The World Health Organization (WHO) declared the current COVID-19 a public health emergency of international concern on January 30, 2020. Countries in the Eastern Mediterranean Region (EMR) have a high vulnerability and variable capacity to respond to outbreaks. Many of these countries addressed the need for increasing capacity in the areas of surveillance and rapid response to public health threats. Moreover, countries addressed the need for communication strategies that direct the public to actions for self- and community protection. This viewpoint article aims to highlight the contribution of the Global Health Development (GHD)/Eastern Mediterranean Public Health Network (EMPHNET) and the EMR’s Field Epidemiology Training Program (FETPs) to prepare for and respond to the current COVID-19 threat. GHD/EMPHNET has the scientific expertise to contribute to elevating the level of country alert and preparedness in the EMR and to provide technical support through health promotion, training and training materials, guidelines, coordination, and communication. The FETPs are currently actively participating in surveillance and screening at the ports of entry, development of communication materials and guidelines, and sharing information to health professionals and the public. However, some countries remain ill-equipped, have poor diagnostic capacity, and are in need of further capacity development in response to public health threats. It is essential that GHD/EMPHNET and FETPs continue building the capacity to respond to COVID-19 and intensify support for preparedness and response to public health emergencies.

Infectious threats to humans are continuously emerging. The 2022 worldwide monkeypox outbreak is the latest of these threats with the virus rapidly spreading to 106 countries by the end of September 2022. The burden of the ongoing monkeypox outbreak is manifested by 68,000 cumulative confirmed cases and 26 deaths. Although monkeypox is usually a self-limited disease, patients can suffer from extremely painful skin lesions and complications can occur with reported mortalities. The antigenic similarity between the smallpox virus (variola virus) and monkeypox virus can be utilized to prevent monkeypox using smallpox vaccines; treatment is also based on antivirals initially designed to treat smallpox. However, further studies are needed to fully decipher the immune response to monkeypox virus and the immune evasion mechanisms. In this review we provide an up-to-date discussion of the current state of knowledge regarding monkeypox virus with a special focus on innate immune response, immune evasion mechanisms and vaccination against the virus.

COVID-19 pandemic has underscored the need for a well-trained public health workforce to save lives through timely outbreaks detection and response. In Yemen, a country that is entering its seventh year of a protracted war, the ongoing conflict severely limited the country's capacity to implement effective preparedness and response measures to outbreaks including COVID-19. There are growing concerns that the virus may be circulating within communities undetected and unmitigated especially as underreporting continues in some areas of the country due to a lack of testing facilities, delays in seeking treatment, stigma, difficulty accessing treatment centers, the perceived risks of seeking care or for political issues. The Yemen Field Epidemiology Training Program (FETP) was launched in 2011 to address the shortage of a skilled public health workforce, with the objective of strengthening capacity in field epidemiology. Thus, events of public health importance can be detected and investigated in a timely and effective manner. During the COVID-19 pandemic, the Yemen FETP's response has been instrumental through participating in country-level coordination, planning, monitoring, and developing guidelines/standard operating procedures and strengthening surveillance capacities, outbreak investigations, contact tracing, case management, infection prevention, and control, risk communication, and research. As the third wave is circulating with a steeper upward curve than the previous ones with possible new variants, the country will not be able to deal with a surge of cases as secondary care is extremely crippled. Since COVID-19 prevention and control are the only option available to reduce its grave impact on morbidity and mortality, health partners should support the Yemen FETP to strengthen the health system's response to future epidemics. One important lesson learned from the COVID-19 pandemic, especially in the Yemen context and applicable to developing and war-torn countries, is that access to outside experts becomes limited, therefore, it is crucial to invest in building national expertise to provide timely, cost-effective, and sustainable services that are culturally appropriate. It is also essential to build such expertise at the governorate and district levels, as they are normally the first respondents, and to provide them with the necessary tools for immediate response in order to overcome the disastrous delays.

BackgroundMultidrug-resistant tuberculosis (MDR-TB) is a major challenge to ending TB occurrence by 2035. In Yemen, the 2011 survey showed an MDR-TB prevalence of 1.4% among new cases and 14.4% among previously treated cases. The National Tuberculosis Control Program (NTCP) established four MDR-TB sentinel surveillance sites in 2013 to monitor the MDR-TB situation. In Yemen, the 2011 survey showed an MDR-TB prevalence of 1.4% among new cases and 14.4% among previously treated cases. The NTCP established four MDR-TB sentinel surveillance sites in 2013 to monitor the MDR-TB situation.ObjectiveThis study aimed to assess the performance of MDR-TB surveillance and determine its strengths and weaknesses.MethodsWe used the updated Center for Diseases Control and Prevention guidelines for evaluating public health surveillance systems. Interviews were conducted with NTCP managers and Regional MDR-TB centers’ staff using a semistructured questionnaire. We used a 5-point Likert scale to assess the usefulness and other attributes (eg, simplicity and flexibility). The mean percentage was calculated for each attribute and used for the final rank of the performance: poor (<60%), average (60%-80%), and good (>80%).ResultsThe MDR-TB surveillance system achieved good performance in usefulness (87%), acceptability (82%), and data quality (91%); average performance in flexibility (61%) and simplicity (72%); and poor performance in stability (55%). The overall performance score was average (74%). Although strong commitment, good monitoring, and well-trained staff are the main strengths, depending on an external fund is a major weakness along with unavailability of the MDR-TB unit at the governorate level.ConclusionsAlthough the MDR-TB surveillance system has achieved an average overall performance, more efforts are required to improve its stability by ensuring constant power supply to enable laboratories to perform necessary diagnostic and follow-up tests. Gradual replacement of donors’ funds by the government is recommended. Scaling up of MDR-TB services and removing access barriers are crucial.

Background Cutaneous leishmaniasis (CL) is endemic in Yemen. About 4440 cases were reported in 2019. On July 23, 2018, a Hajjah governorate surveillance officer notified the Ministry of Public Health and Population about an increase in the number of CL cases in Bani-Oshb, Kuhlan district, Hajjah governorate. On July 24, 2018, Yemen Field Epidemiology Training Program sent a team to perform an investigation. Objective We aimed to describe a CL outbreak in Hajjah governorate and determine its risk factors. Methods A descriptive study and case-control study (1:1 ratio) were conducted. Cases included people who met the suspected or confirmed case definition of the World Health Organization and lived in Bani-Oshb subdistrict during the period from August 2017 to July 2018. Controls included people living for at least 1 year in Bani-Oshb without new or old skin lesions. Crude odds ratios (cORs) and adjusted odds ratios (aORs) with 95% CI were used to test the significance of associations. Results We identified 30 CL cases. Among the 30 patients, 7 (23%) were younger than 5 years, 17 (57%) were 5 to 14 years, 17 (57%) were females, and 23 (77%) had one lesion. The attack rate was 7 per 1000 population in the age group <15 years and 1 per 1000 population in the age group ≥15 years. On bivariate analysis, the following factors were significantly associated with CL: female gender (cOR 5.2, 95% CI 1.7-16.5), malnutrition (cOR 5.2, 95% CI 1.7-16.5), not using a bed net (cOR 14.5, 95% CI 1.7-122.4), poor house lighting (cOR 6.4, 95% CI 2.1-19.7), poor house hygiene (cOR 11.2, 95% CI 3.1-40.7), poor sanitation (cOR 14.5, 95% CI 1.7-122.4), living in houses without window nets (cOR 5.2, 95% CI 1.3-21.2), plantation around the house (cOR 6.5, 95% CI 2.1-20.5), animal barn inside or close to the house (cOR 9.3, 95% CI 1.9-46.7), raising animals (cOR 8.1, 95% CI 1.6-40.7), and having animal dung in or near the house (cOR 6.8, 95% CI 1.7-27.7). The following risk factors remained significant on multivariate stepwise analysis: female gender (aOR 22.7, 95% CI 1.6-320.5), malnutrition (aOR 17.2, 95% CI 1.3-225.8), poor house hygiene (aOR 45.6, 95% CI 2.5-846.4), plantation around the house (aOR 43.8, 95% CI 1.9-1009.9), and raising animals (aOR 287.1, 95% CI 5.4-15205.6). Conclusions CL was endemic in Hajjah governorate, and an increase in cases was confirmed. Many individual, housing, and animal related factors were shown to contribute to CL endemicity. Implementation of control measures directed toward altering the factors favoring contact among vectors, reservoirs, and susceptible humans is strongly recommended to control future outbreaks.

Background Noncommunicable diseases (NCDs) kill 41 million people each year, accounting for 71% of all deaths globally. The burden of NCDs is rising faster in developing countries of the Middle East than in other regions. The morbidity and mortality of NCDs are still not well-studied in Yemen. Objective The aim of this study was to describe the epidemiology of NCDs in Sana’a City, Yemen, for 2017. Methods Raw data of a house-to-house survey that was conducted by the Ministry of Public Health and Population in 2017 were analyzed. Data were collected from household heads who were asked if any household member had one of the following five NCDs: hypertension (HTN), diabetes (DM), bronchial asthma (BA), mental disorders (MD), and epilepsy. Data were entered and analyzed using Epi info 7.2. For calculations of prevalence, 2017 projections from the 2004 census were used. Results A total of 241,310 households were surveyed (1,592,646 household members), 59,061 (24.48%) of which included 70,178 members who had at least one NCD. The overall prevalence of NCDs was 4.4%. The disease-specific prevalence was as follows: HTN, 2.3%; DM, 2.2%; BA, 0.4%; MD, 0.27; and epilepsy, 0.19%. The overall NCD prevalence was significantly higher among females than males (5.1% vs 3.8%; odds ratio [OR] 1.35, 95% CI 1.33-1.35), which was also the case for the prevalence of HTN (3.1% vs 1.6%; OR 1.94, 95% CI 1.90-1.98), DM (2.3% vs 2.1%; OR 1.11, 95% CI 1.09-1.13), and BA (0.5% vs 0.3%; OR 1.56, 95% CI 1.49-1.65). In contrast, the prevalence of MD was significantly higher among males than females (0.35% vs 0.16%; OR 2.2, 95% CI 2.06-2.31). The prevalence of NCDs progressively increased with age. Nearly 18% of patients had more than one NCD; 35.2% of the patients with HTN also had DM. Conclusions One-quarter of the surveyed households had at least one member with one or more of the five NCDs and the overall prevalence of NCDs was 4.4%. These data reflect only the tip of the iceberg as the findings are based on self-reported diagnosed cases rather than standardized measures. More attention to NCDs, strengthened health care provision, the ability to obtain high-reliability data, an NCDs stepwise survey, and establishing an NCDs surveillance system are recommended.

BACKGROUND Public health has a pivotal role in strengthening resilience at individual, community and system levels and building healthy communities. During crises, resilient health systems can effectively adapt in response to evolving situations and reduce vulnerability across and beyond the systems. OBJECTIVE To provide expert viewpoint/perspective on the recent lessons learned on the Health Systems Resilience in the Eastern Mediterranean Region METHODS Discussion Areas: In a moderated discussion, experts provided their viewpoints on the matter by providing an introduction to health systems resilience, national public health institutes and their role in health systems resilience, the contribution of the health workforce to health system’s resilience with some empirical and personal experiential examples, building resilient health systems and the role of the Field Epidemiology Training Program (FETPs), with an example from Yemen FETP experience, and an overall reflection on the matter and lessons learned. RESULTS Continuous support is needed for FETP graduates to work toward strengthening surveillance systems and investigating outbreaks and to participate in regional and global efforts in response to COVID-19. CONCLUSIONS Lessons learned from the current situation in the Eastern Mediterranean Region (EMR) and the response to strengthen both pandemic preparedness and health systems, as well as the importance of investing in the essential public health functions (EPHFs), including those required for all-hazards emergency risk management, and institutionalized mechanisms for whole-of-society engagement, as well as strengthening the primary health care (PHC) approach for health security and universal health coverage (UHC), and promoting enabling environments for research, innovation, and learning.

BACKGROUND Noncommunicable diseases (NCDs) kill 41 million people each year, accounting for 71% of all deaths globally. The burden of NCDs is rising faster in developing countries of the Middle East than in other regions. The morbidity and mortality of NCDs are still not well-studied in Yemen. OBJECTIVE The aim of this study was to describe the epidemiology of NCDs in Sana’a City, Yemen, for 2017. METHODS Raw data of a house-to-house survey that was conducted by the Ministry of Public Health and Population in 2017 were analyzed. Data were collected from household heads who were asked if any household member had one of the following five NCDs: hypertension (HTN), diabetes (DM), bronchial asthma (BA), mental disorders (MD), and epilepsy. Data were entered and analyzed using Epi info 7.2. For calculations of prevalence, 2017 projections from the 2004 census were used. RESULTS A total of 241,310 households were surveyed (1,592,646 household members), 59,061 (24.48%) of which included 70,178 members who had at least one NCD. The overall prevalence of NCDs was 4.4%. The disease-specific prevalence was as follows: HTN, 2.3%; DM, 2.2%; BA, 0.4%; MD, 0.27; and epilepsy, 0.19%. The overall NCD prevalence was significantly higher among females than males (5.1% vs 3.8%; odds ratio [OR] 1.35, 95% CI 1.33-1.35), which was also the case for the prevalence of HTN (3.1% vs 1.6%; OR 1.94, 95% CI 1.90-1.98), DM (2.3% vs 2.1%; OR 1.11, 95% CI 1.09-1.13), and BA (0.5% vs 0.3%; OR 1.56, 95% CI 1.49-1.65). In contrast, the prevalence of MD was significantly higher among males than females (0.35% vs 0.16%; OR 2.2, 95% CI 2.06-2.31). The prevalence of NCDs progressively increased with age. Nearly 18% of patients had more than one NCD; 35.2% of the patients with HTN also had DM. CONCLUSIONS One-quarter of the surveyed households had at least one member with one or more of the five NCDs and the overall prevalence of NCDs was 4.4%. These data reflect only the tip of the iceberg as the findings are based on self-reported diagnosed cases rather than standardized measures. More attention to NCDs, strengthened health care provision, the ability to obtain high-reliability data, an NCDs stepwise survey, and establishing an NCDs surveillance system are recommended.