Diphtheria outbreak in Yemen: the impact of conflict on a fragile health system

Background: War in Yemen started three years ago, and continues unabated with a steadily rising number of direct and indirect victims thus leaving the majority of Yemen’s population in dire need of humanitarian assistance. The conflict adversely affects basic socioeconomic and health conditions across the country. Methods: This study analyzed the recent ongoing diphtheria outbreak in Yemen and in particular, the health system’s failure to ensure immunization coverage and respond to this outbreak. Data from the weekly bulletins of the national electronic Disease Early Warning System’s (eDEWS) daily diphtheria reports and district immunization coverage were analyzed. The number of diphtheria cases and deaths, and immunization coverage (DPT) were reviewed by district including the degree to which a district was affected by conflict using a simple scoring system. A logistic regression and bivariate correlation were applied using the annual immunization coverage per district to determine if there was an association between diphtheria, immunization coverage and conflict. Results: The study results confirm the association between the increasing cases of diphtheria, immunization coverage and ongoing conflict. A total of 1294 probable cases of diphtheria were reported from 177 districts with an overall case fatality rate of 5.6%. Approximately 65% of the patients were children under 15 years, and 46% of the cases had never been vaccinated against diphtheria. The risk of an outbreak increased by 11-fold if the district was experiencing ongoing conflict p < 0.05. In the presence of conflict (whether past or ongoing), the risk of an outbreak decreased by 0.98 if immunization coverage was high p > 0.05. Conclusion: The conflict is continuously devastating the health system in Yemen with serious consequences on morbidity and mortality. Therefore, the humanitarian response should focus on strengthening health services including routine immunization procedures to avoid further outbreaks of life-threatening infectious diseases, such as diphtheria

Antimicrobial Activity of Various Plant Extracts on Pseudomonas Species Associated with Spoilage of Chilled Fish

The antimicrobial activity of various plant extracts on Pseudomonas bacteria isolated from spoiled chilled tilapia (Oreochromis sp.) was evaluated in this study. In the first stage of this study, red tilapia was subjected to chilled storage (4°C) for 3 weeks, and spoilage bacteria were isolated and identified from the spoiled fish. Pseudomonas was the dominant bacteria isolated from the spoiled fish and further identification revealed that P. putida, P. fluorescens and Pseudomonas spp. were the main species of this group. In the second stage, methanolic extracts of 15 selected plant species were screened for their antimicrobial activity, by agar disc diffusion method, against the Pseudomonas isolates. Results indicated that most of the extracts had different degrees of activity against the bacterial isolates. The strongest activity was exhibited by bottlebrush flower (Callistemon viminalis) extract. This was followed by extracts from guava bark (Psidium guajava) and henna leaf (Lawsonia inermis). Moderate antimicrobial activities were observed in extracts of clove (Syzygium aromaticum), leaf and peel of tamarind (Tamarindus indica), cinnamon bark (Cinnamomum zeylanicum), wild betel leaf (Piper sarmentosum) and fresh thyme (Thymus spp.). Weak or no antimicrobial activity was observed from the remaining extracts. The potential antimicrobial activity shown by some plant extracts in this study could significantly contribute to the fish preservation