / Surveillance 30th November 2017 Poster Session 30.5 Regional contributions and synergies for Global Health Security Abstract 165 Buruli Ulcer Disease in Greater Accra Region- Ghana Tanko Rufai (1, 2), K. Ameme (1), E.Kenu (1), S. Sackey (1), E. Afari (1) 1. School of public health, Department of epidemiology and disease control, University of Ghana 2. Ghana Health Service Buruli Ulcer (BU) is caused by Mycobacterium ulcerans. It is the third most widespread mycobacterium infection after Tuberculosis and leprosy globally but second in Ghana, causing morbidity in immuno-competent humans. M. ulcerans infection leads to chronic ulcers, deformities and functional limitation and its virulence depend on mycolactone. BU surveillance data are not adequately analysed to effectively identify the distribution of BU disease at regional levels. BU data was therefore analysed to identify the distribution of the disease in Greater Accra. Data from 2011 to 2015 was extracted from the BU02 form. Variables collected were sex, age, district of residence, categories of lesions, location of lesions and clinical forms. Descriptive analysis was done and expressed as frequencies and graphs using Epi info7. A total of 496 confirmed cases of Buruli ulcer were reported from in Greater Accra region. Yearly trends showed cases decreased from 223 (45%) in 2011 to 27 (5.4%) in Of the 496 cases, 259 (52.2%) were males while 190 (38.3%) were children <15yrs. Non-ulcerative early lesions occurred in 48 (9.7%), Ulcer 378 (76.2%) and mixed form 69 (13.9%). During the period, 216 (43.5%) cases were classified under category III, 177 (35.7%) category I and 103 (20.8%) category II. Ga West reported 267 (53.8%) cases to the region but in terms of district of residence of patients, Ga South recorded 225 (52.7%). About 363 (73.2%) lesions were on lower limbs, 81 (16.3%) on upper limbs and 27 (5.4%), on head/neck. The number of reported BU cases decreased considerably over the period with most patients presenting at late stage (Cat III) of the disease. Public education about the disease should be intensify. KEYWORDS: Buruli ulcer, Surveillance system, Ga West Municipal, Ga South Municipality, Ghana Abstract 89 Epidemiological profile and prognostic factors of community-acquiered acute bacterial meningitis in children under 5 years of age in the Tangier-Tetouan-Al Hoceima region (Morocco), Mouad Merabet (1), H. Aoufi (2), M. Badi (3), R. Aouragh (3), A. Idrissi (4) 1. FETP trainee. National School of Public Health. Rabat. Morocco. 2. Tangier-Tétouan-Al Hoceima Regional Health Authority. Morocco 3. Al Hoceima Provincial Health Delegation. Morocco 4. National School of Public Health. Rabat. Morocco. Bacterial meningitis in children is a medical and public health emergency. It is a health problem in Morocco and the Tangier-Tetouan-Al Hoceima region (TTAR). The objective of this work is to describe the epidemiological profile and to identify the factors related to the lethality of this disease in children less than 5 years at TTAR. This is a retrospective prognostic study with descriptive and predictive aim with a purely quantitative approach. The population targets was the cases of bacterial meningitis recorded in children under 5 years at RTTA between 2006 and Data were collected from the regional database of meningitis. The descriptive and analytical analysis (bi-variate and multi-variate) was carried out through Epi-Info 7 at a 95% confidence level. Were included in the study 721 cases with an average incidence of 23 / 100,000 children. The median age was 19 months and the sex ratio M / F was Febrile meningeal syndrome was observed in 56.22% of cases. CSF was purulent in 77.37% of cases. The median number of GB was 1200 elements / mm3. The confirmation rate was 27.18%. Confirmed cases were caused by Neisseria Meningitidis (140), Streptococcus Pneumonae (33) and Haemophilus Influenzae (18). The mean lethality was 11.79%. 4 variables significantly related to death were used in the multivariate analysis: coma at admission (ORadjusted = 10.94), penumococcus (ORadjusted = 7), clear CSF (ORadjusted = 6.54) and increased CSF protein (ORadjusted = 1.49). Bacterial meningitis is a real health problem in TTAR especially in children, requiring the effective involvement of all health personnel and community in the control actions, the allocation of necessary resources and the follow-up Measures taken. KEYWORDS: Bacterial Meningitis, Children, Lethality, Neisseria Meningitidis,Prognosis Factors

157 Surveillance 30th November 2017 Poster Session 30.5 / 157 Abstract 106 Evaluation of Vaccine Preventable Disease Survelliance System in Province Balochistan, Pakistan Dr. Rafiq Ahmed Chhalgari (1) 1. FELTP Pakistan Globally Vaccine preventable diseases are responsible for nearly 20% deaths per year among children <5 years. Pakistan has high child and maternal mortality, population growth and burden of communicable diseases. By 2005, 80% of children immunized in their first year against 9 targeted diseases. Balochistan being the least developed has high morbidity and mortality of communicable diseases. VPD surveillance system plays vital role in looking trends and control of priority preventable diseases. Oobjectives of Evaluation was to assess existing VPD surveillance system in Balochistan, to identify gaps and formulate recommendations. Evaluation was performed in Balochistan during March Qualitative and quantitative assessment of system attributes on basis of CDC updated guidelines for evaluating public health surveillance systems 2001 was done. Interviews were conducted using semi structured questionnaire. System is simple and easy to operate. System is flexible and able to integrate with other systems like DEWs. Data quality was found average; acceptability is good as 80% of health facilities of all reporting districts are involved in data collection. Representation, timeliness and stability were also found good. Sensitivity and PVP calculated for Measles was 2.3% and 75.4 % respectively. Systems covers all the Districts of Balochistan but some reporting Units not reporting timely, Average data quality was found and nearly half of the reports were filled completely. No involvement of private sector, No regular feedback from provincial to district level and Validation of data is not done regularly. Recommendations: More focus should be made on completeness of reports to improve data quality. Integrated disease surveillance system suggested. Regular trainings on reporting tools and early case detection. Full involvement of private sector is required for case detection and reporting. Abstract 40 Causes of low vaccine coverage against rotavirus infectionin Chisinau, Republic of Moldova Ion Birca (1), V. Bukov (1), S. Gheorghita (3), N. Furtuna (1), A. Melnic (1), L. Turcan (1), A. Ceban (1,2) 1. National Center for Public Health, Chisinau, Republic of Moldova 2.Mediterranean Programme for Intervention Epidemiology Training (MediPIET) 3.World Health Organization, Country Office in Republic of Moldova In the Republic of Moldova vaccination against rotavirus infection (RI) was introduced in the National Immunization Program in July 2012, being free of charge and mandatory. The immunization schedule includes two doses of vaccine - at age 2 and 4 months. Vaccination coverage in Chisinau municipality was lower than the average for the country in % and 48.2%, in % and 75.6%. We conducted a study to determine the causes of low coverage against RI in Chisinau municipality. The study was accomplished using a standardized questionnaire which allowed collection of data on the target population aged <1 year eligible for vaccination within 19 Private and Public Medical Sanitary Institutions (PMSI) who provide immunization services, vaccine coverage during the period and the causes from which immunization has not been achieved. Was analyzed the vaccine history of 2612 children born between , of which 882 (33.7%) were not vaccinated against RI. The vaccine coverage rate for 2 doses is on average 66.2%, within the limits from 52.1% to 78.7% in various medical institutions. The most common causes of nevaccination were: false contraindications (anemia, prematurity, hemangioma, encephalopathy) - 28%, refusal %, population flow - 10%, neurological contraindications - 9.7%, unidentified causes - 7%. The outcomes shows the low level of knowledge from family doctors and population about the rotavirus vaccine characteristics, contraindications to vaccination, which explains the large number of refusals and false contraindications. KEYWORDS: Republic of Moldova, rotavirus infection,vaccine coverage,acute diarrheal disease,false contraindications KEYWORDS: Vaccine Preventable Disease,Balochistan,Globally

158 158 / Surveillance 30th November 2017 Poster Session 30.5 Regional contributions and synergies for Global Health Security Abstract 96 Epidemiological profile of end-stage renal disease in Morocco; Nadya Mezzoug (1), Iassine Smaili (2), Mohamed Harrag (3), Asmae Khattabi (1) 1.Field Epidemiology Training Program (FETP)-Morocco, Ecole Nationale de la Santé Publique, Rabat, Morocco 2.Centre Anti Poison et de Pharmacovigilance, Morocco 3.Cellule Provinciale d Epidémiologie, Délégation Médicale de la Santé, Kenitra, Morocco Although the vast majority of patients with end-stage renal disease (ESRD) in Morocco, alittle is known about its epidemiology and management. With the currently credible and sufficiently representative Magredial register established since 2004, it is justified to analyze its data to provide information for nephrological community and health authorities. This is a descriptive analysis of medical records from Magredial registry covering a period from 1993 to 2014 of activities of the hospitals and dialysis centers in three north-west provinces of Morocco (1.904 Million Inhabitants). We analyzed socio-demographic and clinical data such as major comorbidities, presumed etiology of ESRD, diabetes, blood pressure, renal replacement therapy and mortality. A total of 391 ESRD patients were reported in the registry during the study period. Average age was 52.04± years. No difference (p=0.13) was noted between females (53.15±16.20 years) and males (50.65±14.84 years) average age. Only 6.85% of ESRD patients were full time active. More than 11% of them were the ex-smokers and 29% were diabetics. The leading cause of ESRD reported by the primary diagnosis data was diabetes (24%) followed by hypertension (22%). Hemodialysis was the only mode of renal replacement therapy used with a median duration of 3 years. Among the ESRD patients reported, 53.71% present comorbidity. The mortality rate was 15.86% according to our data. The cardiovascular disease was the mean mortality cause (64%) among ESRD patients died. Our data provide a set of epidemiological characteristics of ESRD disease in the provinces studied. Continuous improvement on the Chronic Renal Disease prevention is recommended, as well as the early detection and treatment to ovoid its evolution to the ESRD requiring replacement therapy which is very expensive. Abstract 126 Post-Introduction Evaluation of Rotavirus Vaccine, Georgia, 2014 Ekaterine Jabidze (1), K.Zakhashvili (1), T.Dolakidze (1), T.Sulkhanishvili (1), M.Lashkarashvili (1) 1.National Center for Disease Control and Public Health, Tbilisi, Georgia Rotavirus is one of the leading causes worldwide for child hospitalization and death due to gastroenteritis. In Georgia, the surveillance data for showed that significant proportion of severe diarrhea (up to 40%) in children under five years of age that required hospitalization was induced by rotavirus. Cost effectiveness evaluation showed that rotavirus vaccines are highly cost effective and projected to reduce RV-associated childhood morbidity and mortality in Georgia. Rotavirus vaccination was included into the national immunization schedule in A post-introduction evaluation was conducted in 2014 on the basis of WHO recommendations and technical support. The evaluation was coordinated by NCDC. Experts visited all districts countrywide and administered standardized questionnaires at all health facility levels. Additional interviews were conducted with mothers of vaccinated children. Qualitative and quantitative data were compiled and analyzed and recommendations were formulated by the evaluation team. According to evaluation conducted a year after vaccine introduction, rotavirus vaccine coverage for children born in 2013 was 48% for dose one and 37% for dose two, using the denominator of 58,579 births. This is lower than the planned coverage of 60%. The health facilities visited, had qualified personnel, well-established immunization planning, recording, and monitoring systems. The national vaccine storage site has adequate storage capacity and cold chain monitoring systems in place. Implementation of post-evaluation recommendations yielded increase in coverage %, %, a decrease of RV-associated hospitalizations, therefore demonstrating the high effectiveness of RV vaccinations. Still, there are certain challenges that should be addressed in order to improve the coverage, decrease the number of cases and provide the herd protection. KEYWORDS: End-stage renal disease (ESRD); renal registry, epidemiological profile, Morocco KEYWORDS: Vaccination, Rotavirus, Post-Introduction, Evaluation, Coverage, Gastroenteritis

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168 Instituto de Salud Carlos III Centro Nacional de Epidemiología Monforte de Lemos, Madrid Tel. (+34) /10 info@medipiet.eu CBRN CoE Project 36 IfS/2013/ Further Development and Consolidation of the Mediterranean Programme for Internvention Epidemiology Training.