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Introduction For Oman, a country targeting tuberculosis (TB) elimination, TB among expatriates is a major challenge. Thus, screening for active TB using chest X-ray was made mandatory for expatriates’ residency renewals. Objective To estimate the incidence of bacteriologically confirmed TB and assess impact of chest X-ray based TB screening among expatriates in Muscat Governorate. Methods Applicants for residency and renewals were mandated for chest X-ray-based TB screening in 2018. We collected data of screened subjects with radiological suspicion of TB who were subjected to further bacteriological evaluation. Results Of 501,290 applicants screened during the study period, 436 (0.09%) had X-ray findings suggestive of TB. Among the 436, TB was confirmed in 53 (12.2%; 95% CI 9.2–15.6), giving an overall prevalence of 10.6 (95% CI 8–13.9) per 100,000 applicants (number needed to be screened 9458). Among renewals, the point prevalence of TB was 10.5 per 100,000 expatriates screened (95% CI 6.9–14.04 per 100,000), with a mean follow-up period of 11.8 years. Conclusion Our findings are consistent with the recommendation for utilization of chest X-ray as a preferred tool for active case finding in the setting of expatriate screening. Our findings are also suggestive of the need for latent TB screening and ruling out TB prior to latent TB treatment.

Dengue is currently the most common mosquito-borne disease globally. In Oman, all reported dengue cases were travel-related until 2018 dengue outbreak in Seeb district. The aim of the study was to assess students’ level of knowledge about dengue fever, its symptoms, mode of transmission and prevention, attitudes and practices regarding DF in Seeb district in Muscat Governorate in Oman. Materials and Methods: A cross-sectional study was conducted among students of 13 governmental schools in Seeb district. Multistage stratified random sample method was used and1209 students participated in this study using a pre-structured and self-administered questionnaire. Results: We found that 92% of students have heard about the Aedes aegypti mosquito & 85% reported it as serious disease. 56.9% reported they don’t feel at risk of Dengue fever. The most common source of information was social media, Friends & relatives and TV. Almost half of students answered incorrectly for the mosquitoes’ bite time and most respondents were not able to correctly identify typical symptoms of DF apart from fever. 52% agreed it is important health problem in Muscat and can contribute to the fight of the Aedes aegypti mosquito. Majority of students stated good attitude in terms of importance of preventive and protective measure except for using mosquito repellent. Conclusion: Massive educational campaign targeting school students in addition to incorporating dengue preventive measures into school curriculum should be planned by the concerned stakeholders to enhance level of knowledge, attitude and practice regarding dengue as well as other vector borne diseases in Oman.

Introduction: The pandemic of coronavirus has no parallel in recent history. Human Life has completely transformed. There are no approved standard therapies. Patients with comorbidities, old age, immunocompromised, and cancer are at higher risk of complicated course and higher mortality. Patients and Methods: This study is an analysis of Cancer patients who got COVID-19 infection to assess the rate, demographics, laboratory data, and mortality. The data was compared, with normal non-cancer COVID-19 infected patients. Results: The overall number of COVID-19 positive cancer patients was low (0.47%) compared to normal population (2.17%). The mortality in COVID-19 Positive cancer patients was 35.1% vs 1.03%. Diabetic, hypertensive and cardiac patients are more likely to get COVID-19. Among Normal subjects, ratio of expatriate patients was higher. Septicemia was more frequent in cancer patients. Non-cancerous patients were more commonly ventilated. Leucocytosis, renal impairment, Hypocalcemia, high Troponin, high D-dimer, and high transaminases were seen more in non-cancerous patients. A high Lactate dehydrogenase was more common in cancer patients. The mortality from COVID-19 was higher in cancer patients 25% vs 15.7%. Around 72.8% cancer patients received active treatment with in past 4 weeks before COVID-19 infection. Discussion and Conclusions: There are very few reports of COVID-19 infection in cancer patients. The number of patients is small with limited information and capacity of the healthcare system. Oncologists should consider to tailor cancer clinical management. The cancer patients must practice social distancing, and seek early evaluation for symptoms suspicious for COVID-19, testing for virus and chest radiography. Contintuous...

BACKGROUND: Identifying the immune cells involved in coronavirus disease 2019 (COVID-19) disease progression and the predictors of poor outcomes is important to manage patients adequately. METHODS: This prospective observational cohort study enrolled 48 patients with COVID-19 hospitalized in a tertiary hospital in Oman and 53 non-hospitalized patients with confirmed mild COVID-19. RESULTS: Hospitalized patients were older (58 years vs 36 years, P < 0.001) and had more comorbid conditions such as diabetes (65% vs 21% P < 0.001). Hospitalized patients had significantly higher inflammatory markers (P < 0.001): C-reactive protein (114 vs 4 mg/l), interleukin 6 (IL-6) (33 vs 3.71 pg/ml), lactate dehydrogenase (417 vs 214 U/l), ferritin (760 vs 196 ng/ml), fibrinogen (6 vs 3 g/l), D-dimer (1.0 vs 0.3 µg/ml), disseminated intravascular coagulopathy score (2 vs 0), and neutrophil/lymphocyte ratio (4 vs 1.1) (P < 0.001). On multivariate regression analysis, statistically significant independent early predictors of intensive care unit admission or death were higher levels of IL-6 (odds ratio 1.03, P = 0.03), frequency of large inflammatory monocytes (CD14+CD16+) (odds ratio 1.117, P = 0.010), and frequency of circulating naive CD4+ T cells (CD27+CD28+CD45RA+CCR7+) (odds ratio 0.476, P = 0.03). CONCLUSION: IL-6, the frequency of large inflammatory monocytes, and the frequency of circulating naive CD4 T cells can be used as independent immunological predictors of poor outcomes in COVID-19 patients to prioritize critical care and resources.

Introduction: The coronavirus disease 2019 epidemic emerged in December 2019 and spread worldwide. Since workplaces are high-risk location for occupational exposure, understanding of the dynamics of COVID-19 clusters in occupational settings helps reduce the transmission of infectious disease in workplaces. This study presents an overview of the epidemiological characteristics of COVID-19 workplace clusters, preventive strategies adopted and outbreak responses undertaken in Muscat governorate. Materials and Methods: This is a descriptive study on the epidemiological characteristics of cases and distribution of workplace-related clusters of COVID-19 in Muscat Governorate in Oman. Results: A total of 36,798 COVID-19 cases were confirmed in Muscat from 24th February to 31st July 2020 in which 40.5% was belonging to clusters. Out of them 61% were Workplace-Dormitory clusters, predominantly expatriates. 78.6% of employees were symptomatic at time of examination. Fever and cough were the two most common symptoms reported in workplace related clusters. The number of affected employees ranged from 2 to 358 per cluster. Construction, retail, food, beverages, services, industrial manufacturing, oil & gas and transportation were identified as most at risk settings. Within the cases in workplace-related clusters, there was significant higher prevalence of diabetes, hypertension and obesity among females compared to males as also Omani nationals compared to expatriates and smoking among expatriate males compared to Omani males. In conclusion, understanding the epidemiological characteristics of the affected cases in organization setting will assist the policymakers to understand patterns of epidemiological spread and plan for robust interventions.

Introduction: The coronavirus disease 2019 (COVID-19) was declared as pandemic by WHO by March 11th. First case reported in Oman was on 24th February 2020 and later the country went through stages of epidemic progression. This study describes the sociodemographic and epidemiological characteristics of confirmed COVID-19 cases in Muscat governorate and related outcomes. Materials and Methods: This is a descriptive, exploratory analysis of all lab confirmed COVID 19 cases that were reported from 1st February to 31st May 2020. Data for the study was primarily extracted from notifications system established for surveillance (Tarassud). Secondary data sources were, contact listings and hospital medical records. Results: 11,648 initial cases of confirmed COVID-19 infections were included. The mean age was 35 years, 84.7% (N = 9862) were males, 25.9% (N = 3017) were Omanis, and 74.1% (N = 8631) were expatriates of which Indian origin were the majority (37%). Fever and cough were the most common presentations (46.3% and 29.5% respectively). Diabetes and hypertension were the most common comorbidities (4.9% and 4.6% respectively). Hospital admission was required for 7% (N = 811) of the total reported cases, out of them 171 cases (21%) were admitted to ICU, where 107 (13.2%) were ventilated. The case fatality rate (CFR) was 0.9%. 158 clusters containing 2949 contacts were identified from case records and categorised into 3 groups based on their exposure settings. The incubation period measured was 8 days (IQR 4.0 - 15.0) for workplace, 8 days (IQR 4 - 17) for dormitory and 4 days (IQR 2.0 - 7.0) for family groups. The secondary attack rate (SAR) estimated was 41.6% (95% CI: 0.34 - 0.48), 52% (95% CI: 0.40 - 0.63) and 33% (95% CI: 0.27 - 0.38) for workplace, dormitory and family groups, respectively. Conclusion: Results of this study, determine the transmission trend of COVID-19 in a country with high immigrant population. These findings could be utilised for further response planning in similar settings.

Background: As coronavirus disease (COVID-19) was pervading different parts of the world, little has been published regarding responses undertaken within primary health care facilities in the Arabian Gulf countries. This paper describes such responses from January to mid-April 2020 in primary health care including public health measures in Muscat governorate. Methods: This is a descriptive study showing the trends of the confirmed positive cases of COVID-19 and the undertaken responses to the evolving epidemiological scenario. These responses were described utilising the World Health Organisations’ building blocks for health care system: Leadership and governance, Health workforce, Service delivery, Medical products and technologies, and health information management. Results: In mid-April 2020, cases of COVID-19 increased to 685 (particularly amongst the non-nationals). As the cases were surging up, the primary health care responded by executing all guidelines and policies from the national medical and public health response committees and integrating innovative approaches. These included adapting comprehensive and multi-sectoral strategies, partnering with private establishments, and strengthening the use of technology (in tracking, testing, managing the cases and data management). Conclusions: Facilities in Muscat governorate, with the support from the national teams, seemed to continuously scale-up their preparedness and responses to meet the epidemiological expectations in the management of COVID-19.

Background: In December 2018, routine surveillance identified an autochthonous outbreak of dengue fever in Muscat Governorate, Oman, a region previously free of dengue fever. Methods: Routine surveillance confirmed locally acquired cases in the second week of December, leading to a rapid public health response including case management guidance and epidemiological investigations. The main activity was the vector survey using systematic sampling to assess extent of previously unreported Aedes aegypti presence followed by a campaign aimed to eliminate breeding sites of A. aegypti”. Results: During a 5-month period, 343 suspected cases were reported from Muscat Governorate with 122 from the outbreak affected area. Out of 207 probable cases eligible for laboratory testing as per guidelines issued, 59 cases were confirmed. The vector elimination campaign started on January 8, 2019 after a media advocacy using television and social media and concluded on January 23. By the end of campaign, the case load had decreased significantly in the affected area with no reports of locally acquired cases from adjoining areas of Muscat Governorate, indicating no further spread. Conclusions: Rapid notification and early community-wide, extensive vector control activities effectively contained the autochthonous dengue fever virus outbreak. Keywords: Dengue fever, Autochthonous outbreak, Oman, Aedes aegypti, Vector-borne illness, Disease surveillance

Introduction Predominantly, studies on COVID-19 report quantitative data that often miss the social implications and other determinants of health. The objective of this study was to explore the experiences and perceptions of health care workers (HCWs) in primary health care in the management of COVID-19 with respect to medical response experiences, socio-cultural and religious reforms, psychological impressions, and lessons learned. Methods This was a qualitative study using an empirical phenomenological approach. Six focus group discussions were conducted across various stakeholders working frontline in the management of COVID-19 (managerial, public health/field/community and primary care health centers). They participated in semi-structured, in-depth group discussions from 11th to 20th May 2020. All discussions were audio-recorded, transcribed verbatim and analyzed using thematic analysis. Results Forty participants were involved in this study. Three themes emerged related to the medical response experiences, including the rapid re-structuring of the PHC services, use of technology and challenges of working on COVID-19. Perceptions on the socio-cultural and religious reforms included changes in social and religious norms, and anticipated gaps in accessing health care among the vulnerable groups (elderly, expatriates, and individuals with low economic status). Perceptions on psychological disturbances were themed as consequences of social distancing, management of dead bodies, exhaustion among the health care workers, and risk of exposure. Finally, lessons learned were centered around building on the existing epidemiological and public health capacities, improving access to health care and overcoming resistance to change. Most participants labelled their experience in COVID-19 as an “experience of wisdom” in which learning was a continuous process. Conclusion This qualitative study amongst primary HCWs revealed certain aspects of response to COVID-19 in Muscat, Oman. Results has unfolded various aspects of COVID-19. The situation was perceived by primary HCWs as a new experience that challenged the primary health care; enforced the utilization of public health/epidemiological skills, and linked to unfavorable socio-religious and psychological events.