Yémen : caractéristiques des cas d'hospitalisation associés aux infections respiratoires aiguës sévères, 2014-2015RÉSUMÉ Cette étude présente les agents étiologiques, les données démographiques des patients, la saisonnalité et les pathologies sous-jacentes chez des patients hospitalisés en raison d'infections respiratoires aiguës sévères (IRAS) au Yémen. Nous avons réalisé une analyse descriptive rétrospective des données portant sur les IRAS et couvrant la période de janvier 2014 à décembre 2015. Des sécrétions rhinopharyngées ont été prélevées par écouvillonnage pour chaque patient afin d'être testées en laboratoire. Un total de 1 346 échantillons diagnostiques ont été testés, parmi lesquels 733 (54 %) se sont avérés positifs aux virus de la grippe. Les virus de la grippe A(H3N2) (5 %) et A(H1N1)pdm09 (3 %) étaient prédominants. Le virus respiratoire syncytial (VRS) a été observé principalement chez les enfants (41 %). Les sujets de sexe masculin étaient plus touchés (61 %) que les sujets de sexe féminin. L'âge médian était d'un an (intervalle : 0,5-94). La durée médiane d'hospitalisation était de 6 jours. Les maladies cardio-vasculaires chroniques constituaient la pathologie la plus fréquemment rapportée ; 67 % ne présentaient aucune pathologie sous-jacente établie. Les cas d'hospitalisation étaient généralement associés à des virus respiratoires, en particulier au VRS, à l'adénovirus et à la grippe.ABSTRACT This study aims to describe etiological agents, demographic details of patients, seasonality and underlying conditions among patients hospitalized due to viral severe acute respiratory infection (SARI) in Yemen. We carried out a retrospective descriptive analysis of data from January 2014 to December 2015. Nasopharyngeal swabs were taken from each patient for laboratory testing. A total of 1346 diagnostic specimens were tested, of which 733 (54%) were positive for influenza viruses. Influenza A(H3) and A(H1N1) pdm09 predominated. Respiratory syncytial virus (RSV) was reported predominantly among children (41%). Males (61%) were more affected than females. The median age was 1 year (range 0.5-94.0). The median length of hospitalization was 6 days. Chronic cardiovascular disease was the most commonly reported underlying condition, but 67% had no documented underlying disease. Respiratory viruses, particularly RSV, adenovirus and influenza, were commonly associated with hospitalization for SARI.

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 The national severe acute respiratory illness (SARI) surveillance system in Yemen was established in 2010 to monitor SARI occurrence in humans and provide a foundation for detecting SARI outbreaks. Objective To ensure that the objectives of national surveillance are being met, this study aimed to examine the level of usefulness and the performance of the SARI surveillance system in Yemen. Methods The updated Centers for Disease Control and Prevention guidelines were used for the purposes of our evaluation. Related documents and reports were reviewed. Data were collected from 4 central-level managers and stakeholders and from 10 focal points at 4 sentinel sites by using a semistructured questionnaire. For each attribute, percent scores were calculated and ranked as follows: very poor (≤20%), poor (20%-40%), average (40%-60%), good (60%-80%), and excellent (>80%). Results As rated by the evaluators, the SARI surveillance system achieved its objectives. The system’s flexibility (percent score: 86%) and acceptability (percent score: 82%) were rated as “excellent,” and simplicity (percent score: 74%) and stability (percent score: 75%) were rated as “good.” The percent score for timeliness was 23% in 2018, which indicated poor timeliness. The overall data quality percent score of the SARI system was 98.5%. Despite its many strengths, the SARI system has some weaknesses. For example, it depends on irregular external financial support. Conclusions The SARI surveillance system was useful in estimating morbidity and mortality, monitoring the trends of the disease, and promoting research for informing prevention and control measures. The overall performance of the SARI surveillance system was good. We recommend expanding the system by promoting private health facilities’ (eg, private hospitals and private health centers) engagement in SARI surveillance, establishing an electronic database at central and peripheral sites, and providing the National Central Public Health Laboratory with the reagents needed for disease confirmation.

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BACKGROUND The national Severe Acute Respiratory Illness surveillance system in Yemen was established in 2010 to monitor SARI occurrence in humans and provide a foundation for detecting SARI outbreaks. OBJECTIVE To ensure that the objectives of the national surveillance are being met, this study aimed to determine the level of usefulness and assess the performance of the SARI surveillance system in Yemen. METHODS The updated Centers for Disease Control and Prevention (CDC) guidelines were used for the purpose of evaluation. Related documents and reports were reviewed. Data were collected from four central-level managers and stakeholders, and from ten focal points at four Sentinel sites using semi-structured questionnaire. For each attribute, the score percent was calculated and ranked as the following: very poor (≤ 20 %), poor (>20-≤ 40%), average (>40-≤ 60%), good (>60-≤80 %) and excellent (>80 %). RESULTS As rated by the evaluators, SARI surveillance system achieved its targets. The system attributes flexibility (percent score: 86%) and acceptability (percent score: 82%) were rated as excellent, and simplicity (percent score: 74%) and stability (percent score: 75%) were rated as good. The percent score of timeliness was 23% in 2018, indicating poor timeliness. The overall data quality percent score of SARI system was 98.5%. Despite its many strengths, the SARI system has some weakness in that it depends on irregular external financial support. CONCLUSIONS Overall, the SARI surveillance system was useful in estimating morbidity and mortality, monitoring the trend of disease, stimulating researches to inform prevention and control measures. SARI surveillance system was excellent in flexibility, acceptability and data quality. Its simplicity and stability were good; its timeliness was poor. It is recommended to expand the system and engage private sites in SARI surveillance, establish an electronic database at central and peripheral levels, and provide the lab with the reagents needed for confirmation.