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Infection is one of the leading causes of death in the world especially in low and lower-middle income countries. Objective: To determine the frequency of nosocomial infection in the Intensive Care Unit of a tertiary care teaching hospital, Lahore, Pakistan. Methods: Patients (n=270) were included in a study that was conducted in ICU of a tertiary care public sector, Jinnah Hospital, Lahore for a period of 18 months. Patients were divided into two groups (pre and post educational intervention). During this period, information about patient’s nosocomial infection rate, its distribution and patient’s excess length of stay in hospital collected. Data were analyzed using SPSS version 26.0. Chi-square Test was applied to find out the significance of nosocomial infection keeping P-value of ≤ 0.05 as significant. Results: Total of 115 (42.6%) were males and 155 (57.4%) were females. Results showed 42 (15.9%) out of 270 participants suffered in Nosocomial Infection/Hospital Acquired Infection during treatment and stay in ICU. Conclusion: It was concluded that educational intervention played a significant role in controlling the nosocomial infection among patients admitted in the ICU.

Background: The WHO Regional Office for the Eastern Mediterranean and the United Nations System Staff College (UNSSC) launched the Leadership Programme on Epidemic and Pandemic Preparedness and Response during the second half of 2021. Aims: To reflect on the leadership roles and actions played by the WHO Jordan Country Office from the onset of the COVID-19 pandemic to date via the unique lens provided by the WHO EMRO/UNSSC course. Methods: The role of the Jordan WCO was reflected on through the unique lens provided by the WHO EMRO/UNSSC course, whose first cohort included COVID-19 pandemic responders in the Eastern Mediterranean countries. Results: The Jordan Country Office was successful in leveraging several aspects included in the Leadership Programme, such as leadership in times of crisis, strategic thinking and planning, emotional resilience, preparedness, adopting a system approach and multisectoral partnership-building. This was particularly evident through the generation of evidence for policy-making and promotion of equitable access to health. Conclusion: The experience of WHO country offices during COVID-19 can be examined through the lens of the EMRO/UNSSC course, which can further advance the search for better leadership in collaboration with national counterparts and partners.

BACKGROUND Outbreaks of circulating vaccine-derived polioviruses (cVDPVs) pose a threat to the eventual eradication of all polioviruses. In 2017, an outbreak of cVDPV type 2 (cVDPV2) occurred in the midst of a war in Syria. We describe vaccination-based risk factors for and the successful response to the outbreak. METHODS We performed a descriptive analysis of cVDPV2 cases and key indicators of poliovirus surveillance and vaccination activities during 2016-2018. In the absence of reliable subnational coverage data, we used the caregiver-reported vaccination status of children with non-polio acute flaccid paralysis (AFP) as a proxy for vaccination coverage. We then estimated the relative odds of being unvaccinated against polio, comparing children in areas affected by the outbreak to children in other parts of Syria in order to establish the presence of poliovirus immunity gaps in outbreak affected areas. FINDINGS A total of 74 cVDPV2 cases were reported, with paralysis onset ranging from 3 March to 21 September 2017. All but three cases were reported from Deir-ez-Zor governorate and 84% had received

Background Countries are transitioning assets and functions from polio eradication to integrated immunization and surveillance activities. We assessed the extent of linkages between and perceptions of National Immunization Technical Advisory Groups (NITAGs) and National Certification Committees (NCCs) for polio eradication to understand how linkages can be leveraged to improve efficiencies of these expert bodies. Methods During May 2017 to May 2018, we administered a 15-question survey to a NITAG chair or member and an NCC counterpart in all countries of the WHO Regions for Africa (AFR) and for the Eastern Mediterranean (EMR) that had both a NITAG and an NCC. Data were analysed using frequency distributions. Results Of countries with both a NITAG and an NCC (n = 44), the response rate was 92% (22/24) in AFR and 75% (15/20) in EMR. Some respondents reported being very familiar with the functions of the other technical bodies, 36% (8/22) for NITAG members and 38% (14/37) for NCC members. Over 85% (51/59) of respondents felt it was somewhat useful or very useful to strengthen ties between bodies. Nearly all respondents (98%, 58/59) felt that NCC expertise could inform measles and rubella elimination programmes. Conclusions We observed a broad consensus that human resource assets of NCCs may serve an important technical role to support national immunization policy-making. At this stage of the polio eradication initiative, countries should consider how to integrate the technical expertise of NCC members to reinforce NITAGs and maintain the polio essential functions, beginning in countries that have been polio-free for several years.

Since 2007, national public health laboratories in the WHO Eastern Mediterranean Region (EMR) have participated in a regional external quality assessment scheme in bacteriology to improve testing proficiency.To assess laboratory performance in bacteriology in the EMR between 2011 and 2019 using the regional external quality assessment scheme.We analysed the accuracy of participant-reported data in bacterial identification, Gram stain microscopy, and antimicrobial susceptibility testing. For each category, we assessed the performance over time, the performance on multiple organisms, and whether a laboratory repeatedly failed to attain satisfactory results.Between 2011 and 2019, 70% of laboratories achieved satisfactory performance for bacterial identification and antimicrobial susceptibility testing, and 85% performed satisfactory Gram stain microscopy. Testing did not improve on multiple organisms and results were consistently low for some pathogens and test categories. Twenty-nine percent of laboratories underperformed throughout the study period.The unchanged performance over time and underperformance of laboratories highlight the need for improvements in the regional external quality assessment scheme. Participating laboratories and WHO need to work more actively to strengthen the problem areas.التقييم الخارجي لجودة أداء المختبرات المتخصصة في علم الجراثيم في إقليم شرق المتوسط، 2011–2019.همايون أصغر، كارين نهابتيان، أماني غنيم، فرانك كونينجز، أمينة الجرداني.منذ عام 2007 ، شاركت مختبرات الصحة العامة الوطنية في إقليم شرق المتوسط في مخطط إقليمي للتقييم الخارجي للجودة في علم الجراثيم لتحسين كفاءة الاختبارات.هدفت هذه الدراسة الى تقييم أداء المختبرات في مجال علم الجراثيم في إقليم شرق المتوسط بين عامَي 2011 و 2019 ، باستخدام النظام الإقليمي للتقييم الخارجي للجودة.حللنا دقة البيانات التي أبلغ بها المشاركون فيما يخص تحديد الجراثيم، والفحص المجهري لصبغة جرام، واختبار الحساسية لمضادات الميكروبات. وبالنسبة إلى كل فئة، قيمنا الأداء مع مرور الزمن، والأداء على كائنات حية متعددة، وما إذا كان المختبر قد فشل مرارًا في تحقيق نتائج مُرضية.بين عامَي 2011 و 2019 ، حقق 70 ٪ من المختبرات أداءً مُرضيًا في التعرف على الجراثيم وتحديدها واختبار الحساسية لمضادات الميكروبات، ونفذ 85 ٪ منها الفحصَ المجهري لصبغة جرام تنفيذًا مُرضيًا. ولم يتحسن مستوى الاختبار على كائنات حية متعددة، وكانت النتائج منخفضة باستمرار فيما يخص بعض مسببات الأمراض وفئات الاختبارات. وكان أداء 29 ٪ من المختبرات دون المستوى خلال فترة الدراسة.إن عدم تغيُُّّر الأداء بمرور الوقت والأداء القاصر للمختبرات يبرزان الحاجة إلى إدخال تحسينات على الخطة الإقليمية للتقييم الخارجي للجودة. لذا، يتعيََّّن على المختبرات المشارِكة و المختبرات المشاركة ومنظمة الصحة العالمية بحاجة إلى العمل بشكل أكثر نشاطا لتقوية مناطق المشاكل.Évaluation externe de la qualité des performances des laboratoires en bactériologie dans la Région de la Méditerranée orientale, 2011-2019.Depuis 2007, les laboratoires de santé publique nationaux de la Région OMS de la Méditerranée orientale ont participé à un système régional d'évaluation externe de la qualité en bactériologie afin d'améliorer la bonne exécution des analyses.Évaluer les performances des laboratoires en bactériologie dans la Région de la Méditerranée orientale entre 2011 et 2019 à l'aide du système régional d'évaluation externe de la qualité.Nous avons analysé l'exactitude des données communiquées par les participants concernant l'identification bactérienne, la microscopie après coloration de Gram et les tests de sensibilité aux antimicrobiens. Pour chaque catégorie, nous avons évalué la performance au fil du temps, la performance sur plusieurs micro-organismes et avons vérifié si un laboratoire n'a pas obtenu des résultats satisfaisants à plusieurs reprises.Entre 2011 et 2019, 70 % des laboratoires ont obtenu des résultats satisfaisants pour l'identification bactérienne et les tests de sensibilité aux antimicrobiens, et 85 % ont effectué une microscopie après coloration de Gram satisfaisante. Les tests ne se sont pas améliorés sur plusieurs micro-organismes et les résultats étaient systématiquement faibles pour certains agents pathogènes et certaines catégories de tests. Vingt-neuf pour cent des laboratoires ont eu des résultats insuffisants tout au long de la période d'étude.Les performances inchangées au cours du temps et les résultats insuffisants des laboratoires soulignent la nécessité d'améliorer le système régional d'évaluation externe de la qualité. Les laboratoires participants et l'OMS doivent collaborer plus activement pour renforcer les domaines qui posent problème.

Since 1988, when World Health Organization (WHO) Member States and partners launched the Global Polio Eradication Initiative, the number of wild poliovirus (WPV) cases has declined from 350,000 in 125 countries to 176 in only two countries in 2019 (1). The Global Commission for the Certification of Poliomyelitis Eradication (GCC) declared two of the three WPV types, type 2 (WPV2) and type 3 (WPV3), eradicated globally in 2015 and 2019, respectively (1). Wild poliovirus type 1 (WPV1) remains endemic in Afghanistan and Pakistan (1). Containment under strict biorisk management measures is vital to prevent reintroduction of eradicated polioviruses into communities from poliovirus facilities. In 2015, Member States committed to contain type 2 polioviruses (PV2) in poliovirus-essential facilities (PEFs) certified in accordance with a global standard (2). Member states agreed to report national PV2 inventories annually, destroy unneeded PV2 materials, and, if retaining PV2 materials, establish national authorities for containment (NACs) and a PEF auditing process. Since declaration of WPV3 eradication in October 2019, these activities are also required with WPV3 materials. Despite challenges faced during 2019-2020, including the coronavirus disease 2019 (COVID-19) pandemic, the global poliovirus containment program continues to work toward important milestones. To maintain progress, all WHO Member States are urged to adhere to the agreed containment resolutions, including officially establishing legally empowered NACs and submission of PEF Certificates of Participation.

Since the Global Polio Eradication Initiative (GPEI) was launched in 1988, the number of polio cases worldwide has declined approximately 99.99%; only two countries (Afghanistan and Pakistan) have never interrupted wild poliovirus (WPV) transmission (1). The primary means of detecting poliovirus circulation is through surveillance for acute flaccid paralysis (AFP) among children aged

Global poliovirus surveillance involves virus isolation from stool and environmental samples, intratypic differential (ITD) by PCR, and sequencing of the VP1 region to distinguish vaccine (Sabin), vaccine-derived, and wild-type polioviruses and to ensure an appropriate response. This cell culture algorithm takes 2 to 3 weeks on average between sample receipt and sequencing. Direct detection of viral RNA using PCR allows faster detection but has traditionally faced challenges related to poor sensitivity and difficulties in sequencing common samples containing poliovirus and enterovirus mixtures., Global poliovirus surveillance involves virus isolation from stool and environmental samples, intratypic differential (ITD) by PCR, and sequencing of the VP1 region to distinguish vaccine (Sabin), vaccine-derived, and wild-type polioviruses and to ensure an appropriate response. This cell culture algorithm takes 2 to 3 weeks on average between sample receipt and sequencing. Direct detection of viral RNA using PCR allows faster detection but has traditionally faced challenges related to poor sensitivity and difficulties in sequencing common samples containing poliovirus and enterovirus mixtures. We present a nested PCR and nanopore sequencing protocol that allows rapid (99.9%. This novel method shows promise as a faster and safer alternative to cell culture for the detection and real-time sequencing of polioviruses in stool and environmental samples.

Objective: This article summarises the progress made since the introduction of environmental surveillance in the African Region. Method: Country selection was based on the poor AFP performance indicators i.e. Non polio AFP rate and stool adequacy. It was recommended that any country not meeting the required indicators should consider environmental surveillance activity as an additional tool to support AFP surveillance. The sites selection considered proximity to the target population, the size of the population to be sampled and the sensitivity of the sampling site. Results: One hundred and fifty three sites have been established in Africa since 2011. In 2011, Nigeria was first country to introduce environmental surveillance and currently with of 59 validated sites, followed by Kenya in 2013 validating and sampling 9 sites and Angola 4 active sites in 2014. In 2014, Cameroon introduced ES and 31 sites followed by Niger with 9 sites and Madagascar with 23 sites. Later in the same year, Chad introduced ES activity and 4 active sites were selected. In 2015 Senegal introduced 3 sites, Guinea and Burkina Faso introduced 4 sites each. , and. In 2016, a total of 179 Sabins, 36 Sabin 2s, 196 non polio enteroviruses (NPEV) and 1 vaccine-derived polioviruses (VDPV) were reported in Nigeria. Cameroon and Chad isolated 14 and 4 Sabins and 72 and 40 NPEV respectively. In Madagascar a total of 39 Sabins, 11 Sabin 2s and 277 NPEV were isolated. In other countries a majority of NPEV were isolated (data not shown). Conclusion: This report describes the progress and expansion of environmental surveillance that contributed to the identification of polioviruses from the environment and the interruption of wild poliovirus transmission in the African Region.

Since the 1988 inception of the Global Polio Eradication Initiative (GPEI), progress toward interruption of wild poliovirus (WPV) transmission has occurred mostly through extensive use of oral poliovirus vaccine (OPV) in mass vaccination campaigns and through routine immunization services (1,2). However, because OPV contains live, attenuated virus, it carries the rare risk for reversion to neurovirulence. In areas with very low OPV coverage, prolonged transmission of vaccine-associated viruses can lead to the emergence of vaccine-derived polioviruses (VDPVs), which can cause outbreaks of paralytic poliomyelitis. Although WPV type 2 has not been detected since 1999, and was declared eradicated in 2015,* most VDPV outbreaks have been attributable to VDPV serotype 2 (VDPV2) (3,4). After the synchronized global switch from trivalent OPV (tOPV) (containing vaccine virus types 1, 2, and 3) to bivalent OPV (bOPV) (types 1 and 3) in April 2016 (5), GPEI regards any VDPV2 emergence as a public health emergency (6,7). During May-June 2017, VDPV2 was isolated from stool specimens from two children with acute flaccid paralysis (AFP) in Deir-ez-Zor governorate, Syria. The first isolate differed from Sabin vaccine virus by 22 nucleotides in the VP1 coding region (903 nucleotides). Genetic sequence analysis linked the two cases, confirming an outbreak of circulating VDPV2 (cVDPV2). Poliovirus surveillance activities were intensified, and three rounds of vaccination campaigns, aimed at children aged

The Global Polio Eradication Initiative (GPEI) has made substantial progress since its launch in 1988; only 37 wild poliovirus type 1 (WPV1) cases were detected in 2016, the lowest annual count ever. Wild poliovirus type 3 has not been detected since November 2012, and wild poliovirus type 2 was officially declared eradicated in September 2015. This success is attributable to the wide use of live oral poliovirus vaccines (OPVs). Since 2001, numerous outbreaks were caused by the emergence of genetically divergent vaccine-derived polioviruses (VDPVs) whose genetic drift from the parental OPV strains indicates prolonged replication or circulation (1). In 2015, circulating VDPV type 2 (cVDPV2) outbreaks were detected in five countries worldwide (Nigeria, Pakistan, Guinea, Burma, and South Sudan), and VDPV2 single events were reported in 22 countries. These events prompted the GPEI to withdraw the type 2 component (Sabin2) of trivalent OPV (tOPV) in a globally coordinated, synchronized manner in April 2016 (2,3), at which time all OPV-using countries switched to using bivalent OPV (bOPV), containing Sabin types 1 and 3. This report details for the first time the virologic tracking of elimination of a live vaccine that has been withdrawn from routine and mass immunization systems worldwide (3). To secure elimination, further monitoring is warranted to detect any use of tOPV or monovalent OPV type 2 (mOPV2).

The emergence and re-emergence of viral haemorrhagic fevers (VHFs) is a growing concern worldwide. They are associated with major epidemics with an estimated 51-101 million cases each year, of which around 67 000 are fatal. In 2007, 13 countries in the Eastern Mediterranean Region reported VHF cases.The main purpose of the study was to review the epidemiological situation in the Region vis-à-vis VHFs to obtain baseline epidemiological information for the establishment of the Emerging Dangerous Pathogen Laboratory Network (EDPLN).A literature search was performed using PubMed, ProMED-Mail and GIDEON databases. Reported data included disease burden (reported cases and deaths), human prevalence (general population, high-risk groups), vectors and reservoirs. A scoring method was employed to divide countries into 4 groups (very highly, highly, medium and low affected countries).Very highly affected countries were Afghanistan, Egypt, Islamic Republic of Iran, Saudi Arabia and Sudan. Highly affected countries were Djibouti, Morocco, Oman, Pakistan, Tunisia and Yemen. Medium affected countries were Iraq, Somalia and United Arab Emirates. Low affected countries were Bahrain, Jordan, Lebanon, Libya, Palestine, Qatar and Syrian Arab Republic.This study contributes in prioritizing countries to be part of EDPLN and in addressing specific needs related to outbreak investigations, surveillance and research.التعرُّف على مواقع الخطر للحميات النزفية الفيروسية في إقليم شرق المتوسط: وجهات نظر نحو إنشاء شبكة مختبرات لكشف مسببات الأمراض المستجدة والخطيرة.ماثياس ألتمان، كارين نهابيتيان، همايون أصغر.تثير الحُمَّيات النزفية الفيروسية المستجدَّة والمعاودة للظهور قلقًا متزايدًا في جميع أرجاء العالم. إذ تسبب أوبئة ضخمة يصل تعداد المصابين بها كل عام إلى 51-101 مليون شخص، ينتهي ما يقرب من 67 ألفًا منهم بالموت. وفي عام 2007 ، أبلغ 13 بلدًا من إقليم شرق المتوسط عن حالات مصابة بالحُمَّيات النزفية الفيروسية.تمثل الهدف الرئيسي من هذه الدراسة في مراجعة الأوضاع الوبائية في الإقليم للحُمَّيات النزفية الفيروسية للحصول على المعلومات الأساسية الوبائية لتأسيس شبكة مختبرات مسببات الأمراض المستجدة الخطيرة.أجرى الباحثون بحثًا شاملاً في قواعد البيانات PubMed و ProMED-Mail و GIDEON، وشملت البيانات التي تضمنتها التقارير عبء المرض (عدد الحالات وعدد الوفيات التي أُبْلِغ عنها) ومعدل الانتشار بين البشر (في مجمل السكان وفي المجموعات المعرضة لمخاطر عالية)، ونواقل الأمراض ومستودعاتها. واستخدم الباحثون طريقة لتعيين الدرجات، لتقسيم البلدان إلى 4 مجموعات (بلدان مرتفعة التضرر جدًا، وبلدان مرتفعة التضرر، وبلدان متوسطة التضرر، وبلدان خفيفة التضرر).كانت البلدان المرتفعة التضرر جدًا هي: أفغانستان ومصر وجمهورية إيران الإسلامية والمملكة العربية السعودية والسودان. وكانت البلدان المرتفعة التضرر هي: جيبوتي والمغرب وعُمَن وباكستان وتونس واليمن. وكانت البلدان المتوسطة التضرر هي: العراق والصومال والإمارات العربية المتحدة. وكانت البلدان الخفيفة التضرر هي: البحرين والأردن ولبنان وليبيا وفلسطين وقطر والجمهورية العربية السورية.تساهم هذه الدراسة في وضع البلدان وفق أولويتها لتكون جزءًا من شبكة مختبرات مسببات الأمراض المستجدة الخطيرة، وفي معالجة الاحتياجات المحددة ذات الصلة بعمليات استقصاء الأوبئة، وترصدها، وبحثها.Identification des foyers de transmission de fièvres hémorragiques virales dans la Région de la Méditerranée orientale : perspectives pour le Réseau des laboratoires travaillant sur les agents pathogènes émergents et dangereux (EDPLN).L’émergence et la réémergence des fièvres hémorragiques virales (FHV) est une préoccupation mondiale croissante. Ces fièvres sont associées à la survenue d’épidémies majeures. On estime qu’entre 51 et 101 millions de cas surviennent chaque année, dont environ 67 000 sont mortels. En 2007, 13 pays de la Région de la Méditerranée orientale ont rapporté des cas de FHV.Le principal objectif de la présente étude était d’examiner la situation épidémiologique dans la Région eu égard aux FHV afin d’obtenir des informations épidémiologiques de base pour la mise en place du Réseau des laboratoires travaillant sur les agents pathogènes émergents et dangereux (EDPLN).Une recherche documentaire a été réalisée sur les bases de données PubMed, ProMED-Mail et GIDEON. Les données fournies incluaient la charge de morbidité (cas et décès signalés), la prévalence humaine (population générale, groupes à haut risque), les vecteurs et les réservoirs. Une méthode de notation a été utilisée pour diviser les pays en quatre groupes (pays très gravement touchés, gravement touchés, moyennement touchés et faiblement touchés).Les pays très gravement touchés étaient l’Afghanistan, l’Arabie saoudite, l’Égypte, la République islamique d’Iran et le Soudan. Les pays gravement touchés étaient Djibouti, le Maroc, Oman, le Pakistan, la Tunisie et le Yémen. Les pays moyennement touchés étaient les Émirats arabes unis, l’Iraq et la Somalie. Les pays faiblement touchés étaient Bahreïn, la Jordanie, le Liban, la Libye, la Palestine, le Qatar et la République arabe syrienne.La présente étude aide à classer par ordre de priorité les pays destinés à faire partie de l’EDPLN et à répondre à des besoins spécifiques en lien avec les investigations des flambées, la surveillance et la recherche.

Laboratories need leaders who can effectively utilize the laboratories' resources, maximize the laboratories'capacity to detect disease, and advocate for laboratories in a fluctuating health care environment. To address this need, the University of Washington, USA, created the Certificate Program in Laboratory Leadership and Management in partnership with WHO Regional Office for the Eastern Mediterranean, and implemented it with 17 participants and 11 mentors from clinical and public health laboratories in 10 countries (Egypt, Iraq, Jordan, Lebanon, Morocco, Oman, Pakistan, Qatar, Saudi Arabia, and Yemen) in 2014. Designed to teach leadership and management skills to laboratory supervisors, the programme enabled participants to improve laboratory testing quality and operations. The programme was successful overall, with 80% of participants completing it and making impactful changes in their laboratories. This success is encouraging and could serve as a model to further strengthen laboratory capacity in the Region.تنفيذ برنامج للتطوير المهني بالتوجيه في مجال قيادة وإدارة المختبرات في الشرق الأوسط وأفريقيا.لوسي برون، ديبورا كونفر، إليزابيث سكوت، لورا ليفينغستون، كاتلن برادبورن، أليكس ماك غي، توم فورتوانغلر، آن داونر، علي مُقداد، جين فريدريك فلاندين، سالماز شوتورباني، هومايون أصغر، ه. ي. طلبة، ه. جي. أحمد، علاء العلوان، روبرت مارتين.تحتاج المخترات لقادة يمكنهم الانتفاع مما فيها من موارد بفعالية، وتعظيم قدراتها لأقى قدر يتيح كشف الأمراض، ويدافعون عنها في بيئة متقلبة للرعاية الصحية. ولتلبية هذه الحاجة، أنشأت جامعة واشنطن في الولايات المتحدة الأمريكية برنامجاً لنيل شهادة القيادة والإدارة للمخترات بالشراكة مع المكتب الإقليمي لرق المتوسط لمنظمة الصحة العالمية، وفي عام 2014 تم تنفيذ البرنامج الذي ضم 17 مشاركاً و 11 موجِّهاً ينتمون إلى المخترات السريرية ومخترات الصحة العامة في 10 بلدان (مر والعراق والأردن ولبنان والمغرب وعُان وباكستان وقطر والمملكة العربية السعودية واليمن). وانطلاقاً من كون البرنامج قد تم تصميمه لتعليم المشرفن عى المخترات مهارات القيادة والإدارة، فقد وفّر البرنامج للمشاركين فيه إمكانية تحسن جودة الاختبارات والعمليات. ولقد كان البرنامج ناجحاً عى وجه الإجمال، فقد أكمل % 80 من المشاركين مشاركتهم به، وأحدثوا تغيرات ذات مردود ملحوظ في المخترات التي يعملون فيها. ويبدو نجاح البرنامج مشجعاً ويمكن أن يكون نموذجاً لتطوير المزيد من القدرات في المخترات في الإقليم.Mise en oeuvre d’un programme de mentorat en développement professionnel pour les directeurs et les cadres de laboratoire au Moyen-Orient et en Afrique du Nord.Les laboratoires ont besoin de directeurs à même d’utiliser les ressources internes de façon efficace, de maximiser leurs capacités à dépister les maladies, et d’oeuvrer pour le bien de ces établissements dans un environment de soins de santé en perpétuel changement. Pour répondre à ces besoins, l’Université de Washington (États-Unis), en partenariat avec le Bureau régional de l’OMS pour la Méditerranée orientale, a mis au point le Programme de certification en direction et gestion de laboratoire qui a été suivi par 17 participants et 11 mentors issus de laboratoires de santé clinique et publique dans 10 pays (Arabie saoudite, Égypte, Iraq, Jordanie, Liban, Maroc, Oman, Pakistan, Qatar et Yémen) au cours de l’année 2014. Conçu pour former les responsables de laboratoire aux compétences de direction et de gestion, le programme a permis aux participants de renforcer la qualité du dépistage et des opérations de leurs laboratoires. Le programme a été une réussite dans l’ensemble puisqu’il a été suivi jusqu’à son terme par 80 % des participants et que ceux-ci ont ensuite pu mettre en place des changements réels dans leurs laboratoires. Ce succès est encourageant et pourrait servir de modèle afin de renforcer davantage encore les capacités des laboratoires dans la Région.

Background Enteroviruses are common human pathogens occasionally associated with severe disease, notoriously paralytic poliomyelitis caused by poliovirus. Other enterovirus serotypes such as enterovirus A71 and D68 have been linked to severe neurological syndromes. New enterovirus serotypes continue to emerge, some believed to be derived from nonhuman primates. However, little is known about the circulation patterns of many enterovirus serotypes and, in particular, the detailed enterovirus composition of sewage samples. Methods We used a next-generation sequencing approach analyzing reverse transcriptase polymerase chain reaction products synthesized directly from sewage concentrates. Results We determined whole-capsid genome sequences of multiple enterovirus strains from all 4 A to D species present in environmental samples from the United Kingdom, Senegal, and Pakistan. Conclusions Our results indicate complex enterovirus circulation patterns in human populations with differences in serotype composition between samples and evidence of sustained and widespread circulation of many enterovirus serotypes. Our analyses revealed known and divergent enterovirus strains, some of public health relevance and genetically linked to clinical isolates. Enteroviruses identified in sewage included vaccine-derived poliovirus and enterovirus D-68 stains, new enterovirus A71 and coxsackievirus A16 genogroups indigenous to Pakistan, and many strains from rarely reported serotypes. We show how this approach can be used for the early detection of emerging pathogens and to improve our understanding of enterovirus circulation in humans.

This article summarizes the status of environmental surveillance (ES) used by the Global Polio Eradication Initiative, provides the rationale for ES, gives examples of ES methods and findings, and summarizes how these data are used to achieve poliovirus eradication. ES complements clinical acute flaccid paralysis (AFP) surveillance for possible polio cases. ES detects poliovirus circulation in environmental sewage and is used to monitor transmission in communities. If detected, the genetic sequences of polioviruses isolated from ES are compared with those of isolates from clinical cases to evaluate the relationships among viruses. To evaluate poliovirus transmission, ES programs must be developed in a manner that is sensitive, with sufficiently frequent sampling, appropriate isolation methods, and specifically targeted sampling sites in locations at highest risk for poliovirus transmission. After poliovirus ceased to be detected in human cases, ES documented the absence of endemic WPV transmission and detected imported WPV. ES provides valuable information, particularly in high-density populations where AFP surveillance is of poor quality, persistent virus circulation is suspected, or frequent virus reintroduction is perceived. Given the benefits of ES, GPEI plans to continue and expand ES as part of its strategic plan and as a supplement to AFP surveillance.

The World Health Organization (WHO) formulates recommendations for viruses to be included in vaccines for the influenza seasons in the northern and southern hemispheres on the basis of analyses by its collaborating centres (CCs). This report describes the contribution of influenza laboratories and national influenza centres in countries in the WHO Region for the Eastern Mediterranean to the selection process of seasonal and pre-pandemic influenza virus subtypes. Data submitted by 22 countries to FluNet and FluID between September 2010 and June 2015 were analysed. National Influenza Centres (NICs) in 12 countries (55%) reported data, 5 (23%) to both FluNet and FluID and 7 (32%) only to FluNet. The WHO CC in London characterized 78% of the samples, and the CC in Atlanta, characterized 21%. The contribution of influenza laboratories and NICs from this Region to global influenza surveillance is appreciable. However, enhancing the contribution through initiatives such as the Pandemic Influenza Preparedness Framework is still needed.مساهمة المخترات الموجودة في إقليم شرق المتوسط لمنظمة الصحة العالمية في عملية اختيار اللقاح المرشَّح للإنفلونزا الموسمية في الأعوام 2010-2015.هومايون أصغر، هيلينا براون، جون ماكولي، مامونور مالك، واثق خان.تقوم منظمة الصحة العالمية بصياغة توصيات بشأن الفيروسات التي يتعن تضمينها في اللقاحات الخاصة بمواسم الإنفلونزا في نصفي الكرة الشالي والجنوبي استناداً إلى تحليات تقدمها المراكز المتعاونة معها. ويصف هذا التقرير مساهمة مخترات الإنفلونزا والمراكز الوطنية للإنفلونزا في بلدان إقليم شرق المتوسط في عملية انتقاء الأنواع الفرعية لفيروسات الإنفلونزا الموسمية وفي الفرات السابقة للأوبئة. وقد تم تحليل البيانات التي قدمتها 22 دولة إلى شبكات FluNet و FluID بن سبتمبر/أيلول 2010 ويونيو/حزيران 2015. وقد قدمت المراكز الوطنية للإنفلونزا في 12 بلداً (% 55 ) بيانات، 5(%23) منها لكل من FluNet و FluID، و 7(%32) منها ل FluNet فقط. ولقد حدد المركز المتعاون مع منظمة الصحة العالمية في لندن خصائص % 87 من العينات، كا حدد المركز المتعاون مع المنظمة في أتلانتا خصائص %21 منها. إن مساهمة مخترات الإنفلونزا والمراكز الوطنية للإنفلونزا الموجودة في هذا الإقليم في ترصُّد الإنفلونزا العالمية هي مساهمة جديرة بالتقدير. ومع ذلك، لا بد من تعزيز هذه المساهمة من خال استغلال الفرص؛ من قبيل إطار "التأهُّب لمواجهة الإنفلونزا الوبائية".Contribution des laboratoires de la Région OMS de la Méditerranée orientale au processus de sélection du candidat vaccin contre la grippe saisonnière, 2010-2015.L’Organisation mondiale de la Santé (OMS) émet des recommandations quant aux virus à inclure dans les vaccins contre les grippes saisonnières des hémisphères nord et sud, en fonction des analyses réalisées par ses centres collaborateurs. Le présent article décrit la contribution des laboratoires de la grippe et des centres nationaux de la grippe (CNG) des pays de la Région OMS de la Méditerranée orientale au processus de sélection des sous-types du virus de la grippe saisonnière et pré-pandémique. Les données transmises par 22 pays à FluNet et à FluID entre septembre 2010 et juin 2015 ont été analysées. Les CNG de 12 pays (55 %) ont transmis leurs données, dont 5 (23 %) à la fois à FluNet et à FluID, et 7 (32 %) à FluNet uniquement. Les centres collaborateurs de l’OMS de Londres et d’Atlanta ont caractérisé 78 % et 21 % des échantillons respectivement. La contribution des laboratoires de la grippe et des CNG de cette Région à la surveillance mondiale de la grippe est appréciable. Cependant, il est nécessaire de renforcer cette contribution en tirant parti d’opportunités telles que celle du Cadre de préparation en cas de grippe pandémique.

Following the WHO declaration on 1 February 2016 of a Public Health Emergency of International Concern (PHEIC) with regard to clusters of microcephaly and neurological disorders potentially associated with Zika virus, the WHO Regional Office for the Eastern Mediterranean conducted three rounds of emergency meetings to address enhancing preparedness actions in the Region. The meetings provided up-to-date information on the current situation and agreed on a set of actions for the countries to undertake to enhance their preparedness and response capacities to Zika virus infection and its complications. The most urgent action is to enhance both epidemiological and entomological surveillance between now and the coming rainy seasons in countries with known presence of Aedes mosquitoes. Zika virus like other vector-borne diseases poses a particular challenge to the countries because of their complex nature which requires multidisciplinary competencies and strong rapid interaction among committed sectors. WHO is working closely with partners and countries to ensure the optimum support is provided to the countries to reduce the risk of this newly emerged health threat.لا توجد حالات فيروس زيكا في إقليم شرق المتوسط، ولكن المخاوف تظل قائمة.نجن نو من تران، هدى قدسية، هومايون أصغر، داليا سمهوري، ناصر ابدي أبو بكر، كارولن بروة، إرشاد شيخ، إيفانس موهافانى بوليفا، بير مالا أوموندى، مأمونور مالك.بعد إعان منظمة الصحة العالمية في 1 فبراير/شباط من عام 2016 "حالة طوارئ ذات أهمية دولية في مجال الصحة العامة" بخصوص مجموعة حالات صغر الرأس والاضطرابات العصبية التي يحتمل أن تكون مرتبطة بفروس زيكا، أجرى مكتب منظمة الصحة العالمية الإقليمي لرق المتوسط ثاث جولات من الاجتماعات الطارئة لتناول تعزيز إجراءات التأهب في الإقليم. وقد قدَّمت الاجتماعات أحدثَ المعلومات عن الوضع الراهن، واتُّفق عى مجموعة من الإجراءات كي تتخذها الدول لتعزيز قدراتها في مجال التأهب والتصدي للعدوى بفروس زيكا ومضاعفاته. والإجراء الأكثر إلحاحاً هو تعزيز ترصد كل من الأوبئة والحرات من الآن وحتى مواسم الأمطار القادمة في البلدان التي يُعرف فيها وجود بعوضات (أييدس). إن فروس زيكا - كغره من الأمراض المنقولة بنواقل - تشكل تحدياً استثنائياً للبلدان بسبب طبيعتها المعقدة التي تتطلب كفاءات متعددة الاختصاصات وتفاعاً سريعاً وقوياً بن القطاعات الملتزمة بذلك. وإن منظمة الصحة العالمية تعمل عن كثب مع شركاء وبلدان لضان تقديم الدعم الأمثل للبلدان في سبيل الحد من مخاطر هذا التهديد الصحي الذي ظهر مؤخراً.Maladie à virus Zika : malgré l’absence de cas dans la Région de Méditerranée orientale les craintes persistent.À la suite de la déclaration de l’OMS le 1er février 2016 faisant état d’une urgence de santé publique de portée internationale, eu égard à l’existence de groupes de cas de microcéphalie et de troubles neurologiques potentiellement associés à la maladie à virus Zika, le Bureau régional de l’OMS de la Méditerranée orientale a conduit trois cycles de réunions d’urgence en vue d’améliorer les mesures de préparation dans la Région. Les réunions ont fourni des informations actualisées de la situation actuelle et ont permis de convenir d’un ensemble d’actions à entreprendre par les pays afin d’améliorer leurs capacités de préparation et de réponse face à l’infection à virus Zika et ses complications. L’action la plus urgente consiste à améliorer la surveillance épidémiologique et entomologique à partir d’aujourd’hui et jusqu’à la prochaine saison des pluies dans les pays où la présence de moustiques Aedes est établie. La maladie à virus Zika, comme toutes les maladies à transmission vectorielle, constitue un défi pour les pays du fait de sa nature complexe qui nécessite des compétences multidisciplinaires et une interaction forte et rapide entre les secteurs impliqués. L’OMS travaille en étroite collaboration avec ses partenaires et les pays afin de garantir que le meilleur soutien soit apporté aux pays en vue de la réduction du risque de cette nouvelle menace sanitaire émergente.لا توجد حالات فيروس زيكا في إقليم شرق المتوسط، ولكن المخاوف تظل قائمة.نجن نو من تران، هدى قدسية، هومايون أصغر، داليا سمهوري، ناصر ابدي أبو بكر، كارولن بروة، إرشاد شيخ، إيفانس موهافانى بوليفا، بير مالا أوموندى، مأمونور مالك.بعد إعان منظمة الصحة العالمية في 1 فبراير/شباط من عام 2016 "حالة طوارئ ذات أهمية دولية في مجال الصحة العامة" بخصوص مجموعة حالات صغر الرأس والاضطرابات العصبية التي يحتمل أن تكون مرتبطة بفروس زيكا، أجرى مكتب منظمة الصحة العالمية الإقليمي لرق المتوسط ثاث جولات من الاجتماعات الطارئة لتناول تعزيز إجراءات التأهب في الإقليم. وقد قدَّمت الاجتماعات أحدثَ المعلومات عن الوضع الراهن، واتُّفق عى مجموعة من الإجراءات كي تتخذها الدول لتعزيز قدراتها في مجال التأهب والتصدي للعدوى بفروس زيكا ومضاعفاته. والإجراء الأكثر إلحاحاً هو تعزيز ترصد كل من الأوبئة والحرات من الآن وحتى مواسم الأمطار القادمة في البلدان التي يُعرف فيها وجود بعوضات (أييدس). إن فروس زيكا - كغره من الأمراض المنقولة بنواقل - تشكل تحدياً استثنائياً للبلدان بسبب طبيعتها المعقدة التي تتطلب كفاءات متعددة الاختصاصات وتفاعاً سريعاً وقوياً بن القطاعات الملتزمة بذلك. وإن منظمة الصحة العالمية تعمل عن كثب مع شركاء وبلدان لضان تقديم الدعم الأمثل للبلدان في سبيل الحد من مخاطر هذا التهديد الصحي الذي ظهر مؤخراً.Maladie à virus Zika : malgré l’absence de cas dans la Région de Méditerranée orientale les craintes persistent.À la suite de la déclaration de l’OMS le 1er février 2016 faisant état d’une urgence de santé publique de portée internationale, eu égard à l’existence de groupes de cas de microcéphalie et de troubles neurologiques potentiellement associés à la maladie à virus Zika, le Bureau régional de l’OMS de la Méditerranée orientale a conduit trois cycles de réunions d’urgence en vue d’améliorer les mesures de préparation dans la Région. Les réunions ont fourni des informations actualisées de la situation actuelle et ont permis de convenir d’un ensemble d’actions à entreprendre par les pays afin d’améliorer leurs capacités de préparation et de réponse face à l’infection à virus Zika et ses complications. L’action la plus urgente consiste à améliorer la surveillance épidémiologique et entomologique à partir d’aujourd’hui et jusqu’à la prochaine saison des pluies dans les pays où la présence de moustiques Aedes est établie. La maladie à virus Zika, comme toutes les maladies à transmission vectorielle, constitue un défi pour les pays du fait de sa nature complexe qui nécessite des compétences multidisciplinaires et une interaction forte et rapide entre les secteurs impliqués. L’OMS travaille en étroite collaboration avec ses partenaires et les pays afin de garantir que le meilleur soutien soit apporté aux pays en vue de la réduction du risque de cette nouvelle menace sanitaire émergente.

Background: If exposed to oral poliovirus vaccine (OPV), persons with primary immune deficiency disorders (PID) are at increased risk of paralytic poliomyelitis; and can chronically excrete poliovirus. However, the risk of excretion of vaccine derived poliovirus among immunodeficient persons (iVDPV) is not well characterized. We present summary of data from poliovirus surveillance project among PID patients collected between 2011 and 2014 from 11 Egyptian Governorates. Methods: Stool was tested for polioviruses in suspected or confirmed PID children regardless of whether Acute Flaccid Paralysis (AFP) was present or not. Those excreting poliovirus were followed until three consecutive negative stool samples were obtained. Results: There were 122 patients with suspected or confirmed PID identified; 13/122 (11%) excreted poliovirus; of these, 6 excreted iVDPVs, the remaining 7 excreted Sabin virus. The duration of iVDPV excretion ranged from 1 to 21 months. AFP was detected in 3/6 (50%) of those excreting iVDPVs. All iVDPV excretors had history of receiving OPV. Conclusions: Chronic poliovirus excretion in PID patients is rare, however, poliovirus eradication requires removal of all polioviruses from circulation; and because PID individuals are not necessarily paralyzed they might be missed by current poliovirus surveillance based on detection of AFP. To achieve poliovirus eradication, surveillance for polioviruses among PID patients should be routinely conducted in all countries, and poliovirus antiviral therapy must be made available for those with chronic excretion.

World Health Assembly (WHA) in 1988 encouraged the member states to launch Global Polio Eradication Initiative (GPEI) (resolution WHA41.28) against "the Crippler" called poliovirus, through strong routine immunization program and intensified surveillance systems. Since its launch, global incidence of poliomyelitis has been reduced by more than 99 % and the disease squeezed to only three endemic countries (Afghanistan, Pakistan, and Nigeria) out of 125. Today, poliomyelitis is on the verge of eradication, and their etiological agents, the three poliovirus serotypes, are on the brink of extinction from the natural environment. The last case of poliomyelitis due to wild type 2 strain occurred in 1999 in Uttar Pradesh, India whereas the last paralytic case due to wild poliovirus type 3 (WPV3) was seen in November, 2012 in Yobe, Nigeria. Despite this progress, undetected circulation cannot fully rule out the eradication as most of the poliovirus infections are entirely subclinical; hence sophisticated environmental surveillance is needed to ensure the complete eradication of virus. Moreover, the vaccine virus in under-immunized communities can sometimes revert and attain wild type characteristics posing a big challenge to the program.

Systematic environmental surveillance for poliovirus circulation has been conducted in Egypt since 2000. The surveillance has revealed three independent importations of wild-type poliovirus. In addition, several vaccine-derived polioviruses have been detected in various locations in Egypt. In addition to acute flaccid paralysis (AFP) surveillance, environmental surveillance can be used to monitor the wild poliovirus and vaccine-derived poliovirus circulation in populations in support of polio eradication initiatives.

Type 3 immunodeficiency-associated vaccine-derived polioviruses (iVDPVs) were isolated from a 15-month-old Iranian boy with acute flaccid paralysis (AFP) who was subsequently diagnosed with X-linked agammaglobulinemia (XLA). VP1 nucleotide sequences of the two isolates differed from Sabin 3 by 2.0% and 2.1% and from each other by 0.6%. Although the key determinant of attenuation and temperature sensitivity in the 5'-untranslated region (U(472)-->C) had reverted, a second capsid-region determinant (VP3:Phe(091)) was unchanged, but a presumptive suppressor (VP1:Ala(054)-->Val) was found. The isolates were Sabin 3/Sabin 1 recombinants, sharing a single recombination breakpoint in the 2C region. Although the two isolates were antigenically distinct from Sabin 3, only one amino acid replacement was found in the neutralizing antigenic sites (VP3:Ser(059)-->Asn in site 3). The patient was placed on intravenous immunoglobulin (IVIG) therapy within 9 days of onset of AFP, and iVDPV excretion ceased thereafter, but the patient remained severely paralyzed until his death approximately 11 months after paralysis. No secondary AFP cases were found, and none of the seven tested contacts of the patient were found to be infected with poliovirus.

Persons who have developed acute flaccid paralysis following infection with wild-type polioviruses or vaccine-associated paralytic poliomyelitis usually excrete polioviruses for only a few weeks. However, some patients with paralytic poliomyelitis have had prolonged excretion of polioviruses for periods of up to 10 years after onset of disease. Most prolonged excretors have been identified in industrialized countries. We studied 348 patients 2-28 years old in Ethiopia, Pakistan and Guatemala with residual paralytic poliomyelitis to determine if they had IgA or IgG deficiency or persistent poliomyelitis excretion at least 1 year after onset of disease. None of the 348 affected individuals had IgG deficiency or persistent poliovirus excretion. One child had borderline low serum IgA concentration. Since we did not study children under 2 years of age, persons born with IgG deficiency disorders may have died in developing countries where replacement immunoglobulin therapy is not readily available. Nevertheless, persistent poliovirus excretion among persons 2 years of age and older with residual paralytic poliomyelitis is uncommon in developing countries.

Examination of sewage specimens for poliovirus (environmental surveillance) was adopted as a supplementary tool in the surveillance of poliomyelitis in Egypt. Sewage samples were concentrated about 50-fold using a simple two-phase separation technique, and inoculated in cell cultures in two collaborating laboratories in parallel. All but 9 of the 293 (97%) samples collected from January 2001 to December 2002 contained poliovirus and/or other enteroviruses, with polioviruses being detected in 84% of the samples. The proportion of specimens containing type 1 wild poliovirus (PV1W, the North-East African (NEAF) genotype) was less in 2002 (16%) than in 2001 (57%), and further decreased in 2003. While the overall sensitivity to detect PV1W was similar in the two collaborating laboratories, the specimens scored positive were not identical. Parallel cultures inoculated with aliquots of a given specimen very frequently resulted in isolation of different viruses. Moreover, partial sequence analysis occasionally revealed representatives of different genetic lineages of PV1W in a given specimen. These results emphasize the need to use intensive laboratory analysis to optimise sample sensitivity in environmental poliovirus surveillance, and the difficulties in reproducing the isolation results by simple re-inoculation of samples containing a mixture of different viruses.