A. Elganainy

A. Musani

A. Rady

A. Wasan

A.A. Noor

A.S. Alhamadani

E. Muntasir

M. Ghada

M. Iliana

M.R. Malik

P. Mala

S. Gmach

Z. Mansour

Directory of Open Access Journals

International Journal of Infectious Diseases

Establishment of EWARN system for the Syrian crisis: Experiences and challenges

Mala, P.

Ghada, M.

Wasan, A.

Noor, A.A.

Alhamadani, A.S.

Gmach, S.

Muntasir, E.

Mansour, Z.

Rady, A.

Iliana, M.

Elganainy, A.

Musani, A.

Malik, M.R.

Elsevier - Publisher Connector 

Establishment of EWARN system for the Syrian crisis: Experiences and challenges 

280 16th ICID Abstracts / International Journal of Infectious Diseases 21S (2014) 1–460
Type: Poster Presentation
Final Abstract Number: 53.042
Session: Infectious Disease Surveillance II
Date: Friday, April 4, 2014
Time: 12:45-14:15
Room: Ballroom
Establishment of EWARN system for the Syrian
crisis: Experiences and challenges
P. Mala1,∗, M. Ghada2, A. Wasan3, A.A. Noor4,
A.S. Alhamadani4, S. Gmach5, E. Muntasir1, Z.
Mansour6, A. Rady6, M. Iliana5, A. Elganainy1, A.
Musani1, M.R. Malik1
1 World Health Organization, Cairo, Egypt
2 World Health Organization, Damascus, Syrian Arab
Republic
3 World Health Organization, Baghdad, Iraq
4 World Health Organization, Erbil, Iraq
5 World Health Organization, Amman, Jordan
6 World Health Organization, Beirut, Lebanon
Background: An estimated 5 million Syrian people have either
been internally displaced or taken refuge in Jordan, Iraq, Lebanon
and Egypt owing to the ongoing humanitarian crisis in Syria. Poor
living conditions, depleted access to safe water and sanitation ser-
vices and disruption of preventive health services have put these
Syrian refugees at risk from epidemic-prone diseases. Continu-
ous inﬂux of Syrian refugees into these countries also threatened
the introduction and re-introduction of many diseases in these
countries that were not known to exist previously. Establishment
of early warning and alert response network (EWARN) system for
timely detection and response to disease outbreaks was a critical
part of WHO’s public health response to Syrian crisis
Methods & Materials: An operational framework was devel-
oped by WHO to establish the EWARN system in the countries
affected by Syrian crisis taking into consideration the disease
surveillance structure, available human and technical resources
and operational effectiveness to determine the most appropriate
EWARN design for each settings. Standard tools were adapted,
potential partners to support the operation of EWARN were iden-
tiﬁed and list of disease conditions with epidemic potentials were
ﬁnalized. Alert and epidemic thresholds were set for each disease
conditions taking into consideration the local endemicpatterns and
seasonality of the selected disease conditions.
Results: The EWARN was rapidly rolled out in Iraq, Jordan,
Lebanon and Syria between June 2012 to December 2013 with
immediate notiﬁcations and weekly reporting system. The EWARN
has, so far, detected measles outbreak amongst the Syrian refugees
in Lebanon, Jordan and Iraq, polio outbreak in Syria, acute viral
hepatitis outbreak in northern Iraq, Leishmaniasis in Lebanon and
Brucellosis in Syria. Appropriate control measures, an essential
component of EWARN, were also rapidly implemented following
detection of these outbreaks.
Conclusion: The implementation of EWARN in the countries
affected by the Syrian crisis has demonstrated its value and use-
fulness for timely detection and response to outbreaks in crisis
situations. However, sustaining the progress and maintaining such
early warning component within the routine disease surveillance
system will remain a challenge owing to the complexity of health
systems and variability of surveillance and response capacities in
the affected countries.
http://dx.doi.org/10.1016/j.ijid.2014.03.1001
Type: Poster Presentation
Final Abstract Number: 54.001
Session: Mycology, Fungal Infections and Antifungal Drugs
Date: Friday, April 4, 2014
Time: 12:45-14:15
Room: Ballroom
Identiﬁcation and antifungal susceptibility
pattern of various clinical yeast isolates from a
clinical microbiology laboratory in North India
D.B. Shah1,∗, K. Kant2, S. Garg3, A.K. Gupta3
1 Sarvodaya Multispeciality Hospital & Research
Centre, Faridabad, Haryana, India
2 AIIMS, New Delhi, India
3 Sarvodaya Multispeciality Hospital & Research
Centre, Faridabad, India
Background: Yeast infections other than those caused by Can-
dida albicans have been increasingly reported worldwide. The aim
was to study the distribution of yeast isolates from various clin-
ical specimens, antifungal susceptibility pattern and usefulness
of chromogenic medium in identiﬁcation of “multi-species” yeast
infections.
Methods & Materials: Yeast isolates were identiﬁed by growth
on CHROMagar Candida medium (Difco, Becton Dickinson, Balti-
more, MD, USA), morphology on corn meal agar, sugar assimilation
test aswell as by the automated systemVITEK2 (bioMérieux,Marcy
I’Etoile, France). Antifungal susceptibility testing was done by disk
diffusionmethodasper Clinical Laboratory Standards Institute pro-
tocols.
Results: In a six-month period, a total of 204 yeast non-
repeat isolates were recovered from 182 clinical specimens, viz.
blood (n=42), clean-voided urine (n=48), Respiratory samples
including tracheal aspirates and bronchoalveolar lavage (n=82),
pus(n =4), sterile body ﬂuids (n =2), high vaginal swab(n=4)
from different clinical units of Sarvodaya Multi speciality Hos-
pital & Research Centre. Among these 204 yeast isolates, 62
were identiﬁed as Candida albicans, 136 were non albicans can-
dida spp. and only 6 were identiﬁed as Trichosporon spp. The
chromogenic medium detected the presence of multiple yeast
species in clinical specimens of clean voided urine, tracheal
aspirate and bronchoalveolar lavage (n=11). Out of 136 non
albicans candida isolates, maximum were C.tropicalis (n =64), fol-
lowed by C.glabrata(n =30), C.parapsilosis(n =22), C.krusei (n =10),
C.dublinensis(n =4), C.gullermondii (n =4) and C.kefyr(n =2). 51.6%
and19.4% isolates of candida albicans showed antifungal resistance
for ﬂuconazole(25mcg) and voriconazole(1mcg), respectively.
Non-albicans candida isolates revealed higher resistance for ﬂu-
conazole (76.46%) and voriconazole (23.6%). All 6 isolates of
Trichosporon spp. were found to be resistant against ﬂuconazole,
but susceptible to voriconazole.
Conclusion: There is a signiﬁcant rise in infections caused by
Non-albicans Candida species in this multi speciality hospital as
is noticed in other centres in India and worldwide. Chromogenic
medium facilitates rapid presumptive identiﬁcation of yeast isolate
thereby prompting appropriate antifungal therapy which is very
muchneeded forbetterpatientoutcomedue to the increasing trend
of azole resistance observed among these isolates.
http://dx.doi.org/10.1016/j.ijid.2014.03.1002


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Establishment of EWARN system for the Syrian crisis: Experiences and challenges

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