Prof. Dr. Hameed Aklan The President of the UST Welcome Message It is my pleasure to welcome our distinguished guests from Malaysia, Indonesia, Egypt,

Prof. Dr. Hameed Aklan The President of the UST Welcome Message It is my pleasure to welcome our distinguished guests from Malaysia, Indonesia, Egypt, Saudi Arabia, Syria, Iraq and from Yemen. Our University of Science & Technology (UST) is strongly supporting all this constructive scientific activities that will help not only to improve the medical knowledge and skill for people working in health sector but also improves the health services for the Yemeni people in general. The participation of the Ministry of Public Health and Population and the WHO in supporting this conference made a real differences and helped a lot in holding and success of this conference. We hope that this such cooperation to continue in the future so that the Yemeni community will get benefit from this cooperation. Our doors in the UST university are widely open for cooperation not only to the Ministry of public Health and Population & WHO but to all national and international organizations to make a benefit and services to all Yemeni people. This good number of scientific papers (more than 50), 40 of them will be presented by Yemeni presenters. This indicate that, the Yemeni doctors and researchers are able to do research and produce scientific papers in spite of difficult circumstances they live in. Finally I would like to thank and congratulate the organizing and the scientific committees and all the participants those travelled for a long distance to participate in this important conference and their participations made the success for the infectious diseases conference. Best Wishes to you all. كلمة ترحيبية لرئيس الجامعة األخوة واألخوات المشاركين في مؤتمر األمراض المعدية السالم عليكم ورحمة الله وبركاته إنه لمن دواعي سروري أن أرحب بجميع ضيوفنا الكرام الذين شرفونا من ماليزيا واندونيسيا ومصر والسعودية وسوريا والعراق باإلضافة لكل المشاركين من جميع المحافظات اليمنية. جامعة العلوم والتكنولوجيا ومستشفاها الجامعي تدعم وبقوة كل هذه األنشطة العلمية الهادفة ليس فقط لالرتقاء بالمستوى العلمي للعاملين في مجال الصحة بل أيضا لخدمة المجتمع اليمني بشكل عام والمريض اليمني على وجه الخصوص. إن مشاركة وزارة الصحة العامة والسكان ومنظمة الصحة العالمية ودعمهم لهذا المؤتمر كان سببا رئيسا في إنجاح فعاليات هذا المؤتمر ونحن نتطلع إلى استمرار مثل هذا الدعم في المستقبل إلقامة المزيد من هذه األنشطة والتي تنعكس ايجابيا على خدمة المواطن اليمني. نحن نفتح أبواب الجامعة والمستشفى للمزيد من التعاون مع كل المنظمات المحلية والدولية في كافة المجاالت خاصة تلك التي تخدم العاملين في قطاع الصحة والتي تخدم المجتمع. ستقدم في هذا المؤتمر أكثر من 50 ورقة علمية منها حوالي 40 ورقة سيقدمها باحثون يمنيون وهذا يعكس قدرة األطباء والباحثين اليمنيين وتميزهم على اإلنتاج العلمي على الرغم من الظروف الصعبة التي يعملون فيها والظروف الصعبة التي تمر بها بالدنا حاليا. في الختام أتقدم بالشكر الجزيل لألخوة في اللجنتين التنظيمية والعلمية ولكل المشاركين باألوراق العلمية على هذا اإلنجاز العلمي العظيم والذي تعتز به جامعة ومستشفى العلوم والتكنولوجيا مع تمنياتي للجميع بالتوفيق والسداد. أ.د. حميد محمد عقالن رئيس الجامعة 4 4 5 5

Chairman`s Message Prof. Dr. Husni Al-Goshae Chairman of the Infectious Disease & Control Conference. Dear colleagues, Assalamu Alikum W.W. I would like to welcome all colleagues participated in the Infectious Diseases congress. It is honor to us to have speakers from Turkey, Egypt, Gulf countries and from different Yemeni universities. The positive participation of the Ministry of Public Health and Population and the World Health Organization (WHO) played the major role in the success of this conference. The University and the Hospital of Science & Technology supports strongly the continuous medical education for their staff and for all colleagues working in the health sector. This is the 8th conference to be held in the UST university and hospital in the last 3 years. We did organized conferences in the Surgery and laparoscopic surgery, Orthopedics, Emergency medicine, Cardiology and Cardio-vascular surgery, in Dentistry, Effect of Qaat on Health, Hypertension and Cardiovascular Diseases, and the current Infectious diseases conference. In this congress, more than 50 papers, reviews, presentations and posters will be presented in the field of infectious diseases. Eight workshops also will run on parallel with the congress. More than 50 speakers and 200 trainees will participate in this congress and the workshops. Special respect and gratitude to the administration of UST university & hospital, Ministry of Public Health & Population, WHO, to all participants from abroad especially from Turkey, Indonesia, Egypt, Saudi Arabia, Jordan, Emirates and from all Yemeni Universities and all Yemeni Governorates. I will never forgets the efforts of all members of the organizing and scientific committees. They have worked day and night with a remarkable and appreciable hard working and sincerity. كلمة ترحيبية لرئيس المؤتمر اإلخوة الزمالء جميعا السالم عليكم ورحمة الله وبركاته في البداية أرحب بكل اإلخوة الضيوف الكرام الذين شرفونا بالمشاركة في هذا المؤتمر العلمي الكبير وترحيب خاص بضيوفنا من تركيا ومصر وبعض دول الخليج واليمن وأشكرهم كثيرا على مشاركتهم لنا في هذا العرس العلمي الكبير مما اكسب هذا المؤتمر قيمة علمية ال تقدر بثمن. كما أن الدور اإليجابي لوزارة الصحة العامة والسكان ولمنظمة الصحة العالمية كان له عظيم األثر في نجاح فعاليات هذا المؤتمر. جامعة ومستشفى العلوم والتكنولوجيا تحرص دائما إلى االرتقاء بالمستوى العلمي لمنتسبيها وكذا لجميع األطباء وجميع العاملين في الحقل الصحي في الجمهورية اليمنية ولذلك فنحن نحرص على االستمرار في اقامة مثل هذه المؤتمرات و هذا هو المؤتمر الطبي الثامن الذي يتم عقده خالل الثالث سنوات الماضية, فلقد تم تنظيم مؤتمرات في الجراحة العامة وجراحة المناظير, وجراحة العظام واألسنان والقلب وجراحة األوعية الدموية, والقات واألمراض التي يتسبب فيها, وتم تنظيم سيمنار مع األخوة في جامعة فلورنسا االيطالية في السكر والضغط. ونهاية العام الماضي تم عقد مؤتمر في طب الطوارئ واليوم نعقد هذا المؤتمر الهام الذي يسلط الضوء على األمراض المعدية وطرق الوقاية منها. اليوم نفتتح هذا المؤتمر الهام والذي سيناقش أكثر من 50 ورقة بحثية في مجاالت األمراض المعدية وطرق الوقاية منها وسيصاحب فعاليات هذا المؤتمر عدد 8 ورش عمل ستعقد بشكل متوازي مع المؤتمر لتدريب الكوادر الصحية من جميع المحافظات في مجال األمراض المعدية وكيفية الوقاية منها. شكر خاص لألخوة في وزارة الصحة العامة والسكان ومنظمة الصحة العالمية ولألخوة في إدارة جامعة ومستشفى العلوم والتكنولوجيا لدعمهم المتواصل إلنجاح فعاليات هذا المؤتمر والشكر موصول لكل األخوة المشاركين بأوراق علمية ولألخوة الحاضرين جميعا وألبنائنا الطلبة وهنا أتقدم بالشكر الخاص جدا لألخوة أعضاء اللجنتين التنظيمية والعلمية للجهد الكبير الذي بذلوه طوال األربعة أشهر الماضية والعمل المتواصل إلنجاح فعاليات هذا المؤتمر. والله الموفق رئيس المؤتمر أ.د. حسني الجوشعي 6 6 7 7

Dr. Nasser Haider Consultant and Associate professor of Pediatrics UST Hospital General manger We- in UST Hospital - are really very pleased when such events and activities are held continuously and regularly. In fact, the International Infectious disease congress has been preceded by several medical congresses in different specialties. The importance of this congress comes from the fact that the infectiousdiseases have been known to be a great burden for the advanced countries; these developed countries have made unrivalled efforts and enormous budgets to reduce such diseases. The question that one may ask in this point is: if this is the case with advanced country, what about the developing countrieswhich are still suffering from those infectious diseases in addition to other diseases for several reasons?. Paying attention to the infectious diseases is not only for treating infected people but also for avoiding the occurrences of similar cases again.finally, I would like to thank our colleagues participating in the congress and its preparatoryand Scientific committees for their great efforts they made. I would like also to thank the board of directors for theirsupport and encouragement for implementing these scientific activities that helpall the community classes. Thanks for all the other parties supporting the congress. كلمة مدير عام مستشفى جامعة العلوم والتكنولوجيا بسم الله والصالة والسالم على رسول الله نشعر بمستشفى جامعة العلوم والتكنولوجيا بالسعادة عندما يتم انجاز مثل هذه الفعاليات وبشكل مستمر ومرتب حيث سبق هذا المؤتمر عدة مؤتمرات طبية في تخصصات مختلفة هذا المؤتمر يكسب أهميته أن األمراض المعدية وعدوى المستشفيات مازالت تمثل عبئا في الدول المتقدمة التي بذلت جهود وميزانيات هائلة في سبيل الحد منها وقد تم لهم ذلك فكيف بنا في البلدان النامية التي مازلنا نعاني منها بشكل كبير ألسباب عدة باإلضافة إلى دخول أمراض العصر على خارطة األمراض المختلفة. االهتمام باألمراض المعدية ليس فقط لعالج المصاب ولكن أيضا من خالل عالج هذه الحالة يتم تفادي حدوث حاالت أخرى من نفس المرض. طريقة تنسيق المحاور والجلسات أخذت في الحسبان إظهار حجم المشكلة من خالل اإلحصائيات المحلية ثم كيف معالجتها. االهتمام بتقليل حاالت العدوى في المستشفيات تساعد على سرعة شفاء المريض وتخفيف التكاليف وما يتبعها من أعباء لذلك أقدم الشكر للزمالء المشاركين في المؤتمر واللجنة التحضيرية والعلمية على الجهود المبذولة وأيضا مجلس اإلدارة على دعمهم المستمر وتذليل الصعوبات لتنفيذ هذه األنشطة العلمية التي تخدم المجتمع بكل شرائحه والشكر موصول لكل الداعمين من أي جهة كانت. د.ناصر حيدر مدير عام مستشفى جامعة العلوم والتكنولوجيا 8 8 9 9

Dr.Shafiq.A.Alimad Head of medical department at USTH Head of Scientific committee د. شفيق أحمد العماد رئيس قسم الباطنية في مستشفى جامعة العلوم والتكنولوجيا رئيس اللجنة العلمية Dear colleagues Peace and Allah s mercy and blessings be upon you On behalf of the scientific Committees, we have the great pleasure to invite you to Yemen international congress on infectious disease at university of science and technology hospital. We are hoping that we will be able to make this conference a very special and memorable event; the scientific sessions of the conference will be dominated by scientific data from worthy speakers. Our main objectives from this congress was to improve and update knowledge regarding infectious disease and infection control through sharing experience of different countries. dear colleagues, no doubt that the extent of your participation in the conference are important indicators of success, but the most important criteria of success in this conference is the extent of benefit to our community. Thank you for your attendance Best wish to you all االخوة الزمالء السالم عليكم ورحمه الله وبركاته نيابة عن اللجان العلمية أرحب بحضوركم ومشاركتكم الطيبة في المؤتمراليمني الدولي لألمراض المعدية في مستشفى جامعة العلوم والتكنولوجيا. ان من أهم األهداف الرئيسية لهذا المؤتمر هو تطوير المعرفة النظرية والعملية في ما يتعلق باألمراض المعدية ومكافحة العدوى من خالل تبادل الخبرات من مختلف البلدان. نرجو من الله ان يكون هذا المؤتمر حدثا خاصا ومميزا. وبداية لمؤتمرات الحقة في مجال األمراض المعدية تأتي علينا وبلدنا الحبيب في وضع أمني أفضل. الزمالء األعزاء الشك أن مدى مشاركتكم في المؤتمرهو مؤشر هام للنجاح ولكن أهم المعايير للنجاح في هذا المؤتمر هو مدى فائدة لمجتمعنا. شكرا لحضوركم ومشاركتكم 10 1011 11

Organizing Committee: - Prof. Dr. Husni Al-Goshae, (Congress President) - Prof. Dr. Abdou Saad Ellabban (Vice President of the Congress) - Dr. Shafiq A. Al-Imad (Head of Scientific Committee) - Dr. Abdulqawi Al-Mohamadi (Quality Manager) - Fahmi Alhakimi (Deputy Manager for Financial Affair) - Mohammed Mashni (Manager of Public Relations) - Shikha Al-hobaish (Executive Secretary) - Hajar Alameer (Member) - Nasr Al-Qaderi (Procurement Manager) - Basheer Al-Khateeb (Head of Medical Purchasing Department) - Othman Al-Sheshakly (Head of Marketing Department) - Dr. AbdulBaset Sultan Al-Shaibani (Member) Scientific Committee: - Prof. Dr. Abdou Saad Ellabban (Professor of Rhematology and Deputy Manager for Medical Affair) - Prof. Dr. Ahmed Ali Qaid (Community Medicine) - Dr. Shafiq A. Al-Imad (Head of Medical Department ) - Dr. Mohammed Qaid AL-Obah (Head of Surgical Department) - Dr. Mohammed Abdullah Kubas (Clinical Pharmacist Specialist) - Dr. Abdulqawi Al-Mohamadi (Quality Manager) - Dr. Mahmoud Ali Ahmed AL-Azab (Head of Labratory Department) - Dr. AbdulBaset Sultan Al-Shaibani (Infectious Coordinator) - Dr. Amani Monhammed AL-Modhfri (Secretariat) 12 1213 13

1 2 3 YEMENI INTERNATIONAL CONGRESS ON INFECTIOUS DISEASE Hall A YEMEN SANA A DECEMBER, 15 18 2014. Time Schedule of the Congress Workshop Day Workshops, Monday, 15-12 - 2014 Snapshots in Infectious Diseases ( Interactive Discussion of 5 Interesting ID Cases) (Dr. Qais Haddad) 8,00-10,00 Coffee Break 10 10.30 Febrile Neutropenia.approach.management (Dr Shafiq A. Al-Imad) 10,30-12,30 Lunch break and pray 12,30-1,00 Prevention of nosocomial infection bundles (Dr shafiq A.Al-imad) Ventilator-Associated Pneumonia Bundle 1,00-3,00 Catheter-Associated Urinary Tract Infection Bundle Catheter-Associated Bloodstream Infection Bundle Surgical-Site Infection Bundle Coffee Break 3 3,30 4 5 6 Hemorrhagic Fever (Dr. Ahamed Qaid, Dr. Abdulhakeem Al-Kuhlani, Dr. Abdulwahid Al- Sorori, Dr. Abdullah Almiklafy) 1. Haemorrhagic fever 2. Ebola virus disease global update 3. Ebola virus disease MIPH response 4. General discussion ( question and answers ) End of work shop Day Hall B Hand hygiene and standers precautions (Dr Abdulbaset alshaibani) Hand washing types-techniques-steps of hand washing-missed area after hand washing hand washing time- (Definition of PPE-PPE INCLUDE PPE USE- Sequence OF PPE-PRINCIPELS OF PPE.) video 10 minutes +practical hand washing 30 minutes 3,30-5.30 8,00-10,00 Coffee Break 10 10.30 Sterilization and disinfection. (Dr. Ebtisam Esmail Al-Moayad) Definitions - Reprocessing of reusable medical devices Cleaning Medical devices classification Disinfection and Sterilization levels of disinfection Characteristics of the main chemical disinfectants Common disinfectants/antiseptics used for skin cleansing Common disinfectants used for environmental cleaning in hospitals Methods of Sterilization Sterilization monitoring 10,30-12,30 14 1415 15

7 Lunch break and pray 12,30-1,00 Cleaning of environment and waste management (Dr Mohammed Abdulwahab) Environmental cleaning-danger area inside hospital-medical and nonmedical waste. safe handling of disposal-terminal cleaning. 1,00-3,00 Coffee Break 3 3,30 1 Day 1, Tuesday, 16-12 - 2014 Session 1 ( 8,30-10,3 ) Time Schedule of the Congress Day 1, Tuesday, 162014-12- Opening Ceremony 9-10 State of the art Lecture Ebola virus Outbreak -WHO ramps up response? 10-11 Dr Ahmed Farah Shadoul, WHO Representative Yemen I 8 Infection control in special areas (Dr. Ebtisam Esmail Al-Moayad) 1. Sources of infections in hospital 2. Infection control in Endoscopy 3. Infection control in ICU 4. Infection control in Neonatal ICU 5. Infection control in Dialysis End of work shop Day 3,30-5,30 2 3 4 5 6 Coffee Break 11 11,30 Session 2 (11,00-1,00) Moderators: Prof. Husni Al-Goshae (chairman), Dr.Naser Hider, II Dr. Ahamed Al - arhabi Clinico-Immuno-Pathological Impact of Infection on Rheumatic Diseases 11,30-12 Prof. Abdou Ellabban Rotavirus Analysis among Children in Taiz, Yemen: Pre and Post Vaccination 12-12.15 Dr. Leena Al-Areqi Sarcina Venticulari is a possible causative microorganism other than H.pylori in gastric ulcer pathogensis 12.15 12,30 Dr. Amani Shamshair, Dr.Faris Awn The Potential Effect of The Cyanobacterium Spirulina sp. in Thalassemic children Infected with Hepatitis C 12,30-12,45 Prof. Mohammed Gomaa Impact of Health Education Activities on the Knowledge, Attitude and Practice towards Malaria Control among basic school pupils in Taiz 12,45 1 Governorate. Republic of Yemen Dr.Belquis Abdullah Farea Lunch break & Prayer time 1,00 2,00 16 1617 17

7 8 9 Session 3 (2,00-4,00) Moderators: Huda Basaleem (chairman), Dr. Ahmed Qaid, Dr.Abdullah Almiklafy,Dr. Mohammed Mahdi Helicobacter pylori Update Prof Tawheed Mowafy Physicochemical and Biological Properties of Amoxicillin Capsule Manufactured in Yemen Dr. Mohammed. Ali ALKamarany Acinetobacter baumannii and its antibiotics susceptibility in selected hospital s intensive care units Dr.Abdurhaman Zabad III 2,00 2,30 2,30 2,45 2,45 3,00 14 15 16 Day 2, Wednesday, 17-12 - 2014 Session 1 (8,30-10,30) Moderators: Prof. Abdou Ellabban (chairman), Prof. Yasin Abdulkhader, Dr. Khalid Al-agbari. Serious Bacterial Infections in Children: Detection and Seriousness Dr. Naser Haider H1N1 surveillance data analysis Dr. Awadh Mohammed Ba Saleh Dengue surveillance System Data Analysis Report, 2010-2013 Dr. Ghazi Saleh Awad IV 8,30 9 9 9,15 9,15-9,30 10 11 12 Prevalence of antimicrobial resistance among gram-negative isolates in inpatients at USTH Dr. Mohammed Kubas, Clinical Pharmacist Specialist Carbapenem resistant Acinetobacter baumannii (AB) & Pseudomonas aeruginosa (PA) requires a Rapid and Global Surveillance Strategy Dr. Suleiman Al OBEID Knowledge and Practices of Physicians in Aden about the National Anti- Malaria Case Management Guideline Dr. Khaled Al- Sakkaf 3,00 3,15 3,15 3,30 3,30 3,45 17 18 19 National Program for Leishmania Control surveillance System Data Analysis Dr. Mohammed Hassan Dahnan HIV Surveillance Data Analysis, Yemen, 1987-2013 Dr. Noman Abdul Razzaq Oweidh Mumps outbreak in Beit Tawaf, Amran governorate, February-March 2014 Dr. Qais M. Jassar 9,30 9,45 9,45 10 10-10,15 13 Assessment of infection control among health care workers in Yemeni health care centers Dr. Ameen saleh sherah 3,45 4,00 20 Outbreak Investigation of Chikungunia and other febrile Illnesses Al- Hawtah District, Lahj Governorate 21March 8 May, 2012 Dr. Mohamed A. A. Saleh 10,15 10,30 Coffee break 10,30 11,00 18 1819 19

21 22 23 24 25 26 Session 2 (11,00 1,00) Moderators: Prof. Abdulhafith Al-swaloi(chairman),,Dr. Qais Haddad, Dr. Mohammed Al-sheikh Update in the management of HCV Dr. Redha Al-Ajam Failure of Egyptian Patients with Chronic HCV Infection to INF-alfa Therapy associates with High Frequency of Circulating Myeloid- Derived Suppressor Cells Prof. Mohamed Labib Salem Update in the Management of Hepatitis B Virus Prof. Almetwally Z. Abdelbaset Hepatitis B virus infection among blood donors and attendants screened at National Central Public Health Laboratory, Sana a, Yemen, 2010-2013 Dr. Mohammed Abdullah Al-Amad Prevalence and Associated Factors of Hepatitis C Virus Infection among Renal Disease Patients on Maintenance Haemodialysis in three health centers in Aden, Yemen: A retrospective Study Dr. Khadija Aman Prevalence of type 2 diabetes mellitus patients with hepatitis c virus infection in Sana`a, Yemen Dr. Saeed Mana Almaidamah V 11,00-11,30 11,30 11,45 11,45 12,15 12,15 12,30 12,30 12, 45 12,45 1 27 28 29 30 31 32 Session 3 (2,00-4,00) Moderators: Prof. Yahia Al-Ezzi (chairman),dr.majed Amer. Lutf allah Gulees. Hospital-Acquired Infections Due to Gram-Negative Bacteria, approach and management Dr.Shafiq. A. Alimad. Recent Advances of Tuberculosis Management Dr. Qais Haddad Prolonged measles outbreak among vaccinated children in Ibb, 2014 Dr. Nabil Al Abhar Comparison of the Integrated Diseases surveillance Response system and Communicable Diseases Surveillance system, 2013-2014 Dr. Nabil Mohammed Al-Abhar KNOWLEDG, ATTITUDES AND PRACTICES REGARDING HEPATITIS B AMONG SURGEONS IN SANA`A CAPITAL CITY, YEMEN Dr. ABDUALLAH Al-MIKHLAFY Tuberculosis Surveillance System Data Analysis Report, 2011-2013, Yemen Dr. Manal Salem Baayees VI 2,00 2,30 2.30 3 3 3,15 3.15 3,30 3,30 3,45 3,45 4 Lunch break and Prayer time 1,00 2,00 20 2021 21

33 34 35 36 Day 3, Thursday, 182014-12- Session 1 (8,30-10,30) Moderators: Dr. Redha lajam(chairman), Dr.Mohammed Al-obahi, Dr. Mohammed Kubas Update on septic shock management Dr. Ebrahim Dom Procalcitonin and its role as biomarkers in the diagnosis and management of sepsis Dr.Shafiq.A.Alimad,Dr.Kadijah Bazarah Epidemiological characteristics of human hydatid disease in the major hospitals, Sana a, Yemen Dr. Majed Wadi Role of multidisciplinary team in management of hydatid disease Dr. Rashid Al - Ezzi VII 8,30-9 9-9,15 9,15 9,30 9,30-9,45 39 40 41 42 43 Session 2 (11,00 1,00) Moderators: Prof. Abdulwahid Al sorori (chairman), Dr. Shafiq VIII Alimad, Dr. Mujahed Nassar Update on the prevention, diagnosis and management of Infective Endocarditis (IE) 11,00-11,30 Dr.Ahmed Yahya Mohammed Alarhabi Initial therapy and prognosis of bacterial meningitis in adults 11,30-12 Dr. MOHAMMED AL-SHAIKH, MD Septic arthritis, one of the most urgent case of Rheumatology 12-12,15 Dr. Ahamed Al-Husam Rubella Outbreak in Baharan Village, Sana a, 16th Nov.- 22nd Dec. 2013 12,15-12,30 Dr. Maha Obadi Geographical information system (GIS) in infectious diseases 12,30 1,00 Prof. Shamsul Azhar Shah Closing Session 1-2 Posters 37 38 Successful medical treatment of emphysematous pyelonephritis : our experience with conservative treatment at USTH Dr. Shafiq AL-Imad, Dr.Faris Awn Antibiotic resistance and empiric antibiotic choices of nosocomial bloodstream infection in a developing country setting Dr. Indah K Murni 9,45-10 10,15-10,30 Coffee break 10,30 11,00 44 45 46 47 Measles outbreak with high mortality among non-vaccinated children, Al Zeliah village, Hodeida governorate, November 2014 Dr. Mohamed Al Emad Dengue Fever Outbreak at Al ganaws district, Al Hodeida, Yemen 2014 Dr. Ghazi Bashamakeh H1N1 outbreak in Hareb Baihaan district, Mareb, Yemen, August 2014: The challenges and lessons learned Dr. Eshraq Al Falahi Dengue outbreak in Taiz Governorate, 2012 Dr. Mohamed A. Qasim 22 2223 23

1- Ebola virus Outbreak -WHO ramps up response? Dr Ahmed Farah Shadoul World Health Organization Representative Yemen Human health is inextricably linked to the health of animals and the environment. More broadly, the environment not only encompasses physical, geographical, climatic, ecological, agricultural and veterinary dimensions, but also the social, cultural, political and religious factors that influence those human behaviors that shape it. Addressing the connections between health and the environment requires an urgent expansion of interdisciplinary collaborations and strong political and global will. Viral hemorrhagic fever agents pose serious challenges to human health due to the fact that: (i) Filovirus outbreaks are largely created by man and driven by human behavior, (ii) There is significant nosocomial (hospital) amplification of disease, (iii) There is an associated high morbidity and mortality, (iv) Case management is difficult and, as yet, there are no commercially available vaccines and therapeutic agents, (v) Prevention of infections is fraught with difficulties, and (vi) Infection prevention and control strategies can be frustratingly unsuccessful. This presentation will focus on WHO - Ebola preparedness and response, highlights findings and recommendations of the WHO/EMRO Assessment Mission for Ebola Preparedness and Response Capacities in the Republic of Yemen during the period 1820- November 2014 24 24 2425 25

2- Clinico-Imuno-Pathological Impact of Infection on Rheumatic Diseases Prof. Abdou Ellabban Human and animal studies provide further evidence supporting a role for the periodontal pathogen, Porphyromonas gingivalis, in the development of Rheumatoid Arthritis (RA). The microbiome plays a key role in the developing immune system. Alterations in the bowel microbiome lead to altered innate and adaptive immune responss potentially relevant to the development or persistence of RA. Chronic dysregulation of the immune system in conjunction with immunosuppressive treatment predisposes patients with systemic autoimmune diseases to infections. Therefore the new onset of CNS symptoms always leads to the suspicion of underlying infections in the differential diagnosis of these patients. Several viruses, bacteria, and fungi can imitate the clinical and the radiological picture of CNS involvement of the primary autoimmune diseases.therefore careful evaluation of the CNS manifestation is essential because the impact on the therapeutic decision is great. However, the diagnostic procedure is limited by time because in all patients with severe CNS involvement prompt treatment should be instituted in order to preserve the maximum of cerebral function. Microbes and the host response to microbes are important factors in the maintenance of health. Abnormalities or imbalances in these responses can lead to the development of autoimmune rheumatic inflammatory conditions. 3- Rotavirus Analysis among Children in Taiz, Yemen: Pre and Post Vaccination Leena Al-Areqi 1 Mohammed Amood AL-Kamarany 2,3 *, Abulatif Majily 1, Aisha Jumaan 4,, A.Jabar Al-Mohya 1, Ali Noman Ali 1, Ameen Mohammed Ghaleb 1, Abdo Yehy Mohammed 1, Saeed Al-Amery 1, Fawzia A.Rahman Hael 1,, Samah Mohammed Shediwa 1, Rehab Tawfeq Mohammed 1, Arwa Ali Abdullah 1, Abdulmalik AL - Badani 3 1 The Yemeni-Swedish Hospital, Taiz City, Yemen 2 Department of Department of Pharmacy Practice, College of Clinical Pharmacy, Hodeidah University, P.O. Box 3114, Hodeidah City, Yemen 3 Tihama Foundation for Drug Studies and Research, Hodeidah City, Yemen 4 Independent Consultant, Seattle, WA, USA *: Corresponding author: alkamarany@yahoo.com ; alkamarany@gmail.com Rotavirus is the leading cause of severe acute gastroenteritis among children worldwide. Rotarix TM Rotavirus vaccine is currently licensed for infants in Yemen and was introduced in Year. The vaccination course consisted of two doses. The first dose was administrated at 6 weeks of age and the second dose completed by 24 weeks. We determine the incidence rate of Rotavirus infection pre and post vaccination among children less than 5 years of age at the Yemeni-Swedish Hospital (YSH) in Taiz, Yemen Pre vaccination covered 2009 July 2012 during which 2334 fecal samples were collected from children less than 5 years old. Post vaccination covered August 2012 August 2014 during which 809 fecal samples were collected. Rotavirus was detected by Enzyme Linkage Immunosorbent Assay (ELISA) on stool specimens of children and genotyping of Rotavirus was identified by Polymerase Chain Reaction (PCR). The results showed that 39.16 % of the specimens were Rotavirus-positive in pre vaccination period and was reduced to 17.5 % post vaccination. The peak incidence of Rotavirus diarrhea in infants and young children was reduced by 50 %. Keywords: Rotavirus, Prevalence, Vaccination, Yemen 26 2627 27

4- SARCINA VENTICULARI IS A POSSIBLE CAUSATIVE MICROORGANISM OTHER THAN H.PYLORI IN GASTRIC ULCER PATHOGENESIS Dr. Amani Shamshair, Dr.Rasheed Alezzi Our case presentation for a male patient from Ibb presented with abdominal pain. He was treated many times with anti- H,pylori regimens without benefits. Then he presented to the surgeon for resection of bleeding ulcer. The endoscopic biopsy revealed Sarcina ventriculari in addition to H.pylori. After the surgery the patient came again with same complain. Then the patient was treated by anti Sarcina regimen & was relived from his symptoms. 5- The Potential Effect of the Cyanobacterium Spirulina sp. in Thalassemic Children Infected with Hepatitis C Virus Mostafa Mohamed El-Sheekh1, Metwally Abdel-Azeem Metwally2, Mohamed Ramadan El-Shanshory3, Manal Abdel-Wahed Eid4, Mahmoud Fathi Gomaa5 1Professor of Phycology, Botany Department, Faculty of Science, Tanta University. 2Professor of Microbiology, Botany Department, Faculty of Science, Tanta University. 3Professor of Pediatrics, Faculty of Medicine, Tanta University. 4Professor of Clinical Pathology, Faculty of Medicine, Tanta University. 5M.Sc. Microbiology, Tanta University. The target of the present study was to evaluate the efficiency of natural Spirulina preparation in the treatment of HCV infection in thalassemic children. Throughout a regular 6 months treatment, many parameters were considered as health improvement indicators, giving significantly improved values, such as the lowering of ALT, and AST less than 40 U/L in 8 cases, and 12 cases, respectively. Ferritin values between 10002500- ng/l at the end of treatment; 15 cases recorded haemoglobin values more than 9 g/100 ml; CD4, and CD8 concentrations were good indicators for immunity improvement of patients, as their values increased to 53, and 48 x103cells/100ml, respectively. The main parameters of healing for these complicated cases were the promising appearance of 3 cases with ve (0.0 IU/ml) HCV count in patient serum by real time PCR quantification; and the prolonged blood transfusion intervals more than 15 days in 19 cases after 6 months of treatment with Spirulina. Key words:hepatitis C virus (HCV), Thalassemia, Spirulina. Yemeni international congress of infectious disease University of science and technology hospital Sana a,yemen 28 2829 29

6- Impact of Health Education Activities on the Knowledge, Attitude and Practice towards Malaria Control among basic school pupils in Taiz Governorate. Republic of Yemen Belquis Abdullah Farea1 ; Ali Mohamed Assabri2 1- National Malaria Control Program. Ministry of Public Health and Population 2- Community Med. Dept. Faculty of Medicine & Health Sciences. Sana a University Introduction: Malaria is one of the main health problems in Yemen. School-age children represent 25% of Yemen s population and an increased proportion of these children are going to school. Schools provide a good entry point for community malaria prevention and control Objectives: To assess the baseline knowledge of pupils, and to determine the impact of HE campaign towards malaria prevention and control Methods: We conducted a community trial study (pre-post intervention).this study was conducted in four district of Taiz governorate. The sample size was 2130 pupils of 6,7 grades in basic schools, from randomly selected four districts, two of them rural and the others urban. Four schools and their pupils (1065 pupils) were chosen for the study and assigned as an intervention group and four schools with their pupils ( 1065) were chosen for the study and assigned as a control group (1065 pupils). Questionnaire-based interviews conducted before and after the intervention (three months), with the intervention group and the control group. The major intervention activities included lectures about malaria, distribution of educational materials (story, posters, and practical teacher s guide with specialized malaria teaching materials and participatory learning methods). Parried t test was used to analyze differences in the mean knowledge, χ2 was used to compare practices, among intervention and control groups as well as among pre- and post-intervention group. Results: Health education activities in schools were associated with the increased knowledge of malaria symptoms and methods of prevention from 24.5%(SD±14.6) to be 60.2 %(SD±17.1), the difference was statistically significant (p<0.001) in study group compare with increase from 23%(SD±13.9) to be 31%(SD±13.4), the difference was statistically significant (p<0.001) in control group. The difference was higher among intervention group compared with control group ( 35.7% and 8% respectively ). Also the results revealed an increase in the positive attitude and practice toward malaria from 45%(SD±17.3) to be 60%(SD±18) in the intervention group compare with nearly no change (44%(SD±16.92) to be 43.4%(SD±16.93) in the control group. As a result of the intervention program, the knowledge of mode of transmission was increased among the intervention schools pupils from 513(48.2%) to be 918(86.2%), compare with change in the control schools pupils from 256 (48%)to be 315(59.1%), the difference was higher among intervention group of pupils than among control group of pupils ( 38% and 11.1% respectively). The number of pupils who had high level of score of knowledge after the health education activities was increased from zero to 213(20%) in the study group. The number of pupils who had the high level of score of attitude were increased from 170(16%) to be 264(24.8%) in the study group. The rate of having mosquito bed-nets increased from 10.1 % to 16.8% pre and post intervention respectively, out of those who have BN 72% slept under bed-nets in the intervention group compared with 12.1% in the control group, the difference is statistically significant (P. value 0.001). The vast majority of pupils in the intervention group (83.4%) believe on usefulness of bed-nets use, while only 45% of pupils in the control group believe on that, the difference is statistically significant (P. value 0.001) Conclusions and Recommendation: This study concludes that the intervention in schools had a positive impact on the knowledge and attitude of pupils. Since our school-based malaria control study was effective, we recommend to periodically conducting health education activities to improve the role of school pupils in prevention from and control of malaria. 30 3031 31

8- Physicochemical and Biological Properties of Amoxicillin Capsule Manufactured in Yemen 7- Helicobacter pylori update Prof Tawheed Mowafy (H. pylori) is recognized as the most common chronic human bacterial infection,1 affecting up to 50% of the world s population. H. Pylori (initially called Campylobacter pyloridis) and its association with gastritis was first discovered in 1982.It has been said that it s discovery represents one of the most important developments in medicine of the past century H. pylori plays a crucial role in the pathogenesis of upper GI disease including gastritis, peptic ulcer disease (PUD) and gastric cancer,eradication of H. pylori can lead to a reduction in the occurrence of PUD and prevention of gastric cancer, a number of treatment regimens are in the clinician s arsenal however standard PPI based triple therapy and bismuth based quadruple therapy remain first line as the eradication rates remain relatively high (7080%-). The increase in clarithromycin resistance has led to the investigation of other therapeutic options including: Sequential therapy, Concomitant therapy and Levofloxacin based therapy as additional therapeutic regimens, confirming eradication is crucial and in the setting of persistent infection, bismuth based salvage therapy appears to represent areasonable approach for salvage therapy. M. Amood ALKamarany 1,2 *, M. EL Karbane 1 2,Y. Ramli 2, Z AL-Gadary 4, T AL-Harazi 5 1. Department of Department of Pharmacy Practice, College of Clinical Pharmacy, Hodeidah University, P.O. Box 3114, Hodeidah City, Yemen 2. Tihama Foundation for Drug Studies and Research, Hodeidah City, Yemen 3. Physicochemical Service, Drugs Quality Control Laboratory, Direction of Drugs and Pharmacy - Rabat, Morocco. 4. Faculty of Pharmacy, University of Science and Technology, Hodeidah Branch, Yemen 5. Medical Microbiology Department, Faculty of Medicine and Health Science, Taiz University * Correspondence Author: alkamarany@yahoo.com The present study aimed to evaluate the drugs quality control of available in Yemen. The assessment of the quality of some Yemeni Pharmaceutical Industries products namely Amoxicillin capsules 500 mg was based on United State Pharmacopoeia (USP) and European Pharmacopoeia (Ph. Eur.) The identification, dosage of active pharmaceutical ingredients and galenic tests of Amoxicillin capsules were performed. In addition, anti microbial activity of different brands was assayed and the physicochemical and biological properties relationship was correlated. The results have shown high dosage of active component in some products which did not met the acceptance criteria in the USP (93% 107%) due to defects in the pharmaceutical production quality, and on the other hand the availablability of good-quality another products. This could require setting up quality surveillance systems within drug regulatory authorities in the country, supporting manufacturers to improve Good Manufacturing Practice (GMP) compliance. Keywords: Quality Control, Yemen, Amoxicillin, 32 3233 33

9- Acinetobacter baumannii and its antibiotics susceptibility in selected hospital's intensive care units Dr.Abdurhaman Zabad The main challenge with Acinetobacter baumannii; a nosocomial pathogen, is its ability to acquire antimicrobial-resistance rapidly, leading to unsuccess of antibiotics therapy. The ICU environment is frequently contaminated with this pathogen and act as an important reservoir role in infections. Therefore, This cross sectional study investigated the prevalence of Acinetobacter baumannii in ICUs, risk factors contributed for its nosocomial infections and its antibiotics susceptibility patterns and performed during one year in three hospitals in Sana'a city on 280 ICUs patients and 80 environmental samples. The prevalence of Acinetobacter baumannii was 7.1% among 280 individual ICUs patients, where 12.9% was in respiratory specimens and 1.4% in blood specimens. The significant risk factors were the length of stay, mechanical ventilation, uses of tracheal tube, uses of more than two invasive procedures and co-morbidity with underlying diseases; malignancy, pulmonary and central nervous system disorders. All isolated Acinetobacter baumannii were multi-drug resistant, its resistant rates were 95% for Piperacillin-Tazobactam, 90% for Imipenem, Cefepime and Ticracillin, 80% for Amikacin and Doxcycyclin, 60% for Levofloxacin and there was no resistant isolates for Colistin and polymyxin B. The prevalence of Acinetobacter baumannii in ICUs environment was 8.8% and these isolates were indistinguishable from the clinical isolates using biotyping and antibiotics susceptibilities. Multi-drug resistant Acinetobacter baumannii is a threat for ICUs patients and a strict adherence of infection control policies and procedures with particular vigilance needed by the ICUs teams, continued antibiotic resistance surveillance and judicious use of invasive procedures, are important to prevent the Acinetobacter baumannii nosocomial infections. 10- Prevalence of antimicrobial resistance among most gram-negative isolates in inpatients at USTH Dr. Mohammed Kubas, Clinical Pharmacist Specialist Background: Increase bacterial resistance to antibiotics is considered one of the most worldwide health problems. Gram-negative bacteria are responsible for most of hospital-acquired infections. Here, we aimed to study the susceptibility of antimicrobial agents among gram-negative isolates at tertiary care hospital in Sana a, Yemen. Methodology: A total of 2005 isolates of most Gram-negative bacilli were included in this study. Antibiotic susceptibility was tested using the disk diffusion method and Vitek 2 system. Chi-square tests were used for hypothesis testing. Results: the most frequently isolated organisms were Escherichia coli (41.6%), Acinetobacter Spp. (26.7%), Klebsiella pneumoniae (21.0%), and Pseudomonas aeruginosa (10.6%). Antibiotics resistance increase for all isolated microorganism (P < 0.0001) except for P. aeruginosa (P < 0.424). Conclusion: Antimicrobial resistance is an emerging problem at USTH which required urgent new and effective strategies to encourage good antibiotic practices and good hospital hygiene. 34 3435 35

11- Carbapenem resistant Acinetobacter baumannii (AB) & Pseudomonas aeruginosa (PA) requires a Rapid and Global Surveillance Strategy Dr. Suleiman Al OBEID Background: The Susceptibility of Gram negative bacteria to most of antibiotics is an important issue requiring global surveillance. This study reports data from Gram-negative isolates collected at Security Forces Hospital (SFH) in Kingdom of Saudi Arabia (KSA) in 2006, 2009 and 2012. Carbapenems-resistant AB & PA are observed in this study with an unsuspected frequency. Methods: The totality of collected strains of Gram negative bacterium isolated at SFH in KSA in 2006, 2009 and in 2012 were analyzed and tested for the most of antibiotics used in our hospital. Antibiotic susceptibility was determined according to the manufacturers recommendations by microdilution method with commercial dehydrate panel (Dade Behring MicroScan, Sacramento, CA USA) that were read by the Walkway 96 S1 and interpreted according to CLSI criteria. Antibiotic susceptibility was also assessed by disk diffusion on Mueller-Hinton agar (Bio-Rad, Marnes-la- Coquette, France) according to CLSI recommendations. Susceptible (AB) & MDR strains were detected by using CHROMagar Acinetobacter (CHROMagar, NJ, USA). Conclusions: In this study carbapenems, tigecycline and colistin remain active against Enterobacteriaceae. For AB & PA, susceptibility to carbapenems was drastically reduced. For these two species, carbapenems non-susceptible isolates reported worldwide and frequently detected in this study represent a major epidemiological concern. 12- Knowledge and Practices of Physicians in Aden about the National Anti-Malaria Case Management Guideline Khaled Al-Sakkaf, Huda Basaleem, AwsanBahattab, AbeerShaef Objective: Malaria is apublic health probleminyemen where 65% of the people are at some risk to contract it. After the emergence of chloroquine resistancein Yemen, the nationalanti-malariapolicy has been changed in 2009 to artemisinincombination therapy (ACT).To ensure that new treatment is effectively utilizedand to prevent drug resistant development, it is important to assess the knowledge and practices of physician regarding the recentanti-malaria case management policy recommended by the National Malaria Control Program. Materials and Methods: A cross-sectional survey was conducted in Aden governorate during March to April 2014.Two hundreds and eightphysicians involved in managing malaria patients were recruited from selected public and private hospitals. A self-administered semi structured questionnaire was used to obtain information on socio-demographic characteristics of the study participants, their knowledge about anti-malaria national policy including the first line treatment,diagnosis and treatment practices. Statistical analysis was done using SPSS-20. Different descriptivetestswere used as appropriate. Bivariate analysis was set at significance level of P 0.05. Result: Keywords: Antibiotics, Resistance, Carbapenems, A. baumannii, P.aeruginosa. 36 3637 37

Sixty percent of the participants didn t know about the national policy; 23.9% hadthe guidelineand only 10.8% received training on thisguideline.the first line drug treatmentfor simple uncomplicated malaria was identified correctly by the following percentages of physicians: 10.1% for adult,5.7% for children,and 26% for first trimester of pregnancywhereas none of them mentioned the correct first line malarial drug for second and third trimester of pregnancy. Regarding physicians knowledge aboutthe first line drug treatment for complicated malaria,85%, 66.8%, 49% and 6.3% of the physiciansmentioned the correct drugsto treat adult, children, first trimester and the second and third trimester of pregnancy respectively. Knowledge was not significantly differentbetween specialists and general practitioners. Conclusion: This study reveals poor knowledge among physicians regarding national anti-malaria policy and guideline, especially regarding treatment of simple malaria of the vulnerable groups.involvement ofall stakeholders during adoption and implementation of new national policies, providing training sessions and refresher courses is recommended to ensure correct and effective use of current policy. 13- ASSESSMENT OF INFECTION CONTROL AMONG HEALTHCARE WORKERS IN YEMENI HEALTH CENTERS Dr. Ameen saleh saleh sherah Introduction: An Analysis of a Survey Questionnaire on Healthcare Workers knowledge and practices regarding of infection control and complains them to apply universal precautions. Health care Workers are at substantial risk of acquiring blood borne pathogen infections through exposure to blood or other products of patients. Objective: To assess of Infection control among healthcare workers in Yemeni health centers. Methods: A cross-sectional study was conducted in the health center to assess knowledge and practices regarding of infection control among 237 health workers in Sana,a city. Data was analyzed using SPSS version 20 and the associations were tested with chi-square, with p-value of < 0.05. Results: The Health care Workers in public centers was (51.1%) and (48.9%) of them works in private centers. One hundred and seventeen (49.4 %) respondents had poor infection control knowledge, 113 (43.5%) had fair knowledge, and 17 (7.2%) had good knowledge. The knowledge was significantly associated with type of center (P < 0.018), such that the public center had the highest proportion with poor knowledge. And nurses and midwife having the highest proportion with fair knowledge of infection control. Eight (3.4%) respondents had a poor practice of universal precautions, 93 (39.2%) had fair practice, and 136 (57.4%) good practice. The practice was significantly associated with the profession, level of education and work experience (P < 0.001), (P < 0.006), (P < 0.001) respectively, and nurses and midwife as the profession with the highest proportion with good practice. Conclusion: We conclude that the practices and knowledge of universal precautions were low and that s need for intensive programmes to educate health care workers on various aspects of standard precautions and infection control programmes and policies. Key Words: Health care workers, Knowledge, practice, Universal precaution, Health center. 38 3839 39

14- Serious Bacterial Infections in Children: Detection and Seriousness. Dr.Naser Haider Acute infections with fever is the most common presentation to the primary care clinics. Most infections are self-limiting but they remain an important cause of morbidity and mortality even in the developed countries.serious infections in children are usually defined as sepsis, meningitis, pneumonia, pyelonephritis, bacterial gastroenteritis, osteomyelitis, and cellulitis.the difficulties in detecting serious infections are : non-specific initial clinical presentation and low incidence, in addition to the probability of rapid deterioration.in meningococcal disease, coryza or sore throatare the initial presentation in the first 4 hours which are non-specific, and the specific signs as meningeal irritation or haemorrhagic rash appeared late at a median time of 13 22 hours. Based on the child s signs and symptoms, it is important to triage children into a very-low-risk group, in which a serious infection can be safely excluded, or a higher-risk group, in which further action is needed. But unfortunately that is not easily achieved only by reading the book, it needs in addition to the clinical sense, application of a well studied validated sequential steps of assessment. important red flags need to be identified. There is often a need to increase diagnostic certainty by other measures as CBC or other markers of inflammation.disability or even death might be the consequences of serious bacterial infections, if not detected and managed early.the mortality of meningococcal disease might be up to 25%, and around 7% of children who survive bacterial meningitis had hearing loss.in UK and Flanders, infectious diseases are responsible for 8.0% of deaths in children under the age of 1 year, and for 13.6% of deaths aged between 1 and 14 years. Recently a guidelines and Clinical prediction rules (CPRs) published which might help in providing a traffic light system for the initial assessment and management of young children with fever. 15- H1N1 Surveillance systems data analysis, 2009-2013, Yemen Awadh M. Ba Saleh 1, Al Mahaqri A., Qayad M. 2, Al Abhar N.3 Background: During 2009, the World Health Organization declared the first influenza pandemic of the 21st century. In Yemen, a country lab-based surveillance system for Influenza Like Illness (ILI) and Severe Acute Respiratory Illness (SARI) with weekly sampling and reporting was established in 2009. This system was necessary for early detection of emerging novel influenza subtypes and timely response for influenza prevention and control. This study aims to describe the major epidemiological characteristics of H1N1 over the period of 20092013-. Method: We reviewed the surveillance data on influenza A (H1N1) from 82009/ to the 312013 12/ where direct reporting and nasopharyngeal swabs collected from each suspected case and sent to National Public Health Laboratory Center in Sana a. The following variables were collected: gender, governorate, nationality, date of taking swab, date of receiving swab, symptoms, result for both influenza A and H1N1 virus. The diagnosis was confirmed by RT-PCR. Results: 4,347 samples were collected during 82009/ to 312013/12/. The attack rate dropped from 6.3100.000/ in 2009 to 0.3100000/ in 2013. Males to females ratio was 3:2, 47% were among age group 1130- years, and 49% of cases from Sanaa governorate. The most common symptom were fever (23%) and cough (22%). 72% of total cases reported during months of October to December. Conclusion: Data confirm that H1N1 epidemic occurred in Yemen in 2009 that coincides with the international trends. The dropped after 2009 may reflects success of control measures and regression of pandemic however; recession of surveillance activities thereafter could not be excluded. Therefore, strengthening of ILI/SARI surveillance system is highly recommended and quality should be addressed to improve early outbreak detection and response. This can only be achieved through ensuring availability of the necessary human and logistical resources. Key words: H1N1, epidemic, Surveillance, Yemen 40 4041 41

16- Dengue surveillance Data Analysis Report, 2010-2013 Ghazi S Bashamakha1, Jawal A.2, Al shameiry H3, Qayad M.4 Background: Dengue is a global health threat affecting 3.6 billion people living in more than 125 countries in tropics and subtropics. Since 2002, dengue reported in 16 Yemeni governorates. The aim is to describe trend and epidemiology of dengue over 2010 2013. Methods: The analysis was carried out in January 2014 through revising records of dengue cases available at the National Dengue Surveillance, Yemen Field Epidemiology Training Program and National Central Public Health Laboratory in Sana a and its branches in Aden, Al Hodeida, Taiz, Al Mukalla and Seiyun from 1st January 2010 31st December 2013. Results: From 1st January 2010 to 31st December 2013, a total of 5,762 dengue cases were reported of which 3,315 (58%) were in 2010. Only 149 (3%) met the diagnosis of dengue hemorrhagic fever. Annual incidence rate varied from 14 /100,000 in 2010, to 3000,100/ in 2013. 57% of cases were among males and 61% among the 1630- years age group. 1,873 blood samples were collected for lab confirmation, where 566 (30%) were IgM positive, 431 cases (23%) IgG positive, 284 cases (15%) positive for both. More than half of cases reported from Aden, Al Hodeida and Hadramout Al Sahel. Dengue has shown a seasonal tendency as evidenced by an increase in cases during the epidemiologic weeks 15 31. Conclusions: Dengue is shown to be an important health problem in Yemen however; this may represent only the tip of the iceberg. Therefore, launching a national program for hemorrhagic fever and strengthening surveillance system should be the first step. The seasonal tendency as evidenced by an increase number of cases that coincides with rainfall and accumulation of water in containers should call for vector control during rainy seasons. Outdoor biting is likely as more young males were affected therefore, targeting them with awareness raising is recommended. Key Words: Dengue, Surveillance, Yemen. 17- National Program for Leishmania Control surveillance System Data Analysis, Yemen 2013 Mohammed H. Dahnan1, Al-Mahaqri A., Al Serouri A.W3. Background: In spite of the world annual estimated occurrence of Cutaneous Leishmaniasis (CL) of 1.1 million, CL is still considered as one of the neglected disease. In Yemen, the last decade witnessed progressive increase in CL incidence and several outbreaks reported from different governorates. The objective to describe the epidemiology and trend for CL in Yemen for the year 20052013-. Methods: We analyze the surveillance data available at the National Program for Leishmania Control (NPLC) for the year 2005 to 2012. The NPLC adapted the WHO leishmania case definition. Currently no electronic database for leishmania is available and only total numbers of cases are reported. Data on age and gender was only available for the year 2013 from some governorates. Population estimates were obtained from the Central Statistical Organization to calculate the incidence rates. Results: The overall CL incidence rate (IR) increased from 10 per 100,000 in 2005 to 13 in 2013. However, the highest IR found in some governorates where it coincides with reported outbreaks e.g. 156100,000/ at Rimah in 2006, 72 /100,000 at Shabwah in 2009, and 78100,000/ at Sayoun in 2011. 3,312 cases were reported in 2013 where male to female ratio was 1.3 and the most affected group was 514- years. In 2013, Aldhale e, Lahj, Sayoun, and Sa sdah had the highest IR of 49, 42, 37, and 33 per 100,000 population respectively. Conclusion: Irregular reporting system where only aggregated numbers of cases are reported together with weak diagnostic capacities at the health facilities and laboratories are important challenges for Leishmania surveillance System. Therefore, improving reporting through frequent feedback and strong supervision, upgrading laboratory capacities, and training health workers on proper diagnosis are recommended. Including Leishmania in the Integrated Surveillance System and Response should be considered. Key words: Leishmania, Surveillance, Incidence, Yemen 42 4243 43

18- HIV Surveillance Data Analysis, Yemen, 1987-2013 Noaman A. Omer1, Nabeh M. 2, Qayad M. 3, Al Abhar N4. Background Although Yemen is still among the low HIV prevalence countries in the region with an estimated rate of 0.2%, several risk factors exist that could facilitate its spread. The aim is to describe the epidemiology of HIV in the Republic of Yemen from 1987 to 2013. Methods We analyzed the National AIDS Program (NAP) surveillance data for years 1987 to 2013 by age, sex and citizenship. Data was only available: on high-risk groups for 20052013-, on residency for 2010, 2011, and 2013, and on marital status for 2013. Cases were diagnosed using rapid HIV test strip and confirmed by ELISA. Results Since the first case was reported in 1987, cases were progressively increased to reach a peak of 354 in 2010 and slowly decreased to reach 232 in 2013. The total number of registered people who were living with HIV in 2013 was 3,995. Males accounts for two third of cases and 52% was among the productive age group i.e. 2539- years. About one fourth of reported cases were non- Yemenis. In 2013, 56% of reported cases were married. Although, the heterosexual route accounts for about two thirds of transmission, homosexual transmission reported in 6%, blood transfusion in 3%, Inject drug-user in 1%. Nevertheless, in 22% of cases, mode of transmission was not identified. Sana`a Capital had 25% of reported cases, followed by Al Hodeida (20%) and Taiz (16%). Conclusions: Although the number of reported HIV cases in Yemen is still low, this may only represent the tip of iceberg. Therefore, strengthening HIV/AIDS surveillance is mandatory. There is a potential risk for a rapid spread of HIV particularly among the productive age group which need to be targeted by awareness raising. Although other routes of transmission (e.g. homosexual and inject-drug users) are still under reported this may be due to stigma and needs to be explored further. The fact that blood transfusion still account for some cases emphasize the need to strengthen infection control at health facilities. Key words: HIV, prevalence, surveillance, Yemen 19- Mumps outbreak in Beit Tawaf, Amran governorate, February-March 2014 Qais M. Jassar1, Shamsan F 2, Qayad M. 3, Alabhar N.2 Background: Mumps outbreaks are still reported from many countries. In Yemen, where mumps vaccine is not yet part of the Expanded Program on Immunization (EPI), the virus still circulating among children and adults and recurrent outbreaks have been reported. This investigation was undertaken in response to an outbreak of mumps at Beit Tawaf in Amran governorate to confirm the outbreak and recommend preventive measures. Methods We initiate active case finding in Beit Tawaf ( 550 population) between March172014,28- using WHO case definition where a probable case defined as an acute parotitis or other salivary gland swelling lasting at least 2 days, or orchitis or oophoritis unexplained by another more likely diagnosis, in a person with epidemiologic linkage to another probable or confirmed case. The cases/guards were interviewed and the following variables were collected: age, gender, data of onset, symptoms. Results Sixty-nine cases met the case definition of probable mumps. The overall attack rate and the <15 years age specific attack rate were 12 and 26100/ population respectively. 43% were among 5 9 year and 54% were males. The index case was identified as a student of a primary school who had no travel history and could not recall any contact with a suspected mump case before onset of symptoms. The index case appeared to be the source of the outbreak, and there were four outbreak waves. The outbreak started in 8th epidemiological week, the peak of the outbreak was in 14th epidemiological week. Conclusion Finding suggested that mumps general immunity is still weak among general population. Therefore, introducing mumps vaccine to routine EPI needs to be considered in Yemen. We recommended launching a community awareness camping on mumps and asked school headmasters to exclude affected students from schools for 20 days. Improving surveillance system for timely detection and prompt response is highly recommended. Key words: Mumps, outbreak, Yemen 44 4445 45

46 20- Outbreak Investigation of Chikungunya and other febrile Illnesses, Al-Hawtah District-Lahj Governorate, March April 2012 Mohamed A. Saleh1, Obadi M.1, N Abdul Aziz2, Al Serouri A.W. 3 Background: Chikungunya virus (CHIKV) is an acute viral infection transmitted to humans through the bite of an infected adult female Aedes mosquito. In Yemen, the CHIKV was first confirmed in Al-Hodeida governorate in early 2011. On 18 April 2012, a physician working in a private clinic in Al-Hawtah, the capital of Lahj governorate, reported to Lahj governorate surveillance coordinator three patients complaining of fever, headache and severe joint pain not explained by the common infectious diseases in that area. A team was sent to investigate the outbreak and recommend prevention. Methods: We conducted this investigation to characterize the outbreak and confirm the cause and source of the outbreak. We collected socio-demographics, history of illness, signs and symptoms, sources of infection, mode transmission and laboratory results of the cases identified. Results: There were 234 cases identified. The incidence rate was 7.6% (23431129/) population. The males and females affected were 122 (52%) and 112 (48%), respectively. Twenty five percent of the cases were 45 years of age, and 52 % were 25 years of age. Two cases were CHIK IgM positive (ElIZA) and one case was dengue IgM positive and weak CHIKV IgM positive. The majority of suspected cases 108 (46%) were from one area (fish market area) of Al-Hawtah more than expected. Around 73% (171234/) of the suspected cases were living in houses where water was stored in open containers. Major case symptoms include fever and headache (100%), arthralgia (95%), and Joint Swelling (73%). Conclusion: The outbreak was caused by Chickunguna virus and most of the cases were detected near the fish market, where sellers of fish from Al Hudeidah and Taiz sell their goods. Strengthening the surveillance program at all level to ensure early reporting of the cases is needed. Continuous health education in schools about prevention and control of infection are also essential to detect and control such outbreaks. Enhancement of entomological surveillance and support from authorities has to be developed. Key words: Chickunguna, outbreak, Yemen 21- update on treatment of chronic hepatitis c Dr. Redha Al-Ajam Chronic hepatitis c is important cause of liver cirrhosis and liver related morbidity and mortality,till recently treatment is far from perfect with a lot of toxicity,this changed with new direct acting antivirals DAAs Now more than ever this disease is more curable than ever at insignificant side effects but at much cost and financial burden 4647 47

22- Failure of Egyptian patient with chronic HCV infection to IFN-a therapy associates with high frequency of circulating myeloid derived suppressor cells Prof. Mohammed Labib salem,phd Prof. of immunology,faculty o science,tanta university,egypt Director,center of excellence in center research,new teaching university hospital,tanta university,egypt E- mail : mohamed. Labib @ science.tanta edu ed. Mohamedlabibsalem @ yahoo.com. Hepatis C virus ( HCV) with genotype 4,is epidemic in Egypt and causes chronic hepatis anti HCV therapy ( Rivaririn and IFN- a) is not effective in 60 % of patients with chronic HCV infection. We have recently reported accumulation of myeloid derived suppressor cells ( MDSCs) and suppressed immunity in cancer patients. We aimed in this study the assess the frequency of myeloid cells including MDSCs and dendritis cells ( DCs),in chronic HCV patients and correlates it with the responses of the patients to IFN a based therapy. Peripheral blood was drawn from 154 patients with chronic HCV infection and non responders from 25 healthy volunteers. The patients were categorized into responders and non-responders based of titer upon Ribavirin and IFN-a treatment. We found increases in the relative and absolute numbers of MDSC defined as Lin/HLA- DR / CD 33+.CD 11b+ in all HCV patients coincided with increased in the frequency of DCs and T-cells ( CD4+ and CD8+). Interestingly the frequencers of MDSC and DCs in IFN-a responders were lower than those in non-responders.the responders also had higher months of Il-2 than non-responders.,more interestingly the levels of MDSC and DCS in IFN-a responders were lower than those in non responders. the levels MDSC measured 46- months of IFN-a treatment in the responders was much lower than their levels during the treatment. Although the high numbers of MDSC was coincided with decreases in the level of bilirubin and hemoglobin in all IFA-a there was no correlation between MDSC number of liver enzymes AST and ALT. Our data show for the first time in Egyptian patient s that regardless of IFN-a therapy chronic HCV patients harbor high levels of MDSC with high levels in non responders than responders. We conclude that MDSCS might be be used as a biomarker of responsiveness to IFN-based therapy and implicate the use of the drugs that are known to target theses cells to treat HCV patients. 23- Update in the Management of Hepatitis B Virus Prof. Almetwally Z. Abdelbaset Approximately one third of the world s population has serological evidence of past or present infection with HBV and 350 400 million people are chronic HBV surface antigen (HBsAg) carriers. The spectrum of disease and natural history of chronic HBV infection are diverse and variable, ranging from an inactive carrier state to progressive chronic hepatitis B (CHB), which may evolve to cirrhosis and hepatocellular carcinoma (HCC). HBV-related end stage liver disease or HCC are responsible for over 0.5 1 million deaths per year and currently represent 5 10% of cases of liver transplantation. Host and viral factors, as well as coinfection with other viruses, in particular hepatitis C virus (HCV), hepatitis D virus (HDV), or human immunodeficiency virus (HIV) together with other co-morbidities including alcohol abuse and obesity, can affect the natural course of HBV infection as well as efficacy of antiviral strategies. CHB may present either as hepatitis B e antigen (HBeAg)-positive or HBeAgnegative CHB. The prevalence of the HBeAg-negative form of the disease has been increasing over the last decade as a result of aging of the HBV-infected population and predominance of specific HBV genotypes and represents the majority of cases in many areas. Morbidity and mortality in CHB are linked to persistence of viral replication and evolution to cirrhosis and/or hepatocellular carcinoma (HCC). Longitudinal studies of untreated patients with CHB indicate that, after diagnosis, the 5-year cumulative incidence of developing cirrhosis ranges from 8% to 20%. The 5-year cumulative incidence of hepatic decompensation is approximately 20% for untreated patients with compensated cirrhosis. Untreated patients with decompensated cirrhosis have a poor prognosis with a 14 35% probability of survival at 5 years. The worldwide incidence of HCC has increased, mostly due to persistent HBV and/or HCV infections; presently it constitutes the fifth most common cancer, representing around 5% of all cancers. The annual incidence of HBV-related HCC in patients with CHB is high, ranging from 2% to 5% when cirrhosis is established. 48 4849 49

The goal of therapy for CHB is to improve quality of life and survival by preventing progression of the disease to cirrhosis, decompensated cirrhosis, end-stage liver disease, HCC and death. This goal can be achieved if HBV replication can be suppressed in a sustained manner. Then, the accompanying reduction in histological activity of CHB lessens the risk of cirrhosis and decreases the risk of HCC, particularly in non-cirrhotic patients.however, chronic HBV infection cannot be completely eradicated due to the persistence of covalently closed circular DNA (cccdna) in the nucleus of infected hepatocytes, which may explain HBV reactivation. Moreover, the HBV genome integrates into the host genome and might favouroncogenesis and the development of HCC. Seven drugs have been approved for the treatment of chronic hepatitis B. Antiviral treatment has been shown to be effective in suppressing hepatitis B virus replication, decreasing inflammation and fibrosis in the liver, and preventing progression of liver disease. However, current medications do not eradicate hepatitis B virus; therefore, a key question is which patients need to start treatment and which patients can be monitored. Therapy must ensure a degree of virological suppression that will then lead to biochemical remission, histological improvement and prevention of complications. The ideal end point is HBsAg loss, which however is infrequently achievable with the currently available anti-hbv agents. A more realistic end point is the induction of sustained or maintained virological remission. 24- Hepatitis B virus infection among blood donors and attendants screened at National Central Public Health Laboratory, Sana a, Yemen, 2010-2013 Mohamed A. Al Emad1, Al Someni A., Al Akoa a S. 2, Al Serouri A.W3. Background: Although Yemen is one of the five countries of the Eastern Mediterranean Region classified by WHO as Hepatitis B Virus (HBV) high-risk area, still there is no national surveillance system for HBV in Yemen. The aim is to describe the HBsAg prevalence and trend over 20102013- among blood donors and attendants screened for HBV at Sana a National Central Public Health Laboratory (NCPHL). Methods: A soft copy of the 20102013- HBsAg data was obtained from the NCPHL statistical department that contain data on attendants screened for HBsAg by gender and age group but only aggregated numbers of blood donors screened. It also includes HBsAg tests results that conducted using Enzyme linked Immunosorbent Assay (ELIZA). Results: 45,404 HBsAg screening tests were performed during 2010 to 2013 at Sana a NCPHL. Three quarters were attendants screened for different purposes (e.g. suspected cases, employment, travelers, and checkup) and the other quarter was blood donors who routinely screened for HBsAg. The overall HBsAg prevalence is 5.7%, which was significantly higher among screened attendants than blood donors (7% vs. 2%, P < 0.0001). Among screened attendants, adults ( 16 years) had significantly higher prevalence than children 15 years: 8% vs. 0.5%, P < 0.0001, and males than females: 8% vs. 5%, P < 0.0001. There is 2% reduction in prevalence from 2010 to 2013 among all age groups with no single case of positive HBsAg reported among children during the last two years. Conclusions: Our findings shows that the overall prevalence of HBsAg lies within the moderate endemicity. The disappearance of HBsAg among children <15 years during the last two years may reflects the positive impact of introducing HBV vaccination into the routine immunization. Establishment of HBV surveillance system and electronic network between NCPHL and its governorates branches are recommended for improvement of hepatitis B surveillance. Key words: HBV, prevalence, blood donors, Attendants screening, Yemen 50 5051 51

25- Prevalence and Associated Factors of Hepatitis C Virus Infection among Renal Disease Patients on Maintenance Haemodialysis in three health centres in Aden, Yemen: A retrospective Study Authors: Khadija Aman, PhD*1, Saba Kassim PhD², Reema Aman MD3, Aamenah Hawash BSc2, Mustafa Al-Shagga, PhD4, Sami Abdo Radman Al-Dubai, PhD5 1Faculty of Medicine & Health Sciences, Aden University, Aden, Yemen 2Queen Mary, University of London, Barts and The London School of Medicine and Dentistry, Institute of Dentistry, 4 Newark Street, London E1 2AT, UK 3Tayba Haemodialysis center, Al-Gamhuria Teaching Hospital, Aden, Yemen 4Faculty of Medicine & Health Sciences, Nottingham University Malaysia campus. Block B, Jalan Broga, 43500 Semenyih, Selangor Darul Ehsan, Malaysia 5Department of Community Medicine, International Medical University (IMU), No, 126, Jln Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Malaysia *Corresponding author: Khadija Aman, Faculty of Medicine & Health Sciences, Aden University, Aden, Yemen. Email: KHAK-2010@hotmail.com Key words: anti-hepatitis C Virus, Haemodialysis, renal failure, Yemen We aimed to retrospectively assess the prevalence and factors associated with positive anti-hepatitis C virus (HCV) among patients on maintenance haemodialysis in three centres in Aden, Yemen. The records of 219 patients who were anti-hepatitis C virus negative prior to haemodialysis were reviewed and analysed. The mean±sd age of the patients was 47.08/SD±13.9 74.4% of them were married and 14.6% were employed. The prevalence of anti-hcv positive cases was 40.2%. The mean±sd duration of haemodialysis of all the patients was 35.09/SD±38 months. In bivariate analysis, the duration of haemodialysis and attending more than one centre for haemodialysis was found to be statistically significantly (p<0.05) associated with anti-hcv positive. In multivariate analysis, controlling for age, increased in duration of haemodialysis and attending more than one centre for haemodialysis, were all significant predictors for anti-hcv positive (p=0.0005, OR=1.01,95%CI:1.00,1.02; p=0.004, OR= 1.87, 95%CI: 1.22,2.88, respectively). In this study sample, the prevalence of HCV was significant. Patients attending more than one centre and those who underwent haemodialysis for longer durations were found to be more likely to contract HCV. Enhancing existing infection control measures and allocating more resources to haemodialysis centres therefore warrants consideration. 26- PREVALENCE OF TYPE 2 DIABETES MELLITUS IN PATIENTS WITH HEPATITIS C VIRUS INFECTION IN SANA A, YEMEN. Dr/ Saeed Mana Almaidamah The study was aimed toto determine the prevalence of diabetes mellitus type 2 in patients with chronic hepatitis C virus infection and comparison that to prevalence of D. M. in patients with C.L.D. due to other causes.material and Methods:A cross sectional study of HCV positive patients admitted to Alkwait university hospital Sana a Yemen, who were conducted during the period of January 2007 to December 2008.Laboratory records of 90 patients who already or newly diagnosed as having hepatitis C virus infection by +ve serology for HCV Abs. The presence anti-hcv Abs which were assessed using the micro particles enzyme immune assay.medical records were viewed & the following data were collected, age, sex, nationality, the presence of DM were diagnosed by a history of DM or fasting blood glucose >120 mg/dl, or random blood glucose >200 mg/dl.other investigation were done including liver enzymes and abdominal U/S.Statistical analysis: A general descriptive analysis was performed to compare type 2 DM with HCV infections to nondiabetics. All statistical analysis were performed using spss and p. value <0.05 was considered positive.results:during the period between January 2007 to December 2008 about two hundred eighty cases diagnosed as having CLD were selected from those admitted to Alkwait university hospital, 210 (75%) patients were males and 70 (25%) were females.90patients with CLD were diagnosed as having HCV infection, 61(68%) of them are males and 29 (32%) are females.the prevalence of type 2 DM in patients with CLD due to HCV infection were 30 (33%), 20 (22%) (67%) were males, 10 (11%) (33%) were females, while the prevalence of type 2 DM in patients with CLD due to other causes were 8 (4%) ( from 190 cases), P< 0.05.The mean age for type 2 DM was 45.3 years while that of nondiabetic was 51.9 years the difference was statistically significant. (22%)11of patients with type 2 DM with CLD due to HCV were recently diagnosed in hospital as having type 2 DM 9 (82%) of they were males and 2 ( 18% ) were females.regarding the presenting complication of type 2 diabetic patients with CLD 8 (26.6%) presented by heamatemesis& 5 (16.6%) by hepatic encephalopathy.conclusion:our findings indicate that DM is more common in patients with CLD due to HCV than in those with CLD due to other causes.there is strong relationship between DM appearance and CLD due to HCV and no relationship between DM appearance and CLD due to other causes. Liver cirrhosis(cld) alone has not rule in development of DM.Some patients have been diagnosed as HCV during his presentation by complication of CLD,and other patients( with HCV) have been diagnosed as DM and sometimes as DM & HCV during his presentation by complication of CLD.Further studies are needed on this field which will be reflected by possible treatment or prevention of DM by antiviral agents. 52 5253 53

27- Hospital-Acquired Infections Due to Gram-Negative Bacteria, approach and management. Dr.Shafiq.A.Alimad,MD ABSTRACT Hospital-acquired infections are a major challenge to patient safety; Infections caused by gramnegative bacteria have features that are of particular concern. These organisms are highly efficient at up-regulating or acquiring genes that code for mechanisms of antibiotic drug resistance, especially in the presence of antibiotic selection pressure. Furthermore, they have available to them a plethora of resistance mechanisms, often using multiple mechanisms against the same antibiotic or using a single mechanism to affect multiple antibiotics, Gram-negative bacillary sepsis with shock has a mortality rate of 30 to 50 percent; mortality varies depending, in part, on whether the patient receives timely and appropriate antibiotic therapy. 28- Recent Advances in Tuberculosis Management Dr. Qais Haddad Tuberculosis (TB) is caused by Mycobacterium tuberculosis that most often affects the lungs. TB is preventable and curable even in multi-drug resistant tuberculous infections. In spite of that, we are still facing major problems in controlling and treating tuberculosis. Globally, TB is one of the greatest killers among infectious diseases. Although TB deaths have dropped 45% between 1990 & 2012, it still claims 1.5 million lives per year and at least half a million of them are children. Among the 9.0 million new cases of TB diagnosed in 2013, 95% of related deaths occurs in low- and middle-income countries (WHO Global TB Report 2014). With 360,000 deaths per year, HIV co-infection with TB accounts for 13% of total active TB infections. People living with HIV infection who become infected with TB are 30 times more likely to develop active TB disease than people without HIV. Multi-drug Resistant Tuberculosis (MDR-TB) and Extensively Drug Resistant Tuberculosis (XDR-TB) account for a significant number of HIV-TB co-infected patients. Latent TB infection (LTBI) diagnosis remained to be dependent on PPD (Mantoux test) which was first described by Robert Koch in 1890, PPD needs two patient visits and liable for error in reading. Recently Interferon-Gamma Release Assays (IGRAs) are whole-blood tests that can aid in diagnosing LTBI with one patient visit. Chemoprophylaxis of LTBI have been reduced to 3 months from 9 months. Sputum microscopy and culture in liquid medium with subsequent drug-susceptibility testing remains the recommended standard methods for diagnosing active TB. The use of solid culture medium is more cost-effective in resource-limited countries. These tests may need up to eight weeks to obtain a result and a few more weeks for drug susceptibility. Early diagnosis of TB had made remarkable advances during the last few years. Several non-commercial culture and drug susceptibility testing 54 5455 55

methods have been developed, aimed at settings with limited access to sophisticated laboratory infrastructure and technical expertise. One of these methods is microscopic-observation drugsusceptibility (MODS) assay that simultaneously detects M. tuberculosis bacilli, based on cording formation, with isoniazid & rifampicin resistance. Nucleic acid amplification tests (NAT) as Xpert MTB/RIF assay is fully automated and can simultaneously detects Mycobacterium tuberculosis complex and resistance to rifampicin in less than 2 hours. NAT assays are expensive with limited availability at most laboratories. There were no new anti-tb therapies developed for over 40 years since the launch of the last specific anti-tb drug, rifampicin, in 1967. During the last few years, six new molecules have been under development and are currently at different stages of clinical evaluation. Two of them have been approved for treating MDR-TB, Bedaquiline (approved by the Food and Drug Administration) and Delamanid (approved by the European Medicines Agency). However, both are prohibitively expensive and will be of limited use unless their cost decrease drastically. In 2013, the World Health Organization established a target of reducing the incidence of TB to 10 new cases/100,000 of population by the year 2035, and aim at eliminating TB as a public health problem by 2050. This ambitious target requires diligence in early diagnosis using new molecular technology, screening of contacts, and availability of new, effective, and affordable anti-tb drugs with a shorter course of therapy under Directly Observed Therapy (DOT). 29- Prolonged measles outbreak among vaccinated children in Ibb, 2014 Nabil M. Al Abhar 1, Obaid B.2, Taj Abdo3, Al Serouri A.W4 Background: Measles is one of the most infectious human diseases that can cause serious illness and lifelong complications lead to death. Ibb surveillance officer reported increasing number of measles cases since early 2014. The aims were to identify the outbreak, determine its extent and recommend control measures. Methods: We conduct a retrospective analysis of measles cases reported to the Surveillance Department from all Ibb hospitals and health centers from 1st January to 30th October 2014. We adopted WHO measles case definition where a suspected case defined as a case with fever illness and rash that does not meet criteria for any other illness, probable case is a case meeting the clinical case definition without lab confirmation and not epidemiologically linked to a confirmed case, and confirmed cases is a case that is laboratory confirmed or meets the clinical case definition and epidemiologically linked to a confirmed case. Results: Out of 511 suspected measles cases that were reported from 1st January-30th October 2014, 30 cases (6%) met probable case definition with an incidence rate of 11.553%.1,000,000/ was among <5 years age group and 40% among 510- years with females representing 53%. 70% of cases were vaccinated against measles of which 50% received two doses. All cases had fever and skin rash but cough, runny nose and conjunctivitis were reported in 58%, 51% and 46% of cases respectively. 20 (67%) has positive IgM for measles and 7 (35%) positive for both measles and rubella IgM. Conclusion: Prolonged measles outbreak has confirmed in Ibb with high incidence among vaccinated children. As recent measles vaccination and other rash illnesses (e.g. due to parvovirus, rubella, dengue) can cause a falsely positive IgM result, virus isolation (by PCR or Culture) should be introduced in Yemen for confirmation. Meanwhile, immunization cold chain should be thoroughly reviewed. Key Words: Measles, Outbreak, Yemen, vaccinated 56 5657 57

30- Comparison of the Integrated Diseases surveillance Response system and Communicable Diseases Surveillance system, 2013014-, Yemen Nabil M. Al Abhar1, Obadi M. 2, Al Kader K. 2, Al-Ashmory S.2, Al Serouri A.W3 Background Yemen adopted the Communicable Diseases Surveillance (CDS) system in 1998 however, the system thought to be inefficient due to poor reporting quality. In 2014, Yemen has launched the Integrated Disease Surveillance and Response (IDSR) to strengthen selected priority diseases surveillance. We compared both surveillance systems to describe diseases pattern, identify strengths and weakness, and provide recommendations to improve surveillance. Methods: We used the CDS and IDSR data softwares for the first 26 epidemiological weeks (W) for 2013 and 2014 respectively. As some disease categories differs in CDS and IDSR, we incorporated similar diseases under one diagnostic category to facilitate analysis e.g. Hepatitis A and Hepatitis B+D under hepatitis. Conclusion: Although, IDSR shows reporting increase at the launching due to increasing notification sites and regularity of reporting, the later drop may reflects poor supervision and feedback from the central level and fading of interest from peripheral level caused by lack of incentives together with timeconsuming reporting procedure. Therefore, strengthening supervision and feedback from central level together with more training for health facility staff is necessary to ensure timely and quality reporting. Strengthening IDSR capacities in data analysis and information dissemination and use with regular monitoring and feedback should be prioritized. To simply reporting and strengthen the integration, the list of reported diseases should be unified and agreed upon by different surveillance systems and vertical programs. Key words: Surveillance, Integrated, Communicable Diseases, Yemen Results: Although there was an overall 70% increase in diseases reporting in IDSR compared to CDS for the same period, reporting dropped to reach less than 10% in W26 compared to W15. The first five most commonly reported disease in CDS were: acute diarrhea, typhoid/paratyphoid, bloody diarrhea, malaria, and chickenpox compared to upper respiratory tract infection (URTI), acute diarrhea, lower respiratory tract infection (LRTI), malaria, and typhoid/paratyphoid in IDSR. Some governorates e.g. Taiz and Adhali still not reporting in IDSR. URTI and LRTI that ranked the first and the third in IDSR were not included in the CDS reported diseases list. 58 5859 59

31- KNOWLEDG, ATTITUDES AND PRACTICES REGARDING HEPATITIS B AMONG SURGEONS IN SANA A CAPITAL CITY, YEMEN Dr. Abdullah Al-Miklafy Background: Hepatitis B virus is a worldwide public health problem. Surgeons are at risk of contracting and spreading hepatitis B virus to others. Good knowledge, attitudes and practices of the surgeons allow them to handle their patients in such a way that they prevent themselves from contracting and their patient from spreading the infection. Objectives: This study aimed to evaluate the knowledge, attitudes and practices regarding Hepatitis B among surgeons in major governmental hospitals in Sana a. Methodology: A cross sectional study was conducted on surgeons,who work in public hospitals,by using a questionnaire which was consisted of 35-items; it was distributed at three major public hospitals.. The study period was from January to December 2013. Results: Total knowledge percentage was good in 57% and poor in 43%. Just 53.7% believed that hepatitis B virus transmission is possible via saliva. And 32.3% reported that the prevalence of hepatitis B virus in Yemen is between (1-25%) that is the nearest to world health organization report. Only 18.3% of the participants know the correct seroconversion rate of hepatitis B post contaminated needle stick injury. Also 65.3% believed that using gloves is effective for preventing hepatitis B infection. Regarding to practice, it is good in 51.7%, whereas only 43.7% wear double gloves while operating, only 4% use glasses when operating, and 89% always wear masks. Regarding to vaccination coverage, only 47.3% of the participants completed their vaccination. From all participants, 80.3% usually recapping needles before discarding, and the needles are discarded in plastic boxes by 34.9%. 91.7 % of participants exposed to needle stick injuries in the last 3 years. Of the participants, 40.3 % never report the needle stick injuries post exposure. Conclusion and Recommendations: Most of Yemeni surgeons are not aware of the correct percentage of hepatitis B prevalence in Yemen and the seroconversion rate of hepatitis B. The majority of the participants do not use double gloves and usually do not use glasses. Although, most of the participants exposed to needle stick injuries in the last three years, high percentage of the participants never report them. The vaccination coverage rate among them is low. Educational meetings, pamphlets, and facilities must be provided to surgeons, informing them of hazards, preventive measures such as wearing double gloves, vaccination efficacy and post exposure prophylaxis to needle stick injuries. 32- Tuberculosis Surveillance System Data Analysis, 2011-2013, Yemen Manal S. Baayees 1, Abdul Aziz N. 2, Al Serouri A.W.3 Background Tuberculosis (TB) remains one of the priority health problems in Yemen where there is an estimated yearly 14,000 new TB cases and 8 people are dying per 100,000 population. The aim is to analyze TB surveillance system and compare to national TB indicators and targets. Methods: We conducted secondary data analysis of the computerized National Tuberculosis Control Program (NTP) quarterly reports from 1st January 2011 to December 2013. Results: From 1st January 2011 to December 2013, the total number registered was 28,556 with some increase in reported cases in 2012 compared to 2011 (9,947 vs 8,840 respectively). The incidence rate (IR) per 100,000 is lower than the national expected incidence rate for the total TB cases: 35 vs. 50, smear positive Pulmonary TB (PTB) : 13 vs. 25, and smear negative PTB :11 vs. 17 but higher for the extra pulmonary TB (11 vs. 8). Sana a city, Al-Hodeidah, Hajjah and Taiz account for more than half of the total reported cases. While extra pulmonary TB case detection is higher than the target (31% vs 33%), smear negative PTB is reaching the target (31% vs 17%), the smear positive pulmonary TB is still far lower than the target (39% vs 50%). Finally, the actual treatment success rate is higher than the target ( 85%). Conclusion: Strengthening the surveillance system of NTP through regular data analysis and reporting with regular comparison to the national indicators and introducing an annual summary report is recommended. Updating the current registers and reporting forms is crucial to ensure the validity of reported data and improve surveillance. Enhancement monitoring and evaluation through strengthening supervision, enhancing feedback system, and on-job training are important. More research on reasons for not reaching some of the national TB indictors as well as factors behind low IR in some governorates is urgently needed. Key words: Tuberculosis, Surveillance, Incidence, National targets, Yemen 60 6061 61

33- Update on septic shock management Dr. Ebrahim Dom Sepsis is one of the oldest and most elusive syndrome in medicine Sepsis is defined as systemic inflammatory response to infection that may lead to multisystem organ dysfunction (sever sepsis) as well as hypotension that is refractory to fluid challenges (septic shock) Sepsis are the major health care problem, affect millions around the world each year and killing 14 / 2- and have increasing incidence Sever sepsis occur as a result of both community and acquired and health care associated infection. Pneumonia is the most common cause, accounting for about half to all cases, followed by intrabdominal and UTI infection. Risk factor for sever sepsis are related both a patient predisposition and to infectious virulence. The most predisposing factor are chronic disease including DM, CKD, CLD, cancer, HIV and use of immunosuppressive drugs. Before introduction of modern intensive care, sever sepsis & septic shock were typically lethal. MR was reached about 80 % ( 30 years ago ) however in advance in training, better surveillance, good monitoring and prompt initiation of therapy and supporting of failing organs. MR is decreasing and now it is close to 20 30 %. Objectives 1- Improve early diagnosis. One of the main challenges in sepsis management is diagnosis so early detection of sepsis case based on high clinical suspicion and clinical parameters. 2- Increased awareness about sepsis. 3- Training of team &how they deal with every case and improve hemodynamic monitoring and system support. 4- Apply of evidence based guidelines and local policy protocols, 5- Early goal directed therapy ( EGDT ) can improve mortality in sever sepsis., 6- Trials to apply new update in therapeutics. 34- Procalcitonin and its role as biomarkers in the diagnosis and management of sepsis. Dr.Shafiq.A.Alimad, Dr. Khadija Bazara. Recently there has been increasing numbers of bacterial infection in hospitalized patients due to increased nosocomial infection from catheterization and immunosuppressive drugs also increased causes of (MRSA), which may end by sepsis. A common problem in the clinical practice is that the sign and symptoms of bacterial and viral infections are widely overlapping. So the diagnostic uncertainty still remains, even after obtaining a patient history, performing a physical examination, chest x-ray and laboratory tests, So a laboratory test with more specificity would significantly improve the clinical differential diagnosis in these cases. The Procalcitonin act as a biomarker that exhibit greater specificity than other pro-inflammatory markers (e.g. cytokines) in identifying patient with sepsis and can be used in the diagnosis of bacterial infection and monitoring of the therapeutic response and reducing antibiotic exposure, its level also may be elevated in other conditions & diseases like (T.B, Pneumonia, transplantation, malignancy and some drugs). 62 6263 63

35- Epidemiological characteristics of human hydatid disease in the major hospitals, Sana`a, Yemen Dr. Majed Wadi Background: Echinococcosis is a zoonotic disease caused by infection with the larval stage of tapeworm Echinococcusgranulosus. The dogs are the definitive hosts while the sheep are the intermediate host, so the global distribution of the diseases are increased in sheep rising areas (rural areas). It is a chronic disease of major public health importance and considered endemic in Yemen. Objectives: This study aims to describe the epidemiological characteristics of human hydatid disease cases in the major hospitals in Sana a, Yemen (University of Science and Technology UST, Alkuwait, Aljoumhori and Althawra hospitals). Methodology: A cross-sectional study was applied in this research. A modified check list was used to collect data from the diagnosed cases of hydatid disease in the major hospitals archives for the years of 20122013-. Results: Out of 76 files of diagnosed hydatid disease, 65.8% of cases were females while 34.2% were males. The highest age group was less than 30 years that represented 48.7%.The most affected organ was the liver 72.4%, followed by lung 23.7%. Cysts were single in 73.7% of cases and multiple in 26.3% of cases. All of the cases were treated surgically and reported no recurrence or ICU admission. Conclusion: Hydatid disease has major impact on the public. The results of this study are quite similar to other studies worldwide. A call for good preventive methods, including effective health education, should be taken to eradicate such disease. 36- The role of multidispinary team in management of Hydatid cyst disease Dr/ Rasheed ALEEZI (JBGS, MHPBS) Departmement of general surgery, USThospital Sana`a-YEMEN Background: Hydatid disease or echinococcosis is a zoonosis that caused by echinochococus granulosus. Humans contract the disease from dogs, and there is no human-to-human transmission. Hydatid disease is an endemic in Yemen. Hydatid disease stills an emerging problem and is a course of challenge to all the medical practitioners. Due to its non-specific clinical presentation and lack of awareness regarding the parasite in society, it is being overlooked very commonly. There still exists a dilemma of obtaining accurate figures on the prevalence of Hydatid disease, as in majority of cases the disease manifests with a very few specific signs and symptoms. Aim: To estimate the burden of Hydatid disease over the society, Increase the medical awareness and formulate an accurate pathway for diagnosis, management and prevention of the disease. Method: We present two cases of complicated hydatosis which were managed effectively in our hospital and by review of literatures we tried to address the accurate methods for prevention and treatment of hydatid cysts. Conclusion: multidispinary team play an important role in management of hydatid disese and there is a great need of cooperation with the Public Health,the Veterinary Medical and the Environmental Affairs Authorities for control this disease 64 6465 65

37- Successful medical treatment of emphysematous pyelonephritis, our experience with conservative treatment at USTH Shafiq Alimad MD.Nephrologist,Dr.Lutf Gulees Urologist, Dr.Arwa Alsalami GP, Emphysematous pyelonephritis has been defined as a necrotizing infection of the renal parenchyma and its surrounding areas that results in the presence of gas in the renal parenchyma, collecting system or perinephric tissue]. More than 90% of cases occur in diabetics with poor glycemic control. Other predisposing factors include urinary tract obstruction, polycystic kidneys, end stage renal disease and immunosuppression;the management of this condition has traditionally been surgical, with nephrectomy. However, some recent reports have described successful medical interventions. We describe 6 cases of severe emphysematous pyelonephritis was admitted to university of science and technology hospital at Sana a. These conditions were managed medically, not surgically, with intensive antibiotic and circulatory support. The outcome was complete recovery after 21 days of treatment. We discuss the management of this rare but important condition in detail. 38- Antibiotic resistance and empiric antibiotic choices of nosocomial bloodstream infection in a developing country setting Indah K Murni1,2, Trevor Duke2, Sharon Kinney3, Andrew J Daley4, Yati Soenarto1, Ida Safitri1 1Department of Paediatrics, DR. Sardjito Hospital/Faculty of Medicine UniversitasGadjahMada, Yogyakarta, Indonesia, 2Centre for International Child Health, Department of Paediatrics, University of Melbourne, MCRI, and Paediatric Intensive Care Unit, Royal Children s Hospital, Melbourne 3Department of Paediatrics and Nursing, University of Melbourne, Royal Children s Hospital, Melbourne 4Laboratory Services, Infection Prevention and Control, Royal Children s Hospital, Melbourne and Department of Paediatrics, University of Melbourne Background: Bacteria are the most significant pathogen of nosocomial infections. Determining bacteria, antibiotic susceptibility test, and mortality related to those pathogens are very important for better understanding the extent of antibiotic-resistant infections in the field. This information can help the physicians and the infection prevention team to make a decision concerning antibiotic choices and infection control practices. Objectives: This studyaimed to determine the resistance pattern of isolated pathogens in patients with nosocomial bloodstream infection (BSI), to determine mortality related to multidrug resistant nosocomial infections, and to recommend choices of empiric antibiotics for nosocomial BSI based on antibiotic sensitivity tests. Methods: A prospective cohort study was conducted at the pediatric wards and pediatric intensive care unit at the DrSardjitoteaching hospital in Yogyakarta, Indonesia during a 27-month period between 66 6667 67

1st December 2010 and 28th February 2013. We reviewed the bacterial isolates, the antibiotic susceptibility results, and the resistance pattern from patients with nosocomial BSI. Nosocomial BSI were defined using the United States Centers for Disease Control and Prevention (CDC) criteria. Results: Of 249 sterile isolates, 174 (69.9%) were cultured from blood in 170 patients with nosocomial BSI. Bacteria from bloodstream cultures were identified in 168 of cases (96.6% of all positive blood cultures and 67.5% of all sterile site isolates) and fungal isolates in 6 cases (3.4% of all positive blood cultures and 2.4% of all sterile site isolates). Of the 168 bacterial bloodstream isolates, 148 (88.1%) were gram-negative bacteria and 20 (11.9%) were gram-positive bacteria. P. aeruginosa was the most common gram-negative pathogen of 37.3% (93249/). Klebsiella spp. were found in 4% (10249/), Enterobacteriaceae in 2.4% (6249/), A. baumanii in 0.8% (2249/), and E. coli in 0.4% (1249/). Of the gram-positive bacteria, we only isolated coagulase negative staphylococci. Imipenem had the highest coverage of nosocomial bloodstream bacteria at 86.2% (144167/), followed by amikacin at 84.4% (141167/) and ciprofloxacin at 84.4% (141167/). Ceftazidime and chloramphenicol provided similar rates of coverage at 74.8%. The combination of ceftazidime and gentamicin provided bacterial coverage of 65% (204314/). The combination of ceftazidime and amikacin or ciprofloxacin provided coverage of 79.6% (266344/). Among 170 patients with culture positive nosocomial BSI, eleven patients (6.4%) developed infections caused by multidrug resistant organisms. The mortality rate in patients infected with multidrug-resistant pathogens was 64% (711/). Overall, multidrug-resistant organisms causing nosocomial BSI increased the risk of death with RR of 17.9 (95% CI of 5.2 to 61.8). Conclusions: We found a substantial burden of morbidity and mortality in nosocomial bloodstream infection related to resistant pathogens. Amikacin, ciprofloxacin, ceftazidime, or imipenemcould be used for the empirical treatment of nosocomial infections in this setting. 39- Update on the prevention, diagnosis and management of Infective Endocarditis (IE) Dr.Ahmed Yahya Mohammed Alarhabi IE has the proclivity to cause complications both at the cardiac valve site and at extracardiac locations that can predispose affected patients to serious morbidity and mortality. It is for these reasons that management of IE requires a team approach, which generally includes specialists in infectious diseases, cardiovascular medicine, and cardiovascular surgery with particular expertise in IE. Thus every patient with IE should be managed in the inpatient setting of a medical center with experienced medical and surgical specialists to provide care, which often includes emergent diagnostic and surgical interventions. IE is an infection of the endothelial lining of the heart valves, mitral or tricuspid chorda tendinea, valve annulus, and aortic root. Pre-existing heart disease is found in 23/ of the cases of left-sided IE. 13/ patients have normal or clinically unrecognized valve disease. 3.6 to 7.0 cases/100,000 patient-years. People with prosthetic heart valves, previous incidents of endocarditis, complex congenital heart disease, IVDU, and surgically devised systemic pulmonary shunts are at high risk of developing IE. Isolated Aortic Valve (AV) IE is observed in 5560%- of cases,isolated Mitral Valve (MV) IE occurs in 25-30% of cases, IE of both valves occurs in 15% of cases and prosthetic valve IE constitutes 1025%- of all cases of IE. Right-sided IE constitutes 510%- of all cases. IE prophylaxis regimen has been evolving for the past 50 years. Several assumptions have led to development of antibiotics prophylaxis in humans, and these assumptions have been recently questioned. 68 6869 69

40- Initial therapy and prognosis of bacterial meningitis in adults. Dr. MOHAMMED AL-SHAIKH, MD. Bacterial meningitis kills or maims about a fifth of people with the disease. Early antibiotic treatment improves outcomes, but the effectiveness of widely available antibiotics is threatened by global emergence of multidrug-resistant bacteria. Additionally, whether or not dexamethasone improves out comes remains controversial. Other adjunctive therapeutic strategies, such as glycerol, paracetamol, induction of hypothermia are being tested further. The approach to therapy in patients with antimicrobial allergies is challenging. Review of prognosis even with the appropriate antibiotics administration will be introduced. 41- Septic arthritis, One of the most urgent case of Rheumatology Dr. Ahmed Alhusam Many of us have encountered a lot of cases with monoarthritis but many of us ignores theses case assurgent case that our patient may lose his mechanical joint Septic joints signal the presence of a potentially lifethreatening infection. For nongonococcal joint infections,so the mortality rate among adults ranges from 10% to greater than 50%. The most common pathway to a septic joint is through hematogenous seeding from an extraarticular Site of infection, for example, pneumonia, pyelonephritis, or skin infection. The causes of adult nongonococcal septic arthritis are Gram-positive cocci (75% 80%) and Gram negative bacilli (15% 20%). Staphylococcus aureusis most common organism in both native and prosthetic joint infections. Arthrocentesis and synovial fluid analysis are the cornerstones for the diagnosis of septic arthritis. 42- Rubella Outbreak of Baharan Village, Sana a Governorate, Yemen, 2013 Maha A. Obadi1, A. Break2, M. Qayad1 Background: Rubella is a contagious viral infection which often affects children and young adults. Vaccination against Rubella is not currently included in the Expanded Program on Immunization (EPI) in Yemen. Rubella infection in pregnant women may cause congenital rubella Syndrome (CRS), which is of public health concern due to its severe and fatal outcomes. There is no specific treatment for rubella but vaccination of all children is the most effective method to prevent this incurable disease. An outbreak occurred in Baharan village, Sana a governorate on 16th November 2013. The objectives of the investigation were to identify the outbreak, determine its extent and to recommend suitable action for prevention. Methods: Cases were collected from health facilities records using investigation forms. The rubella case definition used was: any generalized rash illness of acute onset with fever during the period of 16th November to 22nd December in Baharan village. A descriptive analysis of cases by age, sex, clinical manifestation and epidemiological information were performed, using EPIINFO. Results: Thirty-six suspected cases were reported from Baharan from 16th Nov-22nd Dec 2013. Twenty-six cases met case definition and three were confirmed by labratory. The first cases were two siblings who had contact with a suspected rubella case in another village nearby. The incidence rates were 87, 98, 73/ 1,000 among 15- years, 610- years, and 1115- years age group. 61% of case-persons were girls. All cases had mild symptoms of maculopapular rash and fever, and 78% reported conjunctivitis, 75% runny nose, and 50% cough. Out of 5 serum samples tested, 3 had anti-rubella IgM by ELISA. Conclusion: The outbreak reflects the urgent need for introducing rubella vaccination in the routine immunization and establishment of surveillance system for Congenital Rubella Syndrome. Keywords: rubella, vaccine, Baharan village, surveillance 70 7071 71

43- Geographical Information System (GIS) in Communicable Disease Control Prof Dr Shamsul Azhar Shah Department of Community Health Faculty of Medicine Universiti Kebangsaan Malaysia Public health has been defined as the science and art of prolonging life, preventing disease, and promoting health through organized efforts of society. The geographical perspective is a key aspect of public health. Populations and communities are geographically distributed and communities tend to have their own defining characteristics. Environment, which includes both physical (i.e., air quality, water quality, soil characteristics, radiation), socio economic and lifestyle aspects have marked geographical variation. GIS, the definition of which has evolved from geographic information systems to geographic information science, involves a scientific problem-solving approach, encompassing the development and application of scientific methods to solve societal problems. It, therefore, has become an integral and essential part of public health research and practice. The use of GIS in communicable disease control has been well documented and currently used by many countries in the world. Development of the software has been tremendous since early 1990s and many of the analysis incorporate useful statistical analysis that help us to understand the spread of diseases. It is undeniably an important tool in disease investigation and must be used by epidemiologists. This lecture will highlight the importance and usage of GIS in communicable disease control such as dengue, tuberculosis, influenza and typhoid. 72 7273 73

44- Measles outbreak with high mortality among non-vaccinated children, Al Zeliah village, Hodeida governorate, November 2014 Mohamed A. Al Emad 1, Qaseem M. 2, Al Serouri A.W 3. Background: On October 12, 2014, the surveillance coordinator in Al Tuhita district notified about 17 suspected measles cases with eight deaths at Al Zeliah village. On 2 November, a team sent for further investigation of the outbreak. The aims were to determine the outbreak extent, identify source, and recommend control and preventive measures. Methods: The team reviewed the surveillance records and used the CDC case definition where suspect case defined as: fever illness and rash that does not meet criteria for any other illness, probable as a case meeting clinical case definition without lab confirmation, and not epidemiologically linked to a confirmed case, and confirmed as a case that is laboratory confirmed or meets the clinical case definition and epidemiologically linked to a confirmed case. Active house-to-house search conducted and 18 blood samples were taken for lab confirmation. Results: Seventy-four cases reported from 29th September to 6th November 2014. All cases were unvaccinated due to documented parents refusal. The attack rate was 15100/ population with a case fatality rate of 16%. 51% were males and 84% were children 10 years. Out of the 18 blood samples collected, 17 (83%) were IgM positive. Four cases needed admission due to the severe complication where two cases had pneumonia, one had blindness, and one had meningoencephalopathy. Conclusions: Measles outbreak with high mortality has been confirmed in Al Zeliah village due to vaccine refusal. Therefore, health education to tackle refusal with an urgent measles immunization campaign and vitamin A supplementation had recommended. For the long-term measles prevention, strengthening the routine and outreach immunization services with awareness rising is crucial. Qualitative research to study reasons behind refusal in this community is prerequisite. Key words: Measles, outbreak, unvaccinated, mortality, Yemen 45- Dengue Fever Outbreak at Al ganaws district, Al Hodeida, Yemen 2014 Ghazi S Bashamakha1, Jawal A.2, Al shameiry H3, Qayad M.4 Background: Dengue Fever (DF) has emerged as public health problem in Yemen where 14 out 23 governorates has reported outbreaks since 2002. In January 2014, the surveillance coordinator in Al ganaws district, Al Hodeida governorate reported an increased number of suspected DF and the Ministry sent a team to characterize the outbreak, confirm the diagnosis and prevent future spread. Methods: A suspected DF defined as an acute febrile illness 27- days with two or more of the followings: severe headache, retro-orbital pain, muscle/ bone/ joint pain and negative malaria test. We conducted face to face interview to collect data on age, gender, residence and symptoms/signs. Blood specimens were collected from 55 suspected cases. Vector surveillance was also conducted. Data entered and analyzed using EPI INFO. Results: During 1st January 28th February 2014, 138 met DF case definition of which 73 cases (53%) from deer Al zaher. 54% of cases were among males and three quarters within 525- years age group. The attack rate was 1510,000/ and case fatality was 2.2%. Out of 55 specimens tested, 3 (5%) were IgM positive, 31 (56%) IgG positive and 15 cases (27%) positive for both. The most frequently reported symptoms were fever (100%), headache, joint pain, muscle pain (99% each), and retro-orbital pain (94%). No hemorrhagic manifestations were identified. Vector surveillance show presence of the vector (Aedes Aegypti), with 23% house index and 25% container index. Conclusion: The investigation confirmed DF outbreak in Al ganaws district with presence of the vector. The high burden of disease among males and young adults suggests outdoor infection. Vector control by insecticide spraying and fogging to eliminate the breeding place is recommended. Improve dengue surveillance system is the corner stone for early outbreaks detection and control. Key Words: Dengue, outbreak, Al Hodeida 74 7475 75

46- H1N1 outbreak in Hareb Baihaan district, Mareb, Yemen, August 2014: The challenges and lessons learned Eshraq N. Alfalahy1, Baayees M.1, Shamsan F.2, Al Abhar N2. Al Serouri A.W.3 Background On August 20, a community member from Hareb Baihan, informed the surveillance department at Ministry of Public Health and Population of a confirmed case of H1N1 from Hareb who admitted to a private hospital on 9th and died on 13th August. The deceased s relatives are also experiencing flu like illness. On August 25, outbreak investigation team deployed to Baihaan aiming to confirm the outbreak existence and implement preventive measures. Methods: A case control study was conducted, where 16 cases and 43 controls were identified. Probable case was defined as an individual with a clinically compatible illness or, who died of an unexplained acute respiratory illness and is epidemiologically linked to confirmed, which defined as an individual with laboratory confirmed H1N1 virus infection by at least one of the following: RT-PCR, Viral culture, Four-fold rise in H1N1 antibodies. The modified Influenza Like Illness questionnaire was used to interview cases and controls. Those who had flue like illness but did not meet the above definitions were considered as suspects. 13 nasopharyngeal swabs were collected for PCR. Controls are those with no symptoms. Results: Beside the known dead confirmed case, 10 cases were met probable case definition (of them two died) and five were suspects. Nine of probable cases are from Baihaan Al Qareah (residence of the dead confirmed case). 81% of cases were females and were > 15 years old. 38% had close contact with the confirmed case as had contact with animal. All cases had fever and cough. All collected samples found to be negative to H1N1 and H5N2 by RT-PCR but were sent to NEMRO-III for further confirmation. Conclusion: Findings highlight challenges encounter outbreak investigation in Yemen. First, late reporting that comes from community indicates weak surveillance system. Second, late deployment of the investigation team more than two weeks after deceased admission underlines the weak response. Finally, lack of virus isolation capacities in Yemen could limit early outbreak confirmation and response. Therefore, strengthening surveillance system and laboratory capacities for early outbreak detection and response is highly recommended. Key words: H1N1, outbreak, challenges, Yemen 76 7677 77

47- Dengue Fever Outbreak Investigation in Taiz Governorate, June 15 September 17, 2012 Mohammed A. Qassim, Al, Eryani Y., Al Dobai A.2, Al Serouri A.W3. Background: The first dengue fever outbreak in Taiz occurred in May 2005 with 253 cases confirmed. In May 2009 another large outbreak occurred with 928 confirmed cases, and in January 2010, an outbreak was reported with 58 cases. On 28 August 2012, the Taiz Department of Health notified the MOPH&P an increase of the number of febrile illnesses in Altaezia district, and a case with bleeding manifestation died in Taiz city. Dengue fever was suspected, and we started an investigation on 2nd of September. Methods: An active case finding was instituted in major hospitals in Taiz. We used WHO case definition for dengue and interviewed cases in Altazia and Sennh village of Almedfer districts. We took blood samples for lab testing. An entomological survey was also conducted. There were 171 suspected cases. All cases were lab tested and 81 were confirmed of dengue (33 IgM and 48 cases IgG). Results: The incidence rate was 2.7100000/ in Taiz Governorate. The age group 2130- years was mostly affected among the confirmed cases 25% (2081/). The median age of all cases was 18 years and males outnumbered females (ratio 3:2). Five cases had bleeding manifestation, and two cases died, with a case fatality rate of 1.2 %. The malaria program started spraying campaign in week 38. The entomological investigation identified abundance of the vector Aedes Egypti. Conclusion: The outbreak was caused by dengue virus with hemorrhagic manifestations and deaths. Strengthening the surveillance at all levels to ensure early reporting of the cases is reconded. Continuous health education on prevention and control of infection are also essential to detect and control such outbreaks. Enhancement of entomological surveillance and support from authorities has to be developed. Key words: Dengue, outbreak, Yemen 78 7879