Update on Pandemic H1N1 2009: Oman

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Abel Barrett
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1 Update on Pandemic H1N1 29: Oman Dr Idris Al-Abaidani, MoH Websites: who.int, ecdc.europa.eu, cdc.gov, moh.gov.om

3 212 countries reported cases and deaths

4 Seasonal Flu & H1N1 29 Flu

5 *The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related.

Pandemic & Seasonal Flu A: 5 Oct-24 Dec 29 Result # Negative 47 H1N1 4141 Flu A 71

Batinah 95 S Batinah 22 Dakhliyah 48 N Sharqiyah 24 S Sharqiyah 97 Dhahira 63 Buraimi 3

6 Pandemic & Seasonal Flu A: 5 Oct-24 Dec 29 Result # Negative 47 H1N Flu A 71 H1N1+Flu A 2 Inconclusive 18 Total 8941 Province FluA positive Muscat 293 Dhofar 57 N Batinah 95 S Batinah 22 Dakhliyah 48 N Sharqiyah 24 S Sharqiyah 97 Dhahira 63 Buraimi 3 Musandam 5 Al Wustah Blanks 5 Total 712 n = 8941 Negative H1N1 Flu A H1N1+Flu A Inconclusive 8% 46% 46%

7 H1N1 Lab-confirmed Cases # 44,47,48,5,52,53 (29) Cases per Wilayat (Administrative unit) No cases < 5 cases 5-9 cases 1-49 cases 5+ cases The decline of the second wave

8 H1N1 Lab-confirmed Cases # 1-6 (21) Cases per Wilayat (Administrative unit) No cases < 5 cases 5-9 cases 1-49 cases 5+ cases The decline of the second wave

9 Lab-confirmed cases of H1N1: Oman (22 nd to 44 th ) 9 Cumulative positive= (48%) 8 7 Positive Negative Testing policy change #

10 Laboratory-confirmed cases:(17 th Jun 7 th Nov) 25. Regional Distribution n= Rate/1, population Age Distribution

11 8 ly Reported Cases of ILI, SARI Inpatients, Lab-Confirmed H1N1 Cases, H1N1 Associated Deaths: Cases of Influenza Like Illnesses (ILI) First cluster SARI Admissions Influenza-like Illnesses Lab-confirmed Cases Deaths associated with H1N1 Private Schools Open Restricted Testing Government Schools Open H1N1 Vaccination Restricted Testing SARI admissions & Lab-confirmed Cases June July August September October November December Note: For surveillance purpose Severe Acute Respiratory Illnesses (SARI) have been defined as admitted cases of acute febrile respiratory illness and the data are compiled manually from daily reports of 14 sentinel hospitals in the country. Similarly data on ILI are compiled by certain grouping of 'J' codes (ICD 1) amongst outpatient cases with respiratory illness. ILI data are retrieved nationally from patients' records available in computerized health care institutions in the country. For non-computerized institutions data are collected manually and merged with the dataset. Deaths associated with H1N1 are recorded according to date of death. Note: Laboratory testing was restricted on two occasions. Once during the surge of cases in the first wave (week 32-33) which coincided with the tourist season (Khareef) in Dhofar and opening of private expatriate schools. Overwhelming cases were reported. Another occasion was in week #44-47 after the opening of Government Omani schools with outbreaks and subsequent increase in number of cases leading to the second wave.

12 ly Reported Cases of ILI, SARI Inpatients, Lab-Confirmed H1N1 Cases, H1N1 Associated Deaths: (29) & 1-6 (21) 8 7 Cases of Influenza Like Illnesses (ILI) Govt. schools open (44-47) Peak of 2nd Wave (47) SARI Admissions Influenza-like Illnesses Lab-confirmed Cases Deaths associated with H1N SARI admissions & Lab-confirmed Cases November December January February March April Note: For surveillance purpose Severe Acute Respiratory Illnesses (SARI) have been defined as admitted cases of acute febrile respiratory illness and the data are compiled manually from daily reports of 14 sentinel hospitals in the country. Similarly data on ILI are compiled by certain grouping of 'J' codes (ICD 1) amongst outpatient cases with respiratory illness. ILI data are retrieved nationally from patients' records available in computerized health care institutions in the country. For non-computerized institutions data are collected manually and merged with the dataset. Deaths associated with H1N1 are recorded according to date of death. Note: Laboratory testing was restricted on two occasions. Once during the surge of cases in the first wave (week 32-33) which coincided with the tourist season (Khareef) in Dhofar and opening of private expatriate schools. Overwhelming cases were reported. Another occasion was in week #44-47 after the opening of Government Omani schools with outbreaks and subsequent increase in number of cases leading to the second wave.

13 Dhofar Governorate (ILI, SARI, H1N1 cases, Deaths: #23-45) 8 ILI Cases # 24# SARI Admissions Influenza-like Illnesses Lab-confirmed Cases Deaths associated with H1N1 25# 26# 27# 28# 29# 3# 31# 32# 33# Restricted Testing 4 34# # 36# 37# 38# 39# 4# 41# 42# 43# 44# 45# SARI admissions & Lab-confirmed Cases June July August September October

14 35 3 Regional Waves of H1N1 in 29: Lab-confirmed cases Muscat Dhofar North Batinah South Batinah Dakhliyah North Sharqiyah South Sharqiyah Dhahira Buraimi Musandam Al Wustah

H1N1 Associated deaths: End of #6 16 14 12 1 8 6 4 2 n = 32 Omani 87% Indian 13% <12 yrs 12-25 yrs 26-4 yrs 41-59 yrs 6 & above 6 5 4 H1N1 associated

15 H1N1 Associated deaths: End of # n = 32 Omani 87% Indian 13% <12 yrs yrs 26-4 yrs yrs 6 & above H1N1 associated death trend: #34-53 (29); 1-6 (21) Females 53% Male 47% #34 #35 #36 #37 #38 #39 #4 #41 #42 #43 #44 #45 #46 #47 #48 #49 #5 #51 #52 #53 #1 #2 #3 #4 #5 #6

16 H1N1 Associated deaths: End of #6 Co-morbidity 44% None 28% Risk factors # None 9 Pregnancy 4 Smoker 3 Obesity 2 Co-morbidity 14 Total 32 Co-morbidity # DM 6 Transplant 2 Malignancy 1 Congenital 3 Others 2 Obesity 6% Smoker 9% Pregnancy 13% Muscat Dhofar N Batinah S Batinah Death rate/1, population 2.9 Dakhliyah.6 N Sharqiyah.6 S Sharqiyah 1.5 n = 32 Dhahira Buraimi Musandam Al Wustah 1.3 National average death rate 1.1/1, population 1 2 3

17 Oseltamivir resistance Total 264 Oseltamivir resistant pandemic influenza A (H1N1) 29 viruses were reported globally (5 th March). All have the H275Y substitution and are assumed to remain sensitive to Zanamivir.

18 Surveillance of Influenza in Oman Communicable Disease Surveillance and Central Public Health Laboratory Surveillance Network: 1. Established in March Influenza included in Group C i.e. monthly reporting of total numbers. Later on, changed to Influenza & ILI from Laboratory surveillance established at sentinel sites from 21. Samples collected virus isolation, identification. 3. CPHL recognized by WHO as NIC since March SARI surveillance launched at sentinel sites from 28.

Oman Study Sites Surveillance network composed of three sentinel hospitals in three provinces: 1. Sohar Hospital (Jan 28) North Batinah Region 2. Ibra Hospital (Sep 28) North Sharqiyah Region 3.

19 Oman Study Sites Surveillance network composed of three sentinel hospitals in three provinces: 1. Sohar Hospital (Jan 28) North Batinah Region 2. Ibra Hospital (Sep 28) North Sharqiyah Region 3. SQ Hospital, Salalah (Nov 29) Dhofar Governorate Ω New site Ibri Hospital (21) Dhahira Region Dhofar Salalah Musandam Dhahira Al Wustah Sohar Hospital North Batinah South Batinah Dakhliyah Muscat North Sharqiyah South Sharqiyah Ibra

20 Characteristics SARI Surveillance in Oman Patient Characteristics Enrolled patients 778 Samples tested by rtpcr 723 Median Age (Range) 1.25 y (4 days - 89 y) Proportion of Males 54% Median onset of illness to hospital admission 3 days ( 2)

21 SARI Surveillance in Oman, Jan 28 - Jan 21 Viral Etiologies Viruses No. of specimens processed Positive No. % Influenza A % Influenza B % Adenoviruses % hmvp % Para influenza % RSV % Co-infections (viral-viral) % Overall %

22 SARI Surveillance in Oman Monthly Proportion of Influenza Viruses among Positive Specimens, Jan 28- Jan 21 Number of positive specimens Jan % of Flu positive Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan No. of positive specimens Date of admission % Flu positive

23 SARI Surveillance in Oman Monthly Proportion of RSV among Positive Specimens No. of positive specimens % RSV cases Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Date of admission No. of positive specimens % RSV positive

24 SARI Surveillance in Oman Age distribution of SARI cases in Oman, Jan 28 Jan 21 6 Number of SARI cases Age Groups

25 SARI Surveillance in Oman Influenza Viruses by age, Jan 28- Jan.21 No. of Influenza Cases Age groups Seasonal H1N1 Seasonal H3N1 Pandemic H1N1 Flu-B

26 Challenges Surveillance issues The H1N1 pandemic was a blessing in disguise. It helped in raising awareness on the importance of SARI surveillance Hospital admissions due to respiratory illnesses do not necessary follow SARI case definition Maintaining sustained interest of team members

27 Questions?

Past Influenza Pandemics

Past Influenza Pandemics Outline Background Pandemic Response in Oman Pre Pandemic Phase Pandemic Phase Post Pandemic Phase p(h1n1) vaccination strategy Cost of Pandemic Impact on Health System Lessons learnt Conclusions 2 Oman..