Seasonal influenza vaccination policies in the Eastern Mediterranean Region:Current status and the way forward

Background: The World Health Organization recommends annual influenza vaccination, especially in high-risk groups. Little is known about the adoption and implementation of influenza vaccination policies in the Eastern Mediterranean Region. Methods: A survey was distributed to country representatives at the ministries of health of the 22 countries of the Region between December 2016 and February 2017 to capture data on influenza immunization policies, recommendations, and practices in place. Results: Of the 20 countries that responded to the survey, 14 reported having influenza immunization policies during the 2015/2016 influenza season. All countries with an influenza immunization policy recommended vaccination for people with chronic medical conditions, healthcare workers and pilgrims. Two of the 20 countries did not target pregnant women. Eight countries used the northern hemisphere formulation, one used the southern hemisphere formulation and nine used both. Vaccination coverage was not monitored by all countries and for all target groups. Where reported, coverage of a number of target groups (healthcare workers, children) was generally low. Data on the burden of influenza and vaccine protection are scarce in the Region. Conclusions: Despite widespread policy recommendations on influenza vaccination, attaining high coverage rates remains a challenge in the Eastern Mediterranean Region. Tackling disparities in influenza vaccine accessibility and strengthening surveillance systems may increase influenza vaccine introduction and use.</p

Responding to cholera outbreaks in Somalia in 2017–2019

Background: Somalia reported repeated cholera outbreaks between 2017 and 2019. These outbreaks were attributed to multiple risk factors which made response challenging. Aims: To describe lessons from the preparedness and response to the cholera outbreaks in Somalia between 2017 and 2019. Methods: We reviewed outbreak response reports, surveillance records and preparedness plans for the cholera outbreaks in Somalia from January 2017 to December 2019 and other relevant literature. We present data on cholera-related response indicators including cholera cases and deaths and case fatality rates for the 3 years. Qualitative data were collected from 5 focus group discussions and 10 key informant interviews to identify the interventions, challenges and lessons learnt from the Somali experience. Results: In 2017, a total of 78 701 cholera cases and 1163 related deaths were reported (case fatality rate 1.48%), in 2018, 6448 cholera cases and 45 deaths were reported (case fatality rate 0.70%), while in 2019, some 3089 cases and 4 deaths were reported in Somalia (case fatality rate 0.13%). The protracted conflict, limited access to primary health care, and limited access to safe water and proper sanitation among displaced populations were identified as the main drivers of the repeated cholera outbreaks. Conclusions: Periodic assessment of response to and preparedness for potential epidemics is essential to identify and close gaps within the health systems. Somalia’s experience offers important lessons on preventing and controlling cholera outbreaks for countries experiencing complex humanitarian emergencies

Management of avulsion wound in a calf: a case report

A male Jersey calf weighing 50kg was presented to the University Veterinary Hospital, University Putra Malaysia with an open non-bleeding contaminated wound situated at the caudo-lateral aspect of carpal joint of the left forelimb. The calf was apparently stable and alert and on examination there was extensive damage to the skin around the wound area. Based on the physical examination and history, the case was diagnosed as that of an avulsed wound. The affected area was cleaned, debrided and lavaged with 0.05% diluted chlohexidine diacetate and Ilium Dermapred®. It was then bandaged after spraying with woundsarex spary; a fly repellant/antiseptic spray. Positive response of the calf to the treatment was noticed within two weeks of treatment. Daily wound dressing, debridement and topical antibiotic treatment was adequate in treatment of non-infected avulsion wound. In order to prevent the occurrence of such type of injuries, it is recommended that farmers should keep animal premises clear of injurious materials such as wire fences, metal sheets, or other sharp objects and stray dogs. Young animals should be segregated from adults to protect them from physical injuries

Perceptions of oral cholera vaccine and reasons for full, partial and non-acceptance during a humanitarian crisis in South Sudan

: Oral cholera vaccination (OCV) campaigns were conducted from February to April 2014 among internally displaced persons (IDPs) in the midst of a humanitarian crisis in Juba, South Sudan. IDPs were predominantly members of the Nuer ethnic group who had taken refuge in United Nations bases following the eruption of violence in December 2013. The OCV campaigns, which were conducted by United Nations and non-governmental organizations (NGOs) at the request of the Ministry of Health, reached an estimated 85-96% of the target population. As no previous studies on OCV acceptance have been conducted in the context of an on-going humanitarian crisis, semi-structured interviews were completed with 49 IDPs in the months after the campaigns to better understand perceptions of cholera and reasons for full, partial or non-acceptance of the OCV. Heightened fears of disease and political danger contributed to camp residents' perception of cholera as a serious illness and increased trust in United Nations and NGOs providing the vaccine to IDPs. Reasons for partial and non-acceptance of the vaccination included lack of time and fear of side effects, similar to reasons found in OCV campaigns in non-crisis settings. In addition, distrust in national institutions in a context of fears of ethnic persecution was an important reason for hesitancy and refusal. Other reasons included fear of taking the vaccine alongside other medication or with alcohol. The findings highlight the importance of considering the target populations' perceptions of institutions in the delivery of OCV interventions in humanitarian contexts. They also suggest a need for better communication about the vaccine, its side effects and interactions with other substances.<br/

Management of fetal dystocia caused by carpal flexion in ewe: a case report

Dystocia or difficulty in parturition in a ewe may need veterinary assistance for the successful parturition. An adult ewe weighing 30 kg was presented to the Hospital of Veterinary Medicine, Universiti Putra Malaysia with the history of difficulty in giving birth. Physical examination of the ewe revealed that the animal was weak and in recumbent position. Head of a dead fetus was observed as protruding out from the vulva region. Through physical evaluation of the ewe by per vaginal examination, the condition was diagnosed as fetal dystocia. Treatment and management plans given to the ewe were episiotomy and manipulative delivery of the dead fetus via mutation and traction method. Post-operative treatment was given with Flunixin meglumine (dosed at 2.2 mg/kg bwt) for 3 days, and Norodine (dosed at 1 mL/16-kg bwt) once intramuscularly. The case was completely cured after 2 weeks. The risk of losing the lamb as well as the ewe increases with delay in treatment of dystocia

Clinical management of pneumonic pasteurellosis in boer kids: a case report

Pneumonic pasteurellosis caused by Mannhaemia haemolytica (M. haemolytica) is a common disease with high prevalence in sheep and goats. This clinical case reports the occurrence of pneumonic pasteurellosis in two of Boer-crossed kids. Two Boer-crossed kids age 1-week old, were presented with complain of in appetence and weakness. The farm had previous history of sudden death among the kids. Clinical examination findings revealed that the kids were having harsh lung sound with present of bilateral serous nasal discharges. Nasal swabs and fecal samples were collected as diagnostic work-ups and both kids were diagnosed with pasteurellosis. The kids were treated with dextrose fluid, penicillinstreptomycin antibiotic and flunixin meglumine non-steroidal anti-inflammatory drug. After third day of hospitalization, both kids showed positive response to the treatments. The prognosis of this case was good where accurate and prompt treatment were able to resolve the case

Caseous lymphadenitis in a goat: a case report

Corynebacterium pseudotuberculosis is the causative agent of caseous lymphadenitis (CLA), a common disease in small ruminant populations across the globe. The following report describes two cases of a 3 year old Boer cross does showing large mass beneath the jaw, on the ventral side of the mandible with strong pain reaction to touch of the affected region. The consistency of the mass was non–movable, solid and hard on deep palpation. The mass was lanced and purulent discharges were evacuated. Phenotypic and biochemical identification methods allocated the isolates in C. pseudotuberculosis biovar ovis. The vast majority of the isolates was able to produce phospholipase D and was susceptible to most of the antimicrobial compounds tested. Furthermore, the isolates were compared with C. pseudotuberculosis isolated from other states with different geographical locations and showed high similarity index, suggesting the prevalence of dominant clones and a potential dissemination across the country

Pneumonia causing bacterial leading to facial abscess in a doe: a case report

An adult Jamnapari-cross doe managed in an intensive, raised-house farm was presented with the primary complaint of left facial swelling. The swelling was approximately 8cm x 15cm with soft, fluidfilled consistency and warm upon palpation. There were also mucoid discharge from both nostrils and mild crackle sound upon lung auscultation. The doe was diagnosed to have pneumonia together with facial abscess where the causative agent was a mix infection. The doe was administered with 2.2mg/kg Flunixin meglumine and Norodine 24 1ml/16kg intravenously, followed by abscess lancing. A ring-block was performed by infiltrating lidocaine hydrochloride 2% around the swelling site, followed by fine needle aspiration (FNA). The pus aspirated was sent for bacteriological culture, which yielded a mixed growth of Arcanobacterium haemolyticum and Mannheimia haemolytica infection. Excessive bleeding resulted from the lancing procedure was countered with cauterization using heated scalpel blade holder, administration of 1ml Vitamin K intravenously and 3ml via topical flushing. Oxytetracycline 20mg/kg was also dispensed for topical flushing at the abscess pocket

Management of horn gore injury and urticaria in a dairy cow: a case report

This paper reports how a 4-year old Friesien-Sahiwal cross cow weighing 380 kg with horn gore injury on the left labia of the vulva was managed at the Large Animal Clinic, University Putra Malaysia. The lacerated wound measuring about 4-cm long was originated as a result of horn goring from another cow two weeks prior presentation of the cow to the clinic. Physical examination of the cow incidentally revealed urticaria on the left ventro-lateral aspect of the neck suspected to be sequel of hypersensitivity. The wound was treated by topical application of a mixture of Iodine, Benacillin LA, Biomectin 1% and Ilium Dermapred made into cream. While the uticaria was treated by intramuscular injection of Chlorpheniramine maleate at 0.5 mg/kg bwt. Animal management, housing design and presence of sharp horns are some of the factors that can lead to physical traumatic injuries in dairy cows

A clinical case of navel and joint ill in a calf - medical management

An intensively managed five days old female Friesian cross breed calf weighing approximately 30kg was presented to the University Veterinary Hospital, Universiti Putra Malaysia (UPM). The complaint was that the calf had swollen navel and joints and had not been able to stand up properly and frequently fell down. But the calf was alert and the appetite was normal at the time of presentation. On physical examination, body condition score was 2.5 out of 5 and and temperature was 39.3 °C (slight pyrexia), pulse and respiratory rates were within the normal range. The navel was swollen with dark necrotic tissues within the navel opening with presence of foul smelling odour. Both the carpal joints of the forelimbs and the hock joints of the hind limbs were swollen. Arthrocentesis and Jugular venipuncture were performed to collect samples for synovial fluid cytology, haematology and blood chemistry. Based on the history, physical examination and laboratory findings, the calf was diagnosed to have navel ill with associated joint ill. Treatment was performed by umbilical debridement and cleaning of necrotic tissues and debris with subsequent application of povidone of iodine. Flunixin meglumine, 1.1 mg/kg, 0.7 mL, was given intramuscularly, twice daily for 3 days as analgesic, anti-inflammatory and antipyretic agent. A combination of penicillin and dihydrostreptomycin (1.2mL) at a dosage of 1 mL/25 kg body weight was administered intramuscularly, once daily for 5 days. Remarkable progressive improvement was observed 3 days after commencement of treatment. The umbilical care by debridement of necrotic tissues and debris and topical antisepsis, coupled with systemic antibiotic therapy using combination of penicillin and dihydrostreptomycin was effective in the treatment of navel ill and/or joint ill