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To describe the epidemiology of measles in Oman and the implications for a vaccination programme, we conducted a retrospective record-based study from 1 January 2000 to 31 December 2003 using data from the national epidemiological surveillance system. All cases notified as suspected measles during the study period were included. Of the 185 notified cases, 19.4% were confirmed measles positive. Blood samples for measles IgM were collected in 97.3% of cases. The mean age of measles cases was 8.0 (SD 10.7) years. The estimated overall incidence rate of measles for the study period was 0.53 per 100,000 person-years. Regression analysis indicated measles was significantly commoner among non-Omanis and children who had not been vaccinated. [ABSTRACT FROM AUTHOR]

Seasonal influenza poses significant health and economic challenges globally each year, particularly impacting the elderly population (aged ≥ 65 years) with increased rates of hospitalization, and mortality. The population of older adults is steadily increasing in the Gulf Cooperation Council (GCC) countries and is likely to increase even further. In addition, there is a high burden of chronic comorbidities in these countries like diabetes and obesity, which increases the likelihood of severe consequences of influenza infection. The GCC countries also host mass gathering events like Hajj, Umrah pilgrimage, Arba'een (nearby Iraq) pilgrimage, and international sports and business events, which further intensify the risk of outbreaks like influenza. These events facilitate the mixing of visitors from various countries. Thus, influenza activity in this North Hemisphere (NH) geography is usually present even before the availability of NH seasonal influenza vaccine. This is especially problematic for the elderly, whose protection from the previous year's immunization would have waned. Higher dosages of antigens or adjuvants have been used to improve immunogenicity in older people with superior vaccine effectiveness. Therefore, there is a compelling argument in favor of the implementation of high-dose seasonal influenza vaccines in the GCC countries to improve the protection of individuals aged 65 years and older against influenza infection and associated severe complications., (© 2024. The Author(s).)

Background: Eating disorders are complex illnesses with serious long-term consequences. They are linked to negative outcomes such as miscarriage, low birth weight, and other obstetric and postpartum difficulties. Our study in Muscat, Oman, examines the eating habits of pregnant women who consult primary care physicians. In this study, our aim is to identify key sociodemographic factors linked with eating disorders in Oman., Method: We used the Eating Disorder Examination Questionnaire to assess the potential for the presence of eating disorders. Chi-Square and Fisher's Exact tests were used to analyze relationships between improper eating behavior and independent variables., Results: The study showed that 1.6% of participants had a potential diagnosis of an eating disorder, with the most common inappropriate behavior being binge eating at a prevalence of 18.8%. A pre-gestational low Body Mass Index (BMI) was associated with a higher prevalence of binge eating during pregnancy. Additionally, we found that pregnant women who were working were more prone to self-induced vomiting. High BMI before pregnancy was significantly associated with various inappropriate eating behaviors, such as restraint behavior ( p = 0.000), shape concern ( p = 0.000), weight concern ( p = 0.040), eating ( p = 0.045), laxative use ( p = 0.020), and excessive exercise ( p = 0.043)., Conclusion: The study reveals a high prevalence of eating disorders in pregnancy. Less educated women exhibit higher laxative use, while working women show more instances of binge eating and self-induced vomiting. These findings emphasize the critical need to prioritize targeted interventions and support for vulnerable pregnant women.

Objectives: Despite a significant reduction in the global case incidence and mortality of malaria in the past 20 years, malaria continues to wreak havoc on people's health across the globe. Oman is a malaria-free country, meeting the World Health Organization's (WHO) criteria, having no indigenous malaria case documented since 2010, and maintaining that status for three consecutive years. Oman has a national strategy for prevention of re-establishment of malaria and to maintain their malaria-free status. In this paper, we explore Oman's malaria elimination progress and provide recommendations for accelerating and sustaining malaria free status using WHO malaria elimination strategies., Methods: Secondary data from the years 1976 to 2020 was extracted from official sources utilized to assess progress. A review and epidemiological analysis of malaria cases, species classification, and source of infection was conducted. The data and situation were compared to WHO malaria elimination pillars., Results: The number of malaria cases reported from 1976 to 2020 was 298 070, a decline from 1.6 to 0.1 per 1000 population. Of the 4415 cases reported between 1994-2004, 98.0% were classified as imported and 73.0% of people diagnosed with malaria were 20-34 years old. The number of autochthonous cases began to decline in 1994 from a high of 4415 cases (3.6 per 1000 population) to zero by 2004 with no deaths attributed to autochthonous malaria cases after the year 2000. By 2020, Plasmodium falciparum accounted for 86.0% of cases, P. vivax cases declined to 9.0% and P. malaria and P. ovale comprised the remaining 6.0% of case notifications., Conclusions: Oman achieved malaria elimination status in 2013. To maintain this status, it is essential to adopt a national prevention strategy of re-establishment of malaria and maintain malaria-free status targets., (Copyright © 2023, Oman Medical Journal.)

Background: Seasonal influenza vaccine can reduce the risk of influenza-associated hospitalizations and deaths among children. Given that parents are the primary decision makers, this study examined the parental attitude toward childhood influenza vaccine and identified determinants of vaccine hesitancy (VH) in the Eastern Mediterranean region (EMR)., Methods: A cross-sectional study was conducted using an anonymous online survey in 14 EMR countries. Parents of children aged 6 months to 18 years were included. The Parent Attitude about Childhood Vaccines (PACV) was used to assess VH. Chi square test and independent t-test were used to test for association of qualitative and quantitative variables, respectively. A structural equations model (SEM) was used to identify direct and indirect determinants of parental VH., Results: Almost half of the parents were hesitant about vaccinating their children against influenza (50.8%). Parental VH was significantly higher among older mothers (37.06 ± 8.8 years, p  = 0.006), rural residents (53.6%, p  < 0.001), high-income countries residents (50.6%, p  < 0.001), and mothers with higher educational levels (52.1%, p  < 0.001). Parents of school-aged children (5-9 years) (55.6%, p  < 0.001), children free from any comorbidities (52.5%, p  < 0.001), children who did not receive routine vaccination at all (51.5%, p  = 0.03), children who were not vaccinated against COVID-19 (54.3%, p  < 0.001), in addition to parents who were not vaccinated against influenza (57.1%, p  < 0.001) were significantly associated with increased likelihood of VH. Parents who were depending on healthcare provider as a source of information regarding vaccines were less likely to report VH (47.9%, p < 0.001), meanwhile those who used social media as their source of health information showed a significantly higher VH (57.2%, p < 0.001). The SEM suggested that mother's age, residence, country income level, child gender, total number of children and source of information regarding vaccines had a direct effect on VH. Meanwhile, parents vaccinated against influenza, children completely or partially vaccinated with routine vaccines and children vaccinated against Coronavirus disease 2019 (COVID-19) had an indirect effect on VH., Conclusion: A high proportion of included parents were hesitant to vaccinate their children against seasonal influenza. This attitude is due to many modifiable and non-modifiable factors that can be targeted to improve vaccination coverage., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Fadl, Al Awaidy, Elshabrawy, Makhlouf, Ibrahim, Abdel-Rahman, Tookhy, Alsalmani, Al-Saeedi, Al-Sawalha, El-Din, Saad, Ayoob, Rourou, Ali, Tawati, Gadain, Al-saidi, Hassan, Alsanafi, Sandouk, Youssef, Alothman, Yazbek, Al-Ansi, Mehdad, Adam, Gebreal and Ghazy.)

Objectives: Dengue fever (DF) is the most common arthropod-borne viral illness with significant public health implications that can cause severe clinical symptoms and possibly death. We sought to determine the epidemiological and clinical characteristics of patients presented with DF to the Royal Hospital in a recent outbreak in Oman., Methods: We conducted a retrospective cohort study between 1 January and 18 April 2022, at the Royal Hospital, Oman, including all patients who presented with febrile illness and laboratory-confirmed DF. Descriptive statistics were used to summarize the results., Results: The cohort included 58 patients with laboratory-confirmed DF, of whom 39 (67.2%) required admission. The overall mean age was 41.0±20.0 years. Over half (55.2%) were females and the majority (86.2%) were Omani citizens. Eighty-one percent of the patients were residents of Bawshar in Muscat governorate. Dengue virus 2 was the isolated serotype. Fever (98.3%), muscular aches and pains (55.2%), and headache (53.4%) were the most common symptoms on presentation. All patients except two had no travel history. The most common comorbidities were hypertension (29.3%) and diabetes mellitus (17.2%). Upon admission, the most prominent hematological and biochemical abnormalities were severe thrombocytopenia (31.0%) with platelet counts of < 50 000/mm 3 and hepatic impairment (15.5%). Antibiotics were prescribed to 27.6% of the patients. All patients improved clinically, and no deaths were reported during the study period., Conclusions: Fever and thrombocytopenia were the commonest presentations of DF. Identification of factors linked to increased risk of hospitalization in patients with DF can assist in recognizing individuals who need close monitoring and intensive support., (The OMJ is Published Bimonthly and Copyrighted 2022 by the OMSB.)

Vaccination to prevent influenza virus infection and to lessen its severity is recommended among healthcare workers (HCWs). Health professionals have a higher risk of exposure to viruses and could transmit the influenza virus to vulnerable patients who are prone to severe disease and mortality. The aim of the current study was to evaluate the levels of influenza vaccine acceptance and uptake as well as its determinants, among Jordanian HCWs over the last influenza season of 2021/2022. This study was based on a self-administered electronic survey that was distributed in March 2022. Psychological determinants of influenza vaccine acceptance and vaccine conspiracy beliefs were assessed using the previously validated 5C scale questionnaire (confidence, complacency, constraints, calculation and collective responsibility) and the vaccine conspiracy beliefs scale. The study sample comprised a total of 1218 HCWs: nurses ( n = 412, 33.8%), physicians ( n = 367, 30.1%), medical technicians ( n = 182, 14.9%), pharmacists ( n = 161, 13.2%) and dentists ( n = 87, 7.1%), among others. About two-thirds of the study sample expressed willingness to receive influenza vaccination if provided free of charge ( n = 807, 66.3%), whereas less than one-third were willing to pay for the vaccine ( n = 388, 31.9%). The self-reported uptake of the influenza vaccine in the last influenza season was 62.8%. The following factors were significantly associated with higher acceptance of influenza vaccination if provided freely, as opposed to vaccine hesitancy/rejection: male sex; physicians and dentists among HCW categories; higher confidence and collective responsibility; and lower complacency, constraints and calculation. Higher influenza vaccine uptake was significantly correlated with nurses and physicians among HCW categories, older age, a higher monthly income, higher confidence and collective responsibility, lower complacency and constraints and lower embrace of general vaccine conspiracy beliefs. The results of the current study can provide helpful clues to improve influenza vaccine coverage among HCWs in Jordan. Consequently, this can help to protect vulnerable patient groups and reserve valuable resources in healthcare settings. Psychological determinants appeared to be the most significant factors for vaccine acceptance and uptake, whereas the embrace of general vaccine conspiracy beliefs was associated with lower rates of influenza vaccine uptake, which should be considered in educational and interventional measures aiming to promote influenza vaccination.

Objectives: To evaluate the knowledge, attitude, and acceptance of COVID-19 vaccine among the general population of Oman, on the eve of the rollout of vaccination program in the country., Methods: A cross-sectional study was conducted using a structured and validated online questionnaire. Adults residing in Oman were invited to participate in the study between 22 and 24 December 2020. Logistic regression analysis was used to identify the factors associated with COVID-19 vaccine acceptability., Results: Of the total of 966 participants, the majority (612; 63.4%) were women. Most participants were younger than 40 years (572; 59.3%). Participants displayed good awareness about COVID-19 (946; 97.9%) and the global vaccine development initiatives (831; 86.0%). Only 265 (27.4%) participants were willing to get themselves vaccinated. The majority were either uncertain 365 (37.8%) or unwilling 336 (34.8%). The main driver of vaccine acceptance was to protect oneself and others (186/265; 70.0%). The main reasons given for vaccination hesitation/refusal were concerns over possible side-effects (505/701; 72.0%), safety concerns (386/701; 55.0%), and ineffectiveness of the vaccine (107/701; 15.3%)., Conclusions: On the eve of the first-ever rollout of COVID-19 vaccine in Oman in December 2020, the surveyed residents of the country expressed significant hesitancy to get themselves vaccinated. Participants' perceptions of risk of contracting COVID-19, their trust in vaccines, government, and their health system were important predictors of vaccine acceptance. These results enabled development of strategies to address such concerns to facilitate vaccine acceptance among the residents of Oman. The results of this study can be used by researchers to conduct comparative research in future, with more emphasis on Omani youth (< 40 years)., (The OMJ is Published Bimonthly and Copyrighted 2022 by the OMSB.)

Objectives: To share the experience of Agile Teams using Lean Method to facilitate improvement projects during the COVID-19 pandemic., Methods: A tertiary hospital in Oman mobilized agile teams using lean methods to streamline the workflow during the early stages of COVID-19 pandemic in year 2020., Results: The collaborative network generated by the agile teams increased interdepartmental engagement within the hospital and trimmed workflows, thus improving patient care despite the pandemic., Conclusions: Agile teams using lean methods demonstrably enhance collaboration and efficiency in healthcare, leading to improved patient care., (The OMJ is Published Bimonthly and Copyrighted 2022 by the OMSB.)

Objectives: To describe the epidemiological characteristics of the first 69,382 patients with COVID-19 infection in Oman., Methods: A retrospective case series study of patients diagnosed with SARS-CoV-2 infection in Oman from 24 February to 23 July 2020. The data were obtained from the National surveillance COVID-19 network., Results: The overall mean age of patients was 34 (± 14) years, 74% (n = 51,391) were males, 40,859 (59%) were Omani citizens, and 28,523 (41%) were foreign-born individuals. The most common symptoms at presentation were fever 50% (n = 34,600), cough 46% (n = 32,062), sore throat 46% (n = 31,953) and shortness of breath (SOB) 35% (n = 24,567). Overall, 8,960 (12.9%) patients required hospitalization with 1189 (13.3%) individuals requiring admission to the intensive care unit (ICU) and mechanical ventilation (MV). Patients hospitalized with COVID-19 infection were mostly Omani nationals and males between 30 and 39 years old (p < 0.001). The mortality rate was 7.7 per 100,000 population (n = 359) with rates of 9.4 (n = 278) and 4.8 (n = 81) deaths per 100,000 population in Omani nationals and foreign-born individuals, respectively. Females hospitalized with COVID-19 had a mean age of 64 (± 18) years versus a mean age of 55 (± 17) years in males. Mean age of patients with COVID-19-related mortality was 58 (± 18) years with significant differences in mean age between females and males 64 (± 18) versus 55 (± 17) years, respectively., Conclusions: Young Omani males accounted for the highest incidence of COVID-19 infection and hospitalization, while mortality rates were higher among males and the older age (> 50 years). Identifying the epidemiological characteristics and outcomes of COVID-19-infected patients is essential for developing targeted intervention strategies and preparing for the resurgence of anticipated second and third waves of this pandemic., (© 2021. The Author(s).)

Background: In Oman, the first liver transplant was performed at the Royal Hospital (RH) in September 2017. Since then, thirteen cases have been operated on at the RH. All of these cases were living-donor liver transplants (LDLT), and the remaining cases were treated in India with a total of approximately 193 recipients. To provide an in-depth overview of donor experiences, challenges, and perceptions, a cross-sectional study was conducted., Methods: A cross-sectional study was conducted at one tertiary hospital in 2019. The survey was designed to collect data composed of closed and open-ended questions to reveal a thorough knowledge of the topic., Results: A total of 50 of 120 donors responded to the survey with male dominance in the sample (68%) and 64% were aged 28 to 38 years. 66% of the respondents came to know about the donation through hospital staff. Interestingly, respondents ( n  = 8/12) who reported that fear of operation is the cause that prevents people from donating are among the male gender, while more men believe that the main cause is lack of knowledge. 90% of the respondents felt satisfied after donation. More men reported ambiguous feelings before donation. Moreover, married donors reported ambiguous feelings before donation ( p  = 0.008). The younger age group reported anxiety and doubt as a challenge through their donation experience., Conclusion: This study revealed that donors have a positive feeling after donating as they have saved a life, as well as being empowered by family and community. The donors encourage individuals to donate a portion of their liver. Some crucial questions arose, such as anxiety before surgery, ambiguous feelings before surgery, and fatigue after surgery. These findings underscore the importance of a holistic approach that would enable donors to be well informed prior to surgery., Competing Interests: The authors declare no conflicts of interest in publishing this article., (Copyright © 2021 Mudhar Al Adawi et al.)

Objectives: We aimed to determine epidemiological risk factors associated with acquiring severe coronavirus disease 2019 (COVID-19) in patients requiring hospitalization., Methods: A prospective cohort study was conducted using a questionnaire comprised of six closed-ended questions to identify potential risk factors for severe COVID-19. Using COVID-19 associated illnesses and complications (pneumonia, acute respiratory distress syndrome, need for mechanical ventilation, acute kidney failure, cardiac failure, and thromboembolic events), we derived an index variable to measure the severity of COVID-19 in patients., Results: We included 143 adult patients with confirmed COVID-19 of whom 62.2% (n = 89) were male and 37.8% (n = 54) were female. The average age of the cohort was 50.6±16.5 years. Our study found that being a female, working at the health care facility, being a healthcare worker, attending a mass gathering within the last 14 days, attending a gathering with 10 persons or less, and being admitted to a hospital were associated with increased risk of developing severe COVID-19. The only risk factor associated with severe COVID-19 was working at a health care facility (odds ratio = 33.42, p = 0.029)., Conclusions: Intervention directed to control risk factors associated with acquiring severe COVID-19 should be a core priority for all countries, especially among high-risk occupations and workplaces, including working at a health care facility. A risk-based approach to prioritize vaccination among these high-risk individuals should be supported to strengthen the implementation of non-pharmaceutical interventions., (The OMJ is Published Bimonthly and Copyrighted 2021 by the OMSB.)

Objectives: The World Health Organization (WHO) published a global strategic response plan in February 2020 aiming to mitigate the impact of the novel coronavirus disease 2019 (COVID-19) outbreak. It identified immediate activities required for global preparedness and response to the outbreak and set eight priority areas (pillars) essential for scaling up countries' operational readiness and response. Despite a semi-annual progress report on implementing the Global Strategic Plan in June 2020, there is limited granular information available on the extent of the national plan's content and implementation, particularly in the Member States of the Gulf Cooperation Council (GCC). Therefore, we sought to review the preparedness and responsiveness towards the COVID-19 outbreak in the GCC in the first phase of the pandemic and to document lessons learned for improving the ongoing response efforts and preparedness for future pandemics., Methods: A rapid appraisal was conducted in June 2020 according to the WHO Strategic Preparedness and Response Plan and the accompanying Operational Planning Guidelines. The survey was administered to public health professionals or/and infectious disease experts in the states. The findings were cross-triangulated with secondary data that was publicly available for each country., Results: The preparedness and response efforts of Bahrain, Saudi Arabia, and the UAE were fully compliant with all 11 (100%) pillars of the modified strategic response measures. Kuwait, Oman, and Qatar complied with eight of the pillars. The component on conducting COVID-19 related research was the lowest-performing across all the six states., Conclusions: All GCC states demonstrated an effective response to the pandemic, enhanced existing infrastructures, and accelerated reforms that would have otherwise taken longer. The lessons learned through the early phase of the pandemic continue to steer the states in realigning their strategies and resetting their goals of controlling the outbreak, particularly in the current context of vaccine introduction and increasing preparedness capacities for future pandemics., (The OMJ is Published Bimonthly and Copyrighted 2021 by the OMSB.)

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Objectives: We sought to study the impact of public health messages on social and behavioral change among recovered patients and the general population in response to coronavirus-2019 (COVID-19) in Oman., Methods: Four focus group discussions among recovered COVID-19 patients were organized and conducted via video conference to collect their insights on public health messages. Upon culmination of each discussion, we held debrief sessions with a particular focus on the responses and making notes of comments. Qualitative themes were also recorded at the end of each focus group., Results: All 40 participants were COVID-19 recovered cases. The participants' mean age was 33.4±28.5 years, and 70.0% (n = 28) were males. We observed a generally positive attitude towards public health messages. However, it was stressed that the nature of such behavioral change posed a significant risk for psychological health. Lack of social interaction, for example, led to lower motivation, a sense of losing the meaning of life, and personal distress. While all participants acknowledged and appreciated the government authorities' efforts in disseminating and educating the masses on such a large scale using different modes of message delivery, all showed a serious concern as to whether they will be able to continue coping with the ongoing situation., Conclusions: The participants' responses suggest that public health messaging brought a significant social change in Oman. However, this conclusion cannot be generalized. Further, there is a continued need for strong public health policies with a particular focus on psychological health., (The OMJ is Published Bimonthly and Copyrighted 2021 by the OMSB.)

Oman, like other countries in the world, was affected by the COVID-19 pandemic. Since the WHO's declaration of the pandemic, the Ministry of Health of Oman has initiated its preparedness and response to the pandemic, with community participation as one of the key components of the national preparedness and response plan. This paper is a descriptive study aims at describing the three community approaches that exist in Oman and reviewing their role in preparedness and response strategies to COVID-19 pandemic and discuss the lessons learned. Community participation approaches in Oman were translated into action during the pandemic through empowering community members, mobilizing resources, and strengthening the ownership among the local community to ensure effective advocacy, proper networking, and dissemination of information and, subsequently, actions at the level of the community. The first community participation approach is community organizations within the healthy cities and villages initiative, which facilitated networking and acted as a platform for community engagement, reviewing the health information and updating them accordingly to meet evloving demands. The second approach is Willayat (District) health committees, with their unique multi-sectoral structure, that enhanced collaboration at the state level with different community leaders and groups to develop pandemic action plans, which were implemented using available local resources. The third approach is community volunteers that remain the key information providers, particularly when physical access becomes limited due to physical distancing measures. Based on this review, we advocate to further strengthen these approaches and recommends that they are implemented for the protection and promotion of health and well-being, including for health emergencies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Al Siyabi, Al Mukhaini, Kanaan, Al Hatmi, Al Anqoudi, Al Kalbani, Al Bahri, Wannous and Al Awaidy.)

Objectives: Substance use disorder is a global challenge. Therefore, this study aimed to provide an updated view of socio-demographic characteristics and patterns of substance use in Oman., Methods: This retrospective descriptive study was conducted between 2004 and 2018. Data were retrieved from Oman's National Drug Addict Registry. The data collected included the socio-demographic characteristics of registered cases, the proportion of various psychoactive substances' consumption and their routes of administration, the associated sociodemographic determinants as well as comorbid conditions., Results: A total of 6,453 cases were registered during the study's timeframe. The majority of which were Omani (97.9%), male (98.7%), single (57.9%), unemployed (50.2%), had an education level below university (81.0%) and were adolescents and young adults (77.0%). Opiates were the most common substance used (66.6%) and more than half of the sample were polydrug users (51.0%). Injecting-drug users constituted 53.4% of the total registered cases. The proportion of people with hepatitis virus C, hepatits virus B and HIV among the registered cases were 46.9%, 5.1% and 3.7%, respectively., Conclusion: The findings are in favour of rapidly escalating the introduction of a substance use preventive programme at all school levels as well as making opioid substitution therapy and other harm reduction programmes available in Oman., Competing Interests: CONFLICT OF INTEREST The authors declare no conflict of interest., (© Copyright 2020, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Introduction: To identify the clinical characteristics and outcomes of hospitalized patients with COVID-19 in Oman., Methods: A case series of hospitalized COVID-19 laboratory-confirmed patients between February 24th through April 24th, 2020, from two hospitals in Oman. Analyses were performed using univariate statistics., Results: The cohort included 63 patients with an overall mean age of 48±16 years and 84% (n=53) were males. A total of 38% (n=24) of the hospitalized patients were admitted to intensive care unit (ICU). Fifty one percent (n=32) of patients had at least one co-morbidity with diabetes mellitus (DM) (32%; n=20) and hypertension (32%; n=20) as the most common co-morbidities followed by chronic heart and renal diseases (12.8%; n=8). The most common presenting symptoms at onset of illness were fever (84%; n=53), cough (75%; n=47) and shortness of breaths (59%; n=37). All except two patients (97%; n=61) were treated with either chloroquine or hydroxychloroquine, while the three most prescribed antibiotics were ceftriaxone (79%; n=50), azithromycin (71%; n=45), and the piperacillin/tazobactam combination (49%; n=31). A total of 59% (n=37), 49% (n=31) and 24% (n=15) of the patients were on lopinavir/ritonavir, interferons, or steroids, respectively. Mortality was documented in (8%; n=5) of the patients while 68% (n=43) of the study cohort recovered. Mortality was associated with those that were admitted to ICU (19% vs 0; p=0.009), mechanically ventilated (31% vs 0; p=0.001), had DM (20% vs 2.3%; p=0.032), older (62 vs 47 years; p=0.045), had high total bilirubin (43% vs 2.3%; p=0.007) and those with high C-reactive protein (186 vs 90mg/dL; p=0.009) and low corrected calcium (15% vs 0%; p=0.047)., Conclusions: ICU admission, those on mechanical ventilation, the elderly, those with high total bilirubin and low corrected calcium were associated with high mortality in hospitalized COVID-19 patients., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: We sought to identify the epidemiological characteristics of the first case series of patients with COVID-19 in Oman., Methods: We included national surveillance data of patients with laboratory-confirmed COVID-19 from 24 February to 17 April 2020. Analyses were performed using descriptive and univariate statistics., Results: Of the 1304 patients studied, the mean age was 37.0±13.0 years old, 80.3% were males, and 35.8% were Omanis. The other mostly affected nationalities were Indian (29.1%), Bangladeshi (20.0%), and Pakistani (10.7%). Out of the total, 80.1% were from the Muscat governorate. Omani patients were significantly more likely to be males than females and aged between 20 and 59 years old ( p < 0.001). On presentation, 95.9% cases were mild, 3.6% moderate, and 0.5% severe. The case fatality rate was 0.5%. All deaths were from Muscat governorate; four from Mutrah, one from A'Seeb, and one from Bawshar., Conclusions: This case series provides epidemiological characteristics as well as the early outcomes of patients with laboratory-confirmed COVID-19., (The OMJ is Published Bimonthly and Copyrighted 2020 by the OMSB.)

Introduction: Middle East respiratory syndrome coronavirus (MERS-CoV), is an emerging infectious disease of growing global importance. This review describes the latest MERS-CoV clusters and the first cases of nosocomial transmission within health care facilities in Oman. We have highlighted lessons learned and proposed steps to prevent healthcare-associated infections., Methods: A descriptive analysis of MERS-CoV cases was conducted between January 23 and February 16, 2019. The data from officials and other published sources used., Results: Thirteen laboratory-confirmed cases of MERS-CoV were reported from three simultaneous clusters from two governorates without an epidemiological link between the clusters. Two clusters were reported from North Al Batinah Governorate, with nine cases (69%) and 1 cluster from South Ash Sharqiyah Governorate with four cases (31%). In total, four deaths were reported (case fatality rate 31%). Four cases (31%) reported were household contacts from the first cluster, 3 (23%) were nosocomial transmission in health care facilities (two for first and one from the second cluster) and 7 (54%) were community-acquired cases., Conclusions: The first local clusters of MERS-CoV reported with evidence suggestive of healthcare and household-associated transmission. Early diagnosis and strict implementation of infection control measures remain fundamental in preventing and managing MERS-CoV infection., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: In 2016, the World Health Assembly adopted the hepatitis B (HB) elimination strategy that aims at ending HB by 2030. In this descriptive review we provide the progress made and challenges to achieving hepatitis B elimination by 2030 in Gulf Health Cooperated (GHC) states., Methods: Data record from relevant online databases and reliable resources were reviewed until the end of 2017. The analysis was based on the core indicators of the WHO monitoring and evaluation framework for viral hepatitis B and the targets of the global health sector strategy by 2016‒2021., Results: The states introduced HB vaccination, including birth-dose for those under 5 years old, with global coverage of more than 95%, in order to prevent mother-to-child transmission of HBV. The prevalence of HB antigens declined in children under age 5 to less than 1%. However, the rate of vaccination among the most-at-risk populations remains suboptimal. All states have implemented safe blood transfusions and injection safety policies as well as universal laboratory-based surveillance for acute HB. However, surveillance for chronic HB and sequelae as well as estimation methods of morbidity and mortality to evaluate impact are not established. Similarly, harm reduction for people who inject drugs and testing and treatment policies and protocols for people with chronic HB are suboptimal., Conclusions: Additional steps are required to strengthen immunisation among the most-at-risk populations, maintain high quality surveillance, use antiviral therapy to treat chronic HBV and stop unsafe injection practices for drug users. Establishing country-specific national hepatitis responses based on country priorities as well as the capacity of the home health sectors to address these needs are paramount. Achieving elimination targets will require a radical alteration in the current hepatitis response and this goal should be elevated to a higher priority in the public health arena., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

We sought to provide an epidemiological situation of HIV in Oman and assess the ongoing impact of the program established in 1987 using data collected from national health reports between 1984 and 2015. Since the report of the first AIDS case in Oman in 1984, the numbers have steadily increased. Eighty percent of the cases were reported between 1996 and 2015. By the end of 2015, there were 2879 people known to be living with HIV (PLHIV) giving a prevalence of < 1%. More males were affected than females ( p < 0.001); 69.7% of affected males and 73.1% of females were aged 20-49 years. The highest HIV rate was in the Musandam governorate. Most (66.8%) new HIV infections were caused via unprotected sex, 8.3% from mother-to-child, 4.3% by intravenous drug abuse, 3.2% via blood transfusion, and 17.4% by unknown causes. PLHIV on antiretroviral drug therapy (ART) increased 57.0% by the end of 2015 ( p < 0.0001). A 23.0% reduction in mortality due to HIV was noted ( p < 0.0001). Maternal-to-child transmission per 100 000 live births were 11, 9, 17, 10, 6, and 4 from 2009 to 2014, respectively. In 2015, 67.6% of PLHIV knew their HIV status, 65.0% were on ART, and 48.0% achieved virological suppression. There is an urgent need to focus on the quality and coverage of treatment, as well as care and support to HIV patients with special attention to high-risk groups.

In 2014, the World Health Assembly adopted the new End TB Strategy that targets ending tuberculosis (TB) by 2035. This article describes the progress made to eliminate TB in Oman. Data from officials and other sources provided the information to assess the situation in Oman. In the period 1981-1992, TB notifications decreased by 11% per year. Between 1992 and 2016, the rates declined more slowly at 4.6% per year, i.e. from 16 to 7.8 per 100 000. During 2010-2016, 2352 TB cases (80% males and 60% Omani nationals) were reported. Bacteriologically confirmed TB cases decreased from 47 to 38 per million population, with a cumulative decline of 19%. The success rate of TB treatment was >87%. Among the new cases, 1.2% were multidrug-resistant TB cases. TB mortality rate dropped by 39% between 1990 and 2016. TB control efforts in Oman have produced remarkable effects. However, the pre-elimination threshold set at <10 notified TB cases per million population per year is not yet in reach. There is a need for an urgent national response and careful consideration of new available interventions., Competing Interests: Conflict of interest: S.T. Al Awaidy has nothing to disclose.

Objectives: Pertussis is a highly contagious disease that causes severe and serious symptoms among infants and young children with fatalities observed in early infancy. The disease is milder among adolescents and adults. In this paper, we describe the progress made towards pertussis control in Oman and the challenges ahead to achieve control and maintain it., Methods: Pertussis data were collected between 1981 and 2015 from various sources including Annual Health Reports, annual Ministry of Health progress reports, and Community Health and Diseases Surveillance Newsletter, which provided information for the calculation of different pertussis indicators., Results: Diphtheria-tetanus-whole cell pertussis 3 (DTwP3) vaccination coverage rose from 19% in 1981 to 97% in 1992 and has been at 3 97% until 2015. The overall incidence of pertussis dropped dramatically from an average of 771 cases per 100 000 population from 1981 through 1985, to 21 cases per 100 000 population between 2011 and 2015 ( p < 0.001). Since 1987, pertussis cases were cyclical, with peaks every three to five years with three major outbreaks reported in some parts of the country. Between 2011 and 2015, 831 cases were notified of which 785 (94.4%) met the pertussis case definition. Of these 785 cases, 625 (79.7%) were in children aged < 12 months (average rate 185 per 100 000 population), and almost all were hospitalized. Of the 625, 357 (57.1%) were aged < 2 months (average incidence of 600/100 000 population), 129 (20.6%) were 2-3 months old (average incidence of 202/100 000 population), 80 (12.8%) were 4-6 months (average incidence of 119/100 000 population), and 59 (9.4%) were 6-12 months old (average incidence is 22/100 000 population). There were 160/785 (20.3%) cases reported in children 3 12 months old (average rate 4/100 000 population). Downward trend rates were reported in the 5-14 year age group and a very low disease rate was observed in the > 15 years group. Since 2007, no deaths recorded were attributed to pertussis., Conclusions: Oman has a high coverage of DTP3; however, pertussis control remains a challenge among infants < 12 months old. Therefore, tetanus, diphtheria, and acellular pertussis (Tdap) vaccination of pregnant women is likely to be the best strategy for preventing the disease in infants.

Introduction: The World Health Organization (WHO) released the Global Leprosy Strategy 2016-2020 towards a leprosy-free world. The author described the progress made towards the elimination of leprosy and suggested recommendations for the acceleration towards a Leprosy-free country according to WHO laid out criterion., Methodology: Case record review of Leprosy patients managed between the years 1992 to 2015 were registered and analyzed. Data were collected from annual reports of the Ministry of Health including demographics, classification of leprosy new cases, relapse, childhood, grades of disability (GD) and multidrug therapy (MDT) completion rates., Results: Leprosy prevalence rate declined from 1.64 to 0.09 per 10,000 population during the period 1992 and 2015 (p<0.0001). Between 2005 and 2015, 77 patients were diagnosed with Leprosy as per definition and 75/77 (98%) had smear or biopsy positive. Of these, 53 (69%) cases were among foreign-born (non-national) (p<0.003) and 19 (25%) were among women. Most of the leprosy cases were notified in Muscat governorate 29 (38%) and among patients between 25-44 years of age 41 (53%), followed by ≥45 years 29 (38%) and 6 (8%) were children age ≤ 14 years. Multi-bacillary (MB) cases reported 60 versus 17 for Pauci-bacillary (PB) (p< 0.01), while MB was highest among both nationals (83%) and foreign-born (75%). MDT completion rate was 100% and no relapse cases were notified among nationals. The rate of new patients diagnosed with leprosy related disability was 2.3 per million population, and grade 2 disability (G2D) rate among nationals was 0.9 per million population. No disability was recorded among women or children less than 14 years within the nationals group from 2013. Almost all the foreign-born patients didn't complete their treatment in Oman as they left the country shortly after diagnosis of leprosy due to a very short term contract, discretionary employment practices by the employers and prefer to go home to complete their treatment., Conclusion: Oman has met the elimination goals and made great strides towards becoming a leprosy-free country. However, challenges such as improving surveillance system efficiency and sensitivity for detecting timely leprosy cases, as well as foreign-born workers are still a major concerns.

Dengue fever has emerged as a major public health problem globally in the past three decades. A 13-year national surveillance data analysis was done to describe the epidemiology and its trend of dengue disease in Oman reported between 2001 and 2013. Laboratory-confirmed dengue virus infections reported were studied retrospectively during the study period. A total of 64 laboratory confirmed cases were reported. All the patients contracted the disease during their visit to South-East Asian countries, hence classified as imported cases. The majority of the cases were reported in the year 2012 (23.4%). The most important clinical characteristics were fever (90.6%), myalgia (35.9%) and rash/petechial rash (20.3%). Thrombocytopenia was seen in 31.2% of the study subjects. The mortality was nearly 4.6% and all other patients made a full recovery. The most effective measure for travellers is taking precautions to avoid mosquito bites., (© The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

Background: Rotavirus gastroenteritis (RGE) is the leading cause of diarrhea in young children in Oman, incurring substantial healthcare and economic burden. We propose to formally assess the potential cost effectiveness of implementing universal vaccination with a pentavalent rotavirus vaccine (RV5) on reducing the health care burden and costs associated with rotavirus gastroenteritis (RGE) in Oman, Methods: A Markov model was used to compare two birth cohorts, including children who were administered the RV5 vaccination versus those who were not, in a hypothetical group of 65,500 children followed for their first 5 years of life in Oman. The efficacy of the vaccine in reducing RGE-related hospitalizations, emergency department (ED) and office visits, and days of parental work loss for children receiving the vaccine was based on the results of the Rotavirus Efficacy and Safety Trial (REST). The outcome of interest was cost per quality-adjusted life year (QALY) gained from health care system and societal perspectives., Results: A universal RV5 vaccination program is projected to reduce, hospitalizations, ED visits, outpatient visits and parental work days lost due to rotavirus infections by 89%, 80%, 67% and 74%, respectively. In the absence of RV5 vaccination, RGE-related societal costs are projected to be 2,023,038 Omani Rial (OMR) (5,259,899 United States dollars [USD]), including 1,338,977 OMR (3,481,340 USD) in direct medical costs. However, with the introduction of RV5, direct medical costs are projected to be 216,646 OMR (563,280 USD). Costs per QALY saved would be 1,140 OMR (2,964 USD) from the health care payer perspective. An RV5 vaccination program would be considered cost saving, from the societal perspective., Conclusions: Universal RV5 vaccination in Oman is likely to significantly reduce the health care burden and costs associated with rotavirus gastroenteritis and may be cost-effective from the payer perspective and cost saving from the societal perspective.

Approximately 2-7% of the Omani population has chronic hepatitis B virus (HBV) infection. To decrease this burden, universal childhood hepatitis B vaccination was introduced in Oman in 1990. The hepatitis B vaccination strategy and reported coverage were reviewed. To assess the impact of the program on chronic HBV seroprevalence, a nationally representative seroprevalence study was conducted in Oman in 2005. Since 1991, hepatitis B vaccination in Oman has reached almost every eligible child, with reported coverage of ≥ 97% for the birth dose and ≥ 94% for three doses. Of 175 children born pre-vaccine introduction, 16 (9.1%) had evidence of HBV exposure, and 4 (2.3%) had evidence of chronic infection. Of 1,890 children born after vaccine introduction, 43 (2.3%) had evidence of HBV exposure, and 10 (0.5%) had evidence of chronic infection. Oman has a strong infant hepatitis B vaccination program, resulting in a dramatic decrease in chronic HBV seroprevalence.

The objective of this study was to describe the epidemiology of invasive pneumococcal disease (IPD) in Omani children. We retrospectively reviewed cases admitted in children <5 years of age who were admitted in one of 4 tertiary care facilities within the Muscat Governorate. These cases represented nearly 95% of all IPD admissions recorded throughout the country from 1 January 2006 to 31 December 2006. Cases of IPD were identified using the ICD-10 discharge code. Case definition required microbiological confirmation (i.e., isolation of Streptococcus pneumoniae from blood, cerebrospinal fluid or any other normally sterile biological fluid) or clinical diagnosis in the absence of a specimen. A total of 41 cases of IPD were identified. The annual incidence of IPD was 26.1 per 100,000 in children <2 years old and 18.6 per 100,000 in children <5 years old. Among the reported IPD cases, 22 (54%) isolates were resistant to at least one antibiotic and 15 (37%) of patients had a known comorbid medical condition. These results demonstrate that the incidence of IPD in Oman during 2006 was high compared to many of the neighboring countries and provides baseline data on the incidence of IPD in an era before the introduction of the pneumococcal conjugate vaccine (PCV). In light of evidence for a significant incidence of IPD, we recommended that a nationwide surveillance system be put in place to monitor the incidence of IPD in children <5 years of age in Oman and to document the impact of PCV., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

The endemicity status of lymphatic filariasis in Oman is uncertain, with only sporadic cases reported, mostly imported. Immunochromatographic card test surveys were carried out to assess the presence of circulating Wuchereria bancrofti antigenaemia as a marker for active infection in children from suspected high-risk areas of Oman (South Batinah and Dhofar). Lot quality assurance sampling surveys were carried out on a minimum of 250 secondary-school children aged 17-18 years in each of 8 districts from February 2004 to March 2004. All tested students were negative for circulating W. bancrofti antigen. Based on these findings as well as previous data, Oman may possibly be classified as a nonendemic country, with no evidence of indigenous lymphatic filariasis transmission.

In the past decade, the Sultanate of Oman has experienced three outbreaks of paralytic poliomyelitis--a widespread polio type 1 epidemic in 1988/1989, four cases of polio type 3 in three different regions in 1991, and a localized type 1 outbreak in 1993. The lessons learnt from each of these epidemics have guided us to modify and improve our polio eradication activities. Currently, these activities include administration of five primary and three booster doses of trivalent oral polio vaccine, yearly national immunization campaigns (NIDs) since 1995 with coverage of >90%, localized immunization campaigns, acute flaccid paralysis (AFP) surveillance which involves reporting of all cases by facsimile to the Department of Surveillance within 24 h of detecting a case and weekly zero reporting from 22 sentinel sites, and virological testing of stool specimens of all AFP cases and their close contacts at the national, World Health Organization accredited laboratory. The cumulative success of these activities has resulted in Oman being free from polio for the past 6 years. However, the possibility of importation of wild poliovirus, particularly from southern and western Asia still exists.

Since 1988, the Sultanate of Oman has experienced three outbreaks of paralytic poliomyelitis. The last outbreak occurred in December 1993 and involved two children aged 10 months and 4 1/2 years. The children had received five and four doses, respectively, of trivalent oral polio vaccine (OPV) and lived in the same village. Serum neutralizing antibody tests suggested that paralytic polio in these children was due to poor antibody response to OPV. Wild poliovirus type 1 was isolated from both patients, as well as from seven of ten close contacts of the older child, and one of eight contacts of the younger child. All contacts had received three to six doses of OPV. Genomic sequence studies indicated that the virus isolates belonged to a genotypic group prevalent in southern and western Asia, but differed markedly from virus isolated during the 1988/89 outbreak, suggesting another importation of poliovirus. In response to the outbreak, supplementary immunization with OPV was given to children <6 years of age, initially in the affected district, and subsequently to children in the whole country. This study demonstrates that immunization with three to six doses of OPV did not prevent infection with wild poliovirus. In those children with sub-optimal response to OPV, infection resulted in paralytic poliomyelitis. The outbreak remained localized in one village, indicating that the outbreak control measures were effective.