Program and Abstracts Tephinet Bi Regional

Table of Contents
Welcome Message 1
Conference Steering Committee 8
Conference Scientific Committee 9
Local Host Committee 10
Abstract Reviewers 11
Pre-Conference Workshops 12
Virtual Tour 16
List of Awards 17
Agenda at-a-Glance 20
Keynote Session: Anthropology and Disease Control 27
Plenary Session
1. Plenary Session 1: Re-Emerging Vaccine Preventable Diseases 29
2. Plenary Session 2: One Health Approach to Outbreak Response 32
3. Plenary Session 3: Field Epidemiology Training Development Strategies 35
4. Plenary Session 4: Communication, Ethics, and Equity in Public Health Emergencies 40
Opening Oral Session: COVID-19 Dominated All Aspects of Our Lives 44
Oral Presentation Sessions
1. Effects of COVID-19 47
2. Non-Communicable Diseases 51
3. Outbreak Investigation and Response 55
4. Surveillance 59
5. COVID-19 Transmission 63
6. Animal Health and Zoonotic Diseases 67
7. Vaccine Preventable Diseases 71
8. More on Surveillance 75
9. Therapeutics 79
10. Severe Illnesses and Deaths 83
11. Foodborne Diseases 87
12. Vectorborne Diseases 91
13. More on COVID-19 95
14. Environmental Health 99
15. Healthcare-Associated Infections 102
16. Malaria 106
17. Vaccine Safety 110
18. More on Vaccine Preventable Diseases 114
19. Other Infectious Diseases 118
Poster Session
1. COVID-19 123
2. Non-Communicable Diseases 133
3. Vectorborne Diseases 136
4. Potpourri 141
Selected Abstracts for Presentation 145
Welcoome Meessage
From
F TE
EPHINE
ET
Itt is indeed a pleasure to welcome yo ou to the 100th Southeasst Asia and Western
W Paccific Bi-regioonal
TEPHINET
T T Scientific Conference
C organized
o byy our esteem
med partnerss, the South Asia Field
Epidemiolog
E gy and Techn nology Netw work (SAFE ETYNET) an nd the Taiwwan Field Eppidemiology Training
Program.
P I am
m certain thhat all the atttendees and participantss will take fu
ull advantagee at all the opportunitie
o es
presented
p at this confereence for kno owledge exchhange and networking.
n
Itt is well-recoognized thatt every coun ntry needs efffective field

d (or applied
d) epidemiolo
logy capacityy to safeguarrd
annd promotee the health of o its citizenns. With the COVID-199 pandemic the world haas recogniseed the
im
mportance oof outbreakss and publicc health emeergencies. Neever before has the needd for increased field
eppidemiologyy capacity beeen more ap pparent thann now. The field
f miologists in our networkk including
epidem
th
hose that aree members of o SAFETY YNET and A ASEAN+3 have h been working
w arouund the clocck to trace
coontacts, inveestigate and manage casses, analyze C COVID-19 data, educatte their com mmunities, an nd much
more.
m Withouut them, min nistries of health
h wouldd not have access to reliable data onn the spread of
COVID-19
C inn their popuulations. In many
m countrries FETP residents
r d graduates are a criticall part of thee
and
workforce
w in place to connduct contaact tracing annd case inveestigations.
TEPHINET
T T salutes the outstandingg work donee by FETPs at the forefrront of diseease surveillaance, public
health
h emerggency and disease outbreeak responsee in the Souutheast Asiann and Westeern Pacific reegions and
yo
our efforts tto build the field epidem
miology worrkforce needded to detectt and responnd to diseasee outbreaks
before
b they bbecome panddemics with h devastatingg human and
d economic consequencces.
There
T will bee other panddemics and non single insstitution has all the capaacity requiredd to be adeq
quately
prepared
p to fface future threats.
t We need
n to harnness the reso
ources and capacities
c off a wide rangge of
partners
p and stakeholderrs and we neeed political leadership, whole-of-go overnment aand whole-o of-society
coommitmentt. It is also crritical to devvelop the huuman resourrces and fieldd epidemiolo logy technical capacity
reequired to pprotect the health
h of all people.
W urge you to support the work off the Strateggic Leadership Group (S
We SLG) to ensuure that everry country in
n
thhe world hass the appliedd epidemioloogy capacitiies needed to
o protect an
nd promote tthe health of
o its own
population,
p aand to collab
borate in thee implementtation of ouur roadmap for
f building global field
eppidemiologyy capacity an nd strengtheening the FE
ETP Enterprise.

Carl Reddy
Director
Training Programs
P inn Epidemiolo
ogy and Pub
blic Health IIntervention
ns Network
1
From
F SA
AFETYN
NET
Welcome
W to tthe first Bi-R
Regional VIDEO confeerence!
I would like tto thank thee Taiwan FE

ETP for instiigating and inspiring
i us to have thiss activity. It speaks
s of
th
heir concernn for program
ms to be able to continuue sharing their experiences so thatt we may leaarn from eacch
other
o notwithhstanding th
he abnormall situation w
we are in.
Thanks
T and ggratitude to TEPHINET for guidinng us and fin
nding ways to
t keep us coonnected. Too,
T for the
unqualified
u suupport of th
he US Centeers for Dise ase Control and Preven
ntion.
We
W are so luccky that in th
his lifetime, we are able to witness the
t outbreak
ks of HIV/A
AIDS, SARSS, Ebola,
Avian
A flu, ME
ERS-CoV, and
a now thiss COVID paandemic. Wee lived them
m, we breatheed them, wee tried to
understand
u thhem so thatt the next geeneration willl be better able
a to preveent and conntrol them. Such
S is our
co
ontribution..
Itt is perfect ttiming (or faate) that even we used too, the
n when we ccannot traveel or socializze the way w
distancing
d th
hat is imposeed on us hap
ppened in thhis day and age
a of high technology.
t We can stilll
co i we’re sepaarated by thoousands of miles. And
ommunicatee well and reeach out in a blink of ann eye, even if
th
herefore we can respondd.
Though
T we w
would like to
o think that we can get iit right the first
f time, it is
i very possiible that we will
en nconveniencces in the neext three dayys of presentations. We beg for you
ncounter gliitches and in ur patience
an
nd expect evverybody’s understandin
u ng. Because we want to share, we want
w to learnn, we want to
o help.
Here’s
H to a prroductive co
onference ah
head of us!

Maria Consorcia
C Lim-Quiizon, MD
Executivee Director
South Asiia Field Epiddemiology and
a Technology Networrk, Inc.
2
From
F Dr.. Riris Andono
A Ahmad
A

Dear
D colleaguues and frien
nds,
Allow
A me to warmly than
nk the organ me the priviilege of
nizers of thiis importantt conferencee for giving m
welcoming
w annd addressin
ng you all. For
F me, it is aan honor an
nd a pleasuree.
I would also like to thankk the Taiwan

n FETP for bringing uss to the 10th
h Southeast A
Asia and Weestern Pacifiic
Bi-regional
B T
TEPHINET
T Conferencee. As I am w
writing this welcome
w add
dress, COVIID-19 pandeemic has
been
b with us for almost two years. Unfortunatel
U ly, last time, our colleagu
ues at the Taaiwan FETP
P had to
postpone
p thee conferencee twice due to
t the COVIID-19 situattion. So no one
o can foreesee even th
he near futurre,
an
nd we all aree experienciing a long tu
unnel of unccertainty in health,
h econ
nomy, and evveryday life.
However,
H as life continuees, we now know
k how C
COVID-19 impacts
i diseease spread iin the popullation and
how
h we shouuld respond to these heaalth problem
ms. It is, therrefore, essen
ntial for us too meet and share what
we
w have learnned in the fiield during th
he pandemiic era. How we
w effectiveely respond tto the COV
VID-19
pandemic,
p annd how we can
c effectiveely respond tto other pub
blic health problems takking into acccount many
reestrictions ddue to the paandemic.
Although
A wee cannot meeet in person this time, I genuinely hope
h you willl join us in tthis excitingg gathering
an
nd make a significant co
ontribution to our comm
mitment to advancing th
he Field Epiidemiology Training
Program.
P Wee are lookingg forward to
o greeting yoou at the virttual conference.

Riris An
ndono Ah
hmad
Member, TEPHINET
T T Advisory Board
Director, Center for T
Tropical Medicine, Facu
ulty of Mediicine, Univerrsitas
Gadjah Mada
M

3
From
F Dr.. Steven Peng-Liim Ooi
Itt is my honoor to deliver this welcom

me message for all particcipants of our
o 10th Souutheast Asia and Western
n
Pacific
P Bi-reggional TEPH
HINET Scieentific Confe
ference.
Our
O conferennce is imporrtant because it brings toogether so muchm of thee good workk being donee at the
fo
orefront of emerging diiseases surveeillance, outtbreak investtigation, commmunity enggagement an nd health
protection.
p Such a confeerence plays a critical rolle in improvving our globbal health seecurity, and abilities
a to
detect
d and reespond to disease threats.
In
n the currennt pandemic,, we care forr both lives and livelihoods. Havingg experienceed outbreak alerts as
governmentss attempt to reopen the economy annd put an en nd to crippling lockdown
wns, we can expect
e
Covid-19
C to wwax and wanne in asynch
hronous cyclles. The harrd lessons leaarned must be shared because viruss
variants
v are sshifty and po
ose a major challenge too control.
An
A epidemic surge is ourr moment fo
or courage aand tenacity in the face of challengee. The key to
o
saafeguarding public healtth is to sustaainably com
mbine vaccinaation strateggy, testing annd tracing with
w
coommunity hhygiene measures and saafe distancinng into an efffective systeem that workks for each country
siituation.
With
W TEPHIINET and FETPs F in plaace, we are ccautiously optimistic at collectively turning the corner. At
th
his conferennce, let us staand togetherr with renew wed confiden nce in our cause
c - uniteed in our herritage of thee
past,
p and determined in our o hopes fo or the futuree!

Assoc Prof
P (Dr) SSteven Oo
oi
Member, TEPHINET
T T Advisory Board
Senior Co
onsultant, Naational Centtre for Infecctious Diseaases, Singapo
ore

4
From
F thee Ministrry of Heealth and
d Welfaree, Taiwan
Itt is with greaat pleasure that

t I welcom me you to thhe 10th Souutheast Asia and Westernn Pacific Bi--regional
TEPHINET
T T Scientific Conference.
C
The
T Taiwan M Ministry of Health and Welfare wass established d more than n a decade aggo by mergin ng Taiwan’s
health
h and w
welfare deparrtments. Oveer the years,, Taiwan hass gained valu uable experieence in prom
moting the
well-being
w off our citizen
ns, in additio
on to minimiizing threatss that challen
nge the heallth of peoplle in Taiwan.
The
T public health comm munity has beeen expectinng and prepaaring for a pandemic
p forr many yearrs. Despite all
th
he preparation, COVIDD-19 has presented challlenges to us like no otheer public heaalth emergen ncies in our
lifetime. The COVID-199 pandemic has
h forced uus to work quickly
q to co
ontain the sppread of the disease
within
w our owwn countries and compelled us all tto forge new
w collaboratiions internattionally, to face
f the
pandemic
p toggether.
Taiwan
T has aactively partiicipated in sh
haring our eexperiences with
w the glo obal public hhealth comm
munity. We
seeek opportuunities to woork with our internationnal partners on o issues reggarding humman and animmal health,
ennvironmenttal health, annd other pub blic health evvents. I hop
pe that throu
ugh this confference, we will be able
to
o learn from
m each otherr and foster newn relationnships.
Taiwan
T is a bbeautiful islan
nd with friendly peoplee. In addition
n, we have a convenientt public transportation
syystem, vibraant culture, and
a diverse cuisines.
c Evven though youy could no ot be here phhysically, I hope
h you willl
be
b able to come and visitt us soon.
Shih-Ch hung Che n, DDS

Minister
Ministryy of Healthh and Welffare, Taiwaan
5
From
F thee Ministrry of Heealth and
d Welfaree, Taiwan
On
O behalf off the Conferrence Steering Committtee, welcomme to the 10thh Southeastt Asia and Western
W
Pacific
P Bi-reggional TEPH
HINET Scieentific Confe
ference in Taaipei, Taiwan
n.
The
T theme of this year’s conference is “Combatting Emergiing and Reem merging Pubblic Health Threats
T
th
hrough Regiional Field Epidemiolog
E gy Training N Networks.” Since the last TEPHIN NET meetingg in Taiwan
in
n 2007, we hhave experieenced severaal emerging ddisease outb breaks, includ ding pandemmic influenzza H1N1 in
2009, MERS in 2012 andd 2013, and now, COVIID-19. In ad ddition, we have
h had a nu number of reeemerging
diseases,
d incluuding Ebolaa infection inn West Africca, Zika viruus infection in the Amerricas in 20166, and
measles
m in thhe Pacific Isllands in 20199. In responnding to eachh outbreak, we are remiinded of thee importance
of
o having an FETP netw work, througgh which wee can share firsthand
f infformation annd experiencce.
I regret that, instead of sitting

s in a conference rroom in Taip pei, you are joining
j us viia videoconfferencing
because
b of thhe COVID-19 pandemiic. Taiwan haas so much to offer in terms t of hisstory, culturee, and naturee.
I hope you wwill be able to
o visit us heere in the neaar future.
Once
O again, w
welcome, an
nd I wish you a successfful conferen
nce.
Jui-Yuan n Hsueh,, MD, LLM M

Deputy Minister
M
Ministryy of Healthh and Welffare, Taiwaan
6
From
F thee Centerss for Dissease Coontrol, Taaiwan
Welcome
W to tthe virtual 10th Southeaast Asia andd Western Paacific Bi-regiional TEPH
HINET Scien
ntific
Conference.
C
Responding
R tto COVID-19 means th hat we are teesting out many of the control
c meassures that we
w have
planned
p for yyears, from quarantine
q to
t social disttancing, to mass
m vaccinaation. Usingg current techhnology, wee
have
h been abble to better implement our control measures an nd understan
nd the effecctiveness of our
in
nterventionss.
Getting
G togetther to sharee our love of
o public heaalth, our exp
periences as trainers andd trainees, an
nd our proud
trraditions froom differentt cultural bacckgrounds hhas been an important part
p of beingg a member of the FET TP
faamily. Even though the pandemic iss keeping uss physically apart,
a througgh technoloogy, we can still
s meet. It
may
m be a bit more difficuult to chat withw someonne from a diffferent program at the cconference, but I hope
we
w can still taake the oppo ortunity to get
g to know each other and learn from each othher.
I want to usee this occasio

on to thank SAFETYN NET for their unflinchin
ng support inn putting toggether this
co
onference. TTheir guidan nce has been
n immeasuraably valuablee.
Once
O again, w
welcome, an
nd enjoy the conferencee.
Jih-Haww Chou, D DDS, MPH H

Directorr-General
Centers for Diseasse Control, Taiwan
7
Conference Steering Committee
Dr. Jui-Yuan Hsueh, Chair

Deputy Minister, Ministry of Health and Welfare, Taiwan
Dr. Jih-Haw Chou, Vice Chair

Director-General, Centers for Disease Control, Taiwan
Dr. Carl Reddy, Committee Member

Director, TEPHINET
Dr. Maria Consorcia Lim-Quizon, Committee Member

Executive Director, SAFETYNET
Dr. Kip Baggett, Committee Member
Chief, Workforce and Institute Development Branch, Division of Global Health Protection, Center for
Global Health, Centers for Disease Control and Prevention, United States
8
Conference Scientific Committee
Dr. Feng-Yee Chang, Chair

Professor and Deputy Superintendent, Tri-Service General Hospital, Former Director-General, Centers for
Disease Control, Taiwan
Prof. Martyn Kirk, Vice Chair
Advisory Board, TEPHINET
Dr. Angela Hilmers, Committee Member

Chief Scientist, TEPHINET
Dr. Maria Concepcion Roces, Committee Member

Senior Technical Officer, SAFETYNET
Dr. Alden Henderson, Committee Member
Epidemiologist, Division of Global Health Protection, Center for Global Health, Centers for Disease
Control and Prevention, United States
Dr. Karoon Chanachai, Committee Member
Former Director, Field Epidemiology Training Program for Veterinarians, Thailand (served until May
2020)
Dr. Fadzilah Kamaludin, Committee Member
Deputy Director, SAFETYNET
Dr. Shan-Chwen Chang, Committee Member

Executive Vice President, National Taiwan University, Taiwan
Dr. Jung-Der Wang, Committee Member
Honorary Chair Professor, Department of Public Health, College of Medicine, National Cheng Kung
University, Taiwan (served until July 2021)
Dr. Chih-Hsien Lin, Committee Member
Deputy Director, Animal Health Inspection Department, Bureau of Animal and Plant Health Inspection
and Quarantine, Taiwan
Dr. Wan-Ting Huang, Committee Member
Attending Physician, National Taiwan University Children’s Hospital, Taiwan
Dr. Song-En Huang, Committee Member

Medical Officer, Centers for Disease Control, Taiwan
Dr. Wan-Chin Chen, Committee Member
Director, Taiwan Field Epidemiology Training Program, Centers for Disease Control, Taiwan
(Representative of Local Host Committee)
9
Local Host Committee
Dr. Philip Yi-Chun Lo, Chair

Deputy Director-General, Centers for Disease Control, Taiwan
Ms. Ju-Hsiu Teng, Vice Chair

Chief Secretary, Centers for Disease Control, Taiwan
Dr. Wan-Chin Chen, Executive Secretary

Director, Taiwan Field Epidemiology Training Program, Centers for Disease Control, Taiwan
Ms. Yumin Chou, Committee Member

Director, Division of Planning and Coordination, Centers for Disease Control, Taiwan
Ms. Kai-Ling Tsao, Committee Member

Director, Public Relations Office, Centers for Disease Control, Taiwan
Mr. Jui-Wei Hsieh, Committee Member

Former Director, Taipei Regional Center, Centers for Disease Control, Taiwan (served until July 2021)
Mr. Shih-Hao Liu, Committee Member

Director, Taipei Regional Center, Centers for Disease Control, Taiwan
Dr. Song-En Huang, Committee Member

Medical Officer, Centers for Disease Control, Taiwan
10
Abstract Reviewers
Valan Adimai Siromany Wan-Ting Huang Michela Sabbatucci

Joseph Agboeze Hsin I Huang Noureddine Sakhri
Mohammed Al Amad Hamid Hussain Muhammad Saleem
Muhammad Asri Amin Zakir Hussain Anak Agung Sagung Sawitri
Miracle Destine Apollon Sarah Jayme Siddharudha Shivalli
Rana Jawad Asghar Fadzilah Kamaludin Yuwono Sidharta
Tin Tin Aye Ernest Kateule Ajay Kumar Singh
Yin Myo Aye Ismeet Kaur Frans Yosep Sitepu
Delia Akosua Bandoh Martyn Kirk Samir Sodha
Ana Maria Barrientos Llovet Jana Lai Chia-ping Su
Mallick Masum Billah Pin Hui Lee Ma. Nemia Sucaldito
Gemechu Gudina Bulcha Yung-Ching Lin David Sugerman
Oneida Castañeda-Porras Chiedza Machingaidze Sangwoo Tak
Karoon Chanachai Hetani Mdose Sukarma Tanwar
Meng-Yu Chen Mary Elizabeth Miranda Tsung Pei Tsou
Wan-Chin Chen Diane Morof Noorhaida Ujang
Thilaka Chinnayah Hamufare Mugauri Aishat Usman
Sushma Choudhary Syed Nadeem ur Rehman Ma. Elaine Joy Villareal
Esther Liliana Cuevas Ortiz Meenakumari Natarajan Grace Viola
Alethea De Guzman Howard Nyika Ngoc Long Vu
Vikki Carr de los Reyes Amy Parry Hsin-Yi Wei
Ahmed Ehsan Amol Patil Krista Wilkinson
Touria Essayagh Saraswathi Bina Rai Seymour Williams
Muhammad Hakim Carl Reddy Thanachol Wonghirundecha
Lisa Hansen Maria Concepcion Roces Rajesh Yadav
Alden Henderson Erika Rossetto
Song-En Huang Eduardo Saad
11
Pre-Conference Workshops
Workshop 1: I am scared of (adverse events following) immunizations — vaccine

safety evaluation and communication
Organizer: Taiwan FETP
Despite having been administered safely for decades, public health and healthcare practitioners may still find
the evaluation and communication about vaccine safety daunting tasks. With new vaccines and vaccine
platforms being used for COVID-19 prevention and control, any adverse event following immunization
(AEFI) may lead to the loss of confidence in COVID-19 vaccines and sow distrust in government disease
control efforts. The objectives of this workshop are to help participants in understanding post-introduction
AEFI surveillance, AEFI investigation and causality assessment, hypothesis strengthening using background
rates, hypothesis testing using controlled studies, and communication response to vaccine-related events
(VRE). The workshop will use real-life examples for an interactive case study, to facilitate participants’
understanding of vaccine safety evaluation and communication.
Workshop 2: Developing FETP Curriculum for Field Epidemiology in Pandemics
Organizer: FETP, Bangladesh
Many FETP fellows and graduates responded to the COVID pandemic. While their FETP training involved
investigation of small and localized disease outbreaks, the COVID response is larger in scope, magnitude and
complexity than most FETP field projects. The response also presented additional challenges with lack of
knowledge of the new virus and its pathogenicity, insufficient resources to respond, use of unfamiliar control
efforts such as quarantine, contact tracing and non-pharmaceutical interventions, and need to respond quickly.
Most FETP curriculum do not contain these topics. We convene a workshop to develop a curriculum that will
teach FETP graduates, future FETP cohorts and other public health professionals how to respond to a
regional epidemic or a global pandemic.
Workshop 3: EpiCore, Crowdsourcing Verification Activities Locally to Enable
Epidemic Intelligence Worldwide
Organizer: ENDING PANDEMICS
Epidemic intelligence (EI) aims to produce timely and verified intelligence on potential public health events
through systematic collection of health information across the one health spectrum from a variety of sources
which is validated, analyzed, and assessed.
The purpose of EI is to speed up the detection of new health threats and to define appropriate control
measures to be acted upon by health authorities.
The EI landscape has gone through several changes recently, including the introduction of new
communication technologies and the increase of collaborative initiatives among health organizations from
different levels and sectors. Today, one of the most relevant EI challenges is the management of an increasing
12
volume of early warning signals, generated by innovative Event-Based Surveillance (EBS) activities, that can
affect the health authorities in their daily work.
EpiCore™ (https://epicore.org/) aims to support the public health verification of EI signals through the
voluntary contribution of a network of animal, environmental, and human health professionals actively
collecting information at the local level in response to unofficial reports. Health professionals can contribute
to global health security by enhancing EI activities that complement the verification and risk assessment
processes implemented by the health authorities.
Participants will discuss recent EI developments in different contexts and learn about EpiCore project: they
will have the opportunity to become members and be actively engaged in the public health events verification
and assessment processes, to be supported in addition to their regular health professional roles. Participants
will be provided with a certificate and have access to EpiCore platform.
Workshop 4: Understanding Infectious Disease Modelling
Organizer: Strengthening Preparedness in the Asia-Pacific Region through Knowledge (SPARK) Modelling
Network
"Public health and biosecurity responses to infectious disease outbreaks can be informed by disease modelling.
This introductory workshop will give participants an understanding of infectious disease models and their
value for public health. The workshop will cover the use of modelling to examine disease causes and to assess
strategies for control in the context of a variety of infectious diseases. No prior detailed knowledge of
modelling infectious diseases or epidemiology is required, and only high school level mathematics is needed.
The workshop provides an excellent opportunity for students and researchers with an interest in the topic to
see a broad range of modelling techniques applied to disease transmission. It aims to demonstrate how these
techniques can support decision-making. The workshop is targeted at a broad range of participants including
epidemiologists, clinicians and public health professionals.
Workshop 5: Evaluating the Impact of Field Epidemiology Training
Organizer: Field Epidemiology in Action
Despite the success of the FETP model globally, there have been relatively few evaluations published. Those
evaluations that have been published have focused on variables that are easy to measure, such as process
indicators (e.g. reaction of trainees to the training) or simple output indicators (e.g. number of students
graduating). There are very few evaluations focusing on the outcomes and impact of FETPs. As the key driver
behind FETPs is to improve the health of populations by improving the ability to detect, investigate and
respond to public health threats, the utility of evaluations focusing solely on process and output indicators is
extremely limited.
International development agencies are placing increasing emphasis on addressing development effectiveness
and impact. Given the high monetary and opportunity costs of FETP programs, there has been a move
towards demonstrating value for money and measuring impact. Demands for increased accountability and
demonstrated returns on investment have not only come from donors, but also from program beneficiaries.
This workshop will introduce participants to different methods for training evaluation, including review of a
mixed-method impact evaluation framework currently being used to evaluate FETP programs in Papua New
13
Guinea and Solomon Islands. No prior evaluation experience is necessary. Evaluation experts and practitioners
will share firsthand experiences of evaluation methods to walk participants through evaluation methodologies
in a practical step-by-step manner. Participants will engage in small group discussions and activities that guide
reflection and critiques of how different impact evaluation approaches relate to their own program contexts.
At the conclusion of this workshop, participants will be able to:
 Recognize the diverse range of training evaluation methods and approaches
 Describe how Theory and Change, Kirkpatrick’s Four Levels of Learning Evaluation, and Success Case
methodologies can contribute to FETP impact evaluation
 Assess the relevance and practicality of different evaluation methods in their contexts
 Develop a draft impact evaluation framework for a specific FETP
Workshop 6: FETP From Face-to-Face to Blended Modality
Organizer: EMPHNET
The COVID-19 pandemic affected the continuity of many running FETP programs and interrupted their
training agenda, most of the planned face to face workshops were cancelled or postponed and this resulted on
extending the programs duration. The main reasons were due to the restrictions associated with the pandemic
(social distancing and lockdown). In addition, most of the trainers as well as the residents are taking part in the
response and control measures. Even before the pandemic, many regions and interested public health
workforces have had limited opportunities to join FETP. Among the causes reported are that their workplaces
cannot withstand absenteeism, personal, social, or economic reasons, as well as the ongoing emergencies and
security concerns.
Within this context, a need arose to evolve existing training modalities to respond to changing public health
context and demand. Some developments are the establishment of online training modules, the establishment
of more intermediate and basic FETPs in the region, the introduction of courses specific to COVID-19,
development of case studies, and more operational research work.
EMPHNET works with CDC and the FETP technical advisors in the countries to review the existing
intermediate FETP training materials and to ensure that they are in line with updated training materials.
EMPHNET has converted the reviewed training materials including the presentations, case studies and the
mentor training package to online content. To meet the countries’ needs, EMPHNET has developed the basic
and intermediate FETP in Arabic and French language in addition to the English language. FETPs in the
target countries are provided with the access to the online intermediate FETP training package and trained
them on its use.
Now those FETP levels are provided as blended training where both online/remote sessions are
complemented by interactive workshops. The model keeps the same amount of learning hours (LH) as in the
classic program. The difference is in the modality where classes are partially flipped. In this model, theoretical
sessions are provided as self-learning materials and interactive workshops are preserved for the exercise, group
projects, and cases studies. Despite being a promising modality in delivering the FETP, the experience is faced
by some challenges that EMPHNET, together with CDC, are working to solve them.
The overall goal of this preconference workshop is to share EMPHNET experience in converting the FETP
from face-to-face to blended modality.
Specific objectives of workshop are
14
 To explain the blended training model for FETP
 To identify the limitations and possible solutions
 To present the example of the blended Intermediate and Basic FETP
Workshop 7: Scientific Writing
Organizer: SAFETYNET
This workshop will focus on the FETP core competency of scientific communication, highlighting four of the
written outputs required by many programs. Starting off with an overview of scientific writing style applicable
to all FETP deliverables, the following segments will present information and strategies linked to reporting an
outbreak investigation, evaluating a surveillance system, writing up the analysis of primary or secondary data in
a quantitative manuscript, and finally wrapping up with abstract development.
If you are planning to write a similar paper or abstract, or are currently writing it, this session will provide tips
and tools to make your paper clearer and more concise. Bring your specific questions and challenges to share
at this workshop.
Workshop 8: Accreditation/Program Quality for Intermediate-Level FETPs
Organizer: TEPHINET
TEPHINET’s Accreditation of FETPs has, since 2016, served as a quality standard bearer in this field, with 18
accredited programs representing all regions, and dozens of trained reviewers. The accreditation program
provides an opportunity for FETPs to align with common standards supporting quality training and increased
recognition of the value of FETPs. For the first time, TEPHINET will be rolling out an accreditation process
for intermediate-level programs in 2022. This workshop will provide an opportunity to learn about the
eligibility requirements, the quality standards, and the documentation required for an intermediate program to
be accredited. Participants will also get a peek into the brand-new online application system.
The workshop will be virtual but with interactive methods and lots of time for Q&A.
15
Virrtual To
our
Datee & Time: 133:30–14:30, GMT+8, Friday,

F Novem
mber 5, 20221
Alth
hough the paandemic keppt us apart, it is a pleasur
ure to see eveeryone onlin
ne and know
w that everyoone is health
hy
and doing well. T
The confereence organizzer has orgaanized a live virtual tour to introducce you to Taiiwanese cultture.
Taip
pei City may seem innovvative, but it is also a cityy full of histtory.
The first stop is the North Gate.

G It is th
he only gate that retaineed its originaal Qing Dynnasty appearaance. The
surro
ounding buiildings tell th
he history of Taipei City
ty.
On to
t Bao’an Teemple, wherre Baoshengg Emperor iss worshiped d. Baosheng Emperor w
was a famouss doctor from
m
the Song
S Dynasty and the in
nitial religion
n of northerrn Taiwan.
The third stop is Taipei Con

nfucius Tem
mple. Taipei C
Confucius Temple
T not only
o serves aas a historiccal monumen
nt,
but also
a uses moodern techn nology to enh
hance peoplle's understaanding of Confucianism
m and its histtory.
The last stop is Dadaochengg, where diffferent archittectural stylees are minglled. Several ooriginal business clusterrs
remaain active, suuch as tea, herbal
h mediccine, and fabbrics. Undouubtedly, Dad
daocheng haas been and willw be one of o
the essential
e placces in Taiwaan's history and
a culture.
16
List of Awards
The following awards will be presented during the Closing Ceremony on Friday, November 5,
2021.
Presentation Awards
Best Oral Presentation, 1st Place
Best Oral Presentation, 2nd Place
Best Oral Presentation, 3rd Place
Best Poster Presentation, 1st Place

Best Poster Presentation, 2nd Place
Best Poster Presentation, 3rd Place
17
Pho
oto Conteest Winnerrs
 1st Placee
Ma. Ivy Rozethh Saavedra--Iturralde

Phillippines FE
ETP
Field
d investigatioon on vaccin
ne-derived poliovirus
p tyype 1 with FETP
F fellow
ws and local ppublic health
h personnel in a
soutthern Mindaanao Island, Philippines,, Novemberr 2019.
 2nd Placce
Werrenfridus Leeonardo Lu
uan
Indoonesia FETTP
Foggging focus: T This activityy is carried out

o in the coontext of overcoming deengue hemoorrhagic feveer, which aim ms to
kill adult
a Aedes aaegypti mosquuitoes infectted with thee dengue viruus so that th
here is no peerson-to-perrson
transsmission. Thhis activity was
w carried outo in Tugu Sub-districtt, Guava Villlage, Trengggalek Districct, East Java
Provvince on Jannuary 21, 20220. This colllection was ccarried out during
d field practice 1: aanalysis of health
h probllems
in th
he health offfice of Trengggalek Distrrict, East Javva Province..
18
 3rd Placee
Dag
gmawi Abeb be
Ethiiopia FELT
TP
A phhoto was takken during a surveillance data analyysis activity, in

i Dire Daw
wa, Ethiopia.. Photo capttured on Ap
pril
25, 2021.
2 This iss a field epiddemiology reesident condducting his epidemiolog
e gic surveillannce activity.
 Facebook Vote Winner

W
Salw
wa Yahya M
Mohammed
d Al-Eryani
Yem
men FETP
As in
ntervention during a meeasles outbreak, vitaminn A supplem
ment for meaasles contactts were given
n by Y-FET
TP
dent in Amraan, Yemen, March 17, 2021.
resid 2
19
Agenda at-a-Glance, GMT+8
Monday, November 1
08:00 – 17:00 Pre-Conference Workshops
Tuesday, November 2
10:00 – 10:30 Opening
10:30 – 11:30 Keynote Session: Anthropology and Disease Control
11:30 – 11:45 Break
11:45 – 13:15 Opening Oral Session: COVID-19 Dominated All Aspects of Our Lives
13:15 – 13:30 Break
Oral Presentation Sessions
13:30 – 15:00 (OP 1) Effects of COVID-19 (OP 2) Non-Communicable Diseases
(OP 3) Outbreak Investigation and Response (OP 4) Surveillance
Wednesday, November 3
10:00 – 11:30 Plenary Session 1: Re-Emerging Vaccine Preventable Diseases
11:30 – 11:45 Break
11:45 – 13:15 Plenary Session 2: One Health Approach to Outbreak Response
13:15 – 13:30 Break
Oral Presentation Sessions:
13:30 – 15:00 (OP 5) COVID-19 Transmission (OP 6) Animal Health and Zoonotic Diseases
(OP 7) Vaccine Preventable Diseases (OP 8) More on Surveillance
Thursday, November 4
10:00 – 11:30 Plenary Session 3: Field Epidemiology Training Development Strategies
11:30 – 11:45 Break
11:45 – 13:15 (OP 9) Therapeutics (OP 10) Severe Illnesses and Deaths
(OP 11) Foodborne Diseases (OP 12) Vectorborne Diseases
13:15 – 13:30 Break
13:30 – 15:00 (OP 13) More on COVID-19 (OP 14) Environmental Health
(OP 15) Healthcare-Associated Infections (OP 16) Malaria
Friday, November 5
10:00 – 11:30 Plenary Session 4: Communication, Ethics, and Equity in Public Health Emergencies
11:30 – 11:45 Break
11:45 – 13:15 (OP 17) Vaccine Safety (OP 18) More on Vaccine Preventable Diseases
(OP 19) Other Infectious Diseases
13:15 – 13:30 Break
13:30 – 14:30 Virtual Tour
14:30 – 15:00 Closing
20
10:30 – 11:30, Tuesday, November 2
Keynote Session: Anthropology and Disease Control
1. Anthropology: A Timely Discipline for Field Epidemiologists
Speaker: Prof. Shao-hua Liu

Opening Oral Session: COVID-19 Dominated All Aspects of Our Lives
1. Retrospective Epidemiological Analysis of SARS-CoV2 Wastewater Surveillance and Case Notifications Data — New South Wales,
Australia, 2020
Presenter: Hendrik Camphor
2. Characteristics and Risk Factors Associated with Severe Coronavirus Disease 2019 (COVID-19), Taiwan, January–June 2020
Presenter: Yang Li
3. COVID-19 Vaccine Acceptance among Health Care Workers: A Cross-Sectional Survey in North Sumatera, Indonesia, 2020
Presenter: Frans Yosep Sitepu
4. Impact of COVID-19 on Diagnosis and Treatment of Pulmonary Tuberculosis in Tianjin, China, 2020
Presenter: Guoqin Zhang

Oral Presentation Session 1: Effects of COVID-19
1. Assessment of Functional Health Status and Persistence of Symptoms among Recovered COVID-19 Individuals, Tamil Nadu,
India 2020
Presenter: Suganya Barani
2. Estimation of Out-of-Pocket Expenditure on COVID-19 Treatment among Patients Managed at Home, Iraq, 2020
Presenter: Falah A. Saeed
3. Surveillance of Vaccine-Preventable Diseases in Iraq during the COVID-19 Pandemic: How much were They Affected?
Presenter: Aqeel Ismaeel
4. Understanding COVID-19 ‘Infodemics’: An Analysis of User-Generated Online Information about Public Health Interventions
during a SARS-CoV-2 Outbreak in Vietnam, July–September 2020
Presenter: Ha-Linh Quach
Oral Presentation Session 2: Non-Communicable Diseases

1. Self-Care Practice and Predicting Factors among Hypertensive Patients in Debre Tabor Referral Hospital, Northwest Ethiopia
Presenter: Shegaw Gelaw
2. Surveillance Data Analysis of Severe Acute Malnutrition in East Hararghe Zone, Oromia Region, Ethiopia, 2011–2015
Presenter: Biniyam Teshome
3. Assessment of the Availability and Readiness of Hypertension Management Services at Primary Healthcare Facilities — Central
Highland region, Vietnam, 2020
Presenter: Thang Hoang
4. Estimation of the Relapse Time to Drug Use in Adolescents — San Jose, Costa Rica, 2018
Presenter: Jose Diaz
Oral Presentation Session 3: Outbreak Investigation and Response

1. Dengue Outbreak in a Coastal Municipality in Catanduanes, Philippines, 2019
Presenter: Richelle Abellera
2. A Case-Control Study on the Measles Outbreak in Mati City — Davao Oriental, January 2020
Presenter: Karla May Manahan
3. The Effectiveness of Class Suspension on Containing Enterovirus Infection Clusters in Preschools — New Taipei City, Taiwan,
2013–2017
Presenter: Yu-Neng Chueh
4. Food Poisoning Outbreak at Night before Eid-Al-Fitr at Islamic Boarding School — Gunungkidul Regency, Indonesia, May 2021
Presenter: Nadiyah Kamilia
Oral Presentation Session 4: Surveillance

1. Data Analysis of the Nutrition Surveillance System, Yemen, 2019
Presenter: Sumia Alturki
2. Consistency of Mobile or Email-Based Reporting to Surveillance System by Private Health Facilities, Poonamallee Health District,
Tamil Nadu, India: A Parallel Group, Exploratory Randomized Open Trial
Presenter: Abishek Stanislaus
21
3. Leptospirosis in Seberang Perai Utara Penang 2015–2019 — The Need to Improve Investigations
Presenter: Wye Lee Chiew
4. Enhanced Event-Based Surveillance for Infectious Diseases during the Tokyo 2020 Olympic and Paralympic Summer Games in
Japan, 2021
Presenter: Ayu Kasamatsu
10:00 – 11:30, Wednesday, November 3

Plenary Session 1: Re-Emerging Vaccine Preventable Diseases
1. Global and Regional Update on Polio
Speaker: Jaymin Patel
2. Measles — Is the Time to Act Now? A Global and Regional Update
Speaker: Meru Sheel
3. COVID-19 Vaccines: How can We Achieve Equitable Distribution and Combat Vaccine Hesitancy to Achieve High Vaccine
Uptake
Speaker: Margie Danchin

Plenary Session 2: One Health Approach to Outbreak Response
1. A Recipe for Good Investigation of Foodborne Disease Outbreaks
Speaker: Martyn David Kirk
2. Successes and Challenges of One Health Approach to Animal Disease Control
Speaker: Sith Premashthira
3. Integrating the Knowledge of Epidemiology and Wildlife Ecology for Understanding the Ecology of Wildlife Origin Pathogens
Speaker: Chen-Chih Chen

Oral Presentation Session 5: COVID-19 Transmission
1. The Detection and Management of Coronavirus Disease 2019 (COVID-19) Outbreak Caused by Imported Cases to Thailand and
Identification of Potential Risks in the Origin Country
Presenter: Kanokkarn Sawangsrisutikul
2. Timeliness of Contact Tracing among Flight Passengers during the COVID-19 Epidemic in Vietnam
Presenter: Ngoc-Anh Hoang
3. COVID-19 Risks in a Restaurant Superspreading Event — Singapore, July 2021
Presenter: Gao Qi
4. The Impact of Arbaeenia Mass Gathering on the Trajectory of COVID-19 in Iraq, 2020
Presenter: Mohammed S. Abdulwahid
Oral Presentation Session 6: Animal Health and Zoonotic Diseases

1. Epidemiological Features of Human Brucellosis — Georgia, 2015–2019
Presenter: Mariam Pashalishvili
2. Case Investigation of Animal Rabies near Thai-Myanmar Border, Northern Thailand, February–March 2020
Presenter: Suwitcha Panchakhan
3. Epidemiological Profile of the Rift Valley Fever in Ruminants — Mauritania, 2002–2014
Presenter: Yacoub Ould Sidi Moctar
4. Investigation of Tuberculosis in Captive Asian Elephants, Kanchanaburi province, Thailand, November 2018
Presenter: Kirana Noradechanon
Oral Presentation Session 7: Vaccine Preventable Diseases

1. Measles Elimination Program Progress in Madhubani District, Bihar, India, 2015–2018
Presenter: Sambit Pradhan
2. Diphtheria Outbreak in Sahar District, Sa’adah Governorate — Yemen, 2020
Presenter: Elham Zeehrah
3. Using Epidemiological Data on a Vaccine-Derived Poliovirus Type 1 (VDPV1) Polio Event in a Southern Mindanao Island to
Guide Outbreak Response — Philippines, November 2019
Presenter: Ivy Rozeth Saavedra-Iturralde
4. Measles Cases in Conflict Areas, Yemen, 2018–2019
Presenter: Waleed Hasan Al-Marrani
22
Oral Presentation Session 8: More on Surveillance
1. COVID-19 Pandemic: Understanding the Trend, Distribution and Surveillance of COVID Cases in Udupi District, Karnataka,
2020
Presenter: Prashant Bhat
2. Assessment of Dengue Disease Surveillance in One of the High Prevalent Districts in Maharashtra, India, 2020
Presenter: Rahul Shimpi
3. Surveillance System Evaluation of COVID-19 National Health Portal — Maharashtra, India, March–April 2020
Presenter: Bomto Riram
4. Importance of COVID-19 Surveillance and Health Profiling of Filipino Repatriates from MV Diamond Princess, Capas, Tarlac,
Philippines, 2020
Presenter: Richelle Abellera
10:00 – 11:30, Thursday, November 4

Plenary Session 3: Field Epidemiology Training Development Strategies
1. The Global Field Epidemiology Roadmap—From concept to Action
Speaker: Kip Baggett, Carl Reddy
2. Learning in the Global FETP Community: FETP Learning Strategy Implementation Updates and Strategies during the Pandemic
Speake: Manickam Ponnaiah
3. Completing the Journey—Field Epidemiology Training Program in Papua New Guinea
Presenter: Tambri Housen, Berry Ropa

Oral Presentation Session 9: Therapeutics
1. Effects of Hydroxychloroquine with or without Azithromycin on SARS-CoV-2 Clearance in COVID-19 Patients, Taiwan, March–
June 2020
Presenter: Yi-Ting Yang
2. Anti-Retroviral Therapy for People Living with Human Immunodeficiency Virus — Yemen, 2018–2020
Presenter: Ehab Al-Sakkaf
3. Survey of Accessibility, Availability, Price and Affordability of Essential Medicines and Diagnostic Technologies for the Clinical
Measure and treatment of Hypertension on Primary Health Care Units of West Gojjam Zone, Northwest Ethiopia, 2020
Presenter: Zelalem Yirga
4. Evaluation of Community Pharmacists’ Involvement and Barriers to Their Participation in Public Health Activities, Assiut, Egypt,
2019
Presenter: Azza Badry
Oral Presentation Session 10: Severe Illnesses and Deaths

1. Investigation of COVID-19 Deaths among the Staff of a University in Aligarh, Uttar Pradesh, India, May 2021
Presenter: Mukesh Kumar Prasad
2. Sex-Based Variations in Clinical Manifestations, Co-Morbidities, and Outcome of COVID-19 Patients in Baghdad, Iraq, 2020
Presenter: Nameer A. Ali
3. COVID-19 Mortality, Kerala, India 2020: A Descriptive Study
Presenter: Ajan M J
4. Diseases and Mortality Representation among Children of the Uitoto Indigenous People of the Colombian Amazon, 2019–2020
Presenter: Marcela Benavides
Oral Presentation Session 11: Foodborne Diseases

1. Kluang Prison Acute Gastroenteritis Outbreak — February 2020
Presenter: Jeyanthini Sathasivam
2. Norovirus Foodborne Outbreak in a Buffet Restaurant — Yilan, Taiwan, August 2020
Presenter: Ching-Hui Huang
3. An Outbreak of Food Poisoning after Consumption of Chicken Curry Contaminated with E. coli in an Old-Age Home, Kannur
District, Kerala, India, 2019
Presenter: Sachin KC
4. Clostridium Perfringens Suspected as Causative Pathogen of Foodborne Outbreak in a Wedding Party-Bantul District, Indonesia,
March 2021
Presenter: Fitriana Puspitarani
23
Oral Presentation Session 12: Vectorborne Diseases
1. Nairobi Fly Dermatitis Outbreak — Boditi, Southern Ethiopia, April 2019
Presenter: Mesay Gunta Gutulo
2. Evaluation of Scrub Typhus Surveillance System — Alwar District, Rajasthan, India, July–August 2020
Presenter: Surendra Mohan Prajapati
3. Case Series: SARS-CoV-2 and Dengue Virus Coinfection in Mexico
Presenter: Noé Hernández Valdivia
4. Dengue Outbreak — Ipil, Zamboanga Sibugay Province, Philippines, 2019: A Case-Control Study
Presenter: Kasmira Maramag

Oral Presentation Session 13: More on COVID-19
1. Outbreak Investigation of Early Coronavirus Disease Cases — Maharashtra, India, March 2020
Presenter: Bomto Riram
2. Comparison of COVID-19 Outbreak Cases in Two Different Call Centers
Presenter: Sangeun Lee
3. Descriptive Epidemiology of COVID-19 in Pathanamthitta District, Kerala, India, March–September 2020
Presenter: Amjith Rajeevan
4. Assessment of Baseline Knowledge and Attitude of COVID-19 among Hotel Staff in Kigali, Rwanda, 2020
Presenter: Aphrodis Hagabimana
Oral Presentation Session 14: Environmental Health

1. An Outbreak of Acute Seizure Illness ─ Eluru, Andhra Pradesh, India, December 2020
Presenter: Sahil Sharma
2. Emergence of Schistosomiasis in a Previously Non-Endemic Area, Leyte, Philippines, December 2018
Presenter: Francis Guimpatan
3. Sudden Deaths due to Leakage of Lindane, a Hazardous Chemical, Jalalpur Village, Sitapur, Uttar Pradesh, India, 2020: A Field
Epidemiological Investigation
Presenter: Piyush Jain
Oral Presentation Session 15: Healthcare-Associated Infections

1. COVID-19 Outbreak in Health Workers, Hospital Nacional Psiquiátrico, Costa Rica, 2020
Presenter: Jose Diaz
2. Descriptive Epidemiology of COVID-19 Affected Health Care Personnel (HCP), from a Tertiary Care Cancer Hospital of Delhi,
March–May 2020
Presenter: Nishant Nirwan
3. Clusters of Hepatitis C Virus Infection among Patients Receiving Chronic Hemodialysis in Three Hemodialysis Facilities —
Northern Region, Taiwan, 2019–2020
Presenter: Pei-Yuan Wu
4. Epidemiology of Traumatic Injection Neuropathy among Acute Flaccid Paralysis Cases in Yemen, 2013–2018
Presenter: Khaled Al-Jamrah
Oral Presentation Session 16: Malaria

1. Malaria in Cambodia: A Retrospective Analysis of a Changing Epidemiology, 2006–2019
Presenter: Srean Chhim
2. Assessment of Adherence to National Malaria Clinical Management and Testing Guidelines in Selected Private Clinics of Gambela
Town, Gambela Region, Ethiopia, February 2020
Presenter: Yamlak Gindola
3. System Evaluation of Malaria Surveillance, N’dorola Health District, Burkina Faso, May 2020
Presenter: Brahima Traore
4. Malaria Outbreak in Bali Sa'ad District, Almahwit Governorate, 2020
Presenter: Samar Nasher
24
10:00 – 11:30, Friday, November 5
Plenary Session 4: Communication, Ethics, and Equity in Public Health Emergencies
1. The Many Aspects of Policy Communication in Health Emergencies
Speaker: Kumnuan Ungchusak
2. Emergency Response: Communications, Ethics, and FETP’s Role
Speaker: Steven Peng-Lim Ooi
3. It’s a Small World After All: Health Equity in Public Health Emergencies
Speaker: Nina T. Castillo-Carandang
11:45 – 13:15, Friday, November 5

Oral Presentation Session 17: Vaccine Safety
1. Incidence of Adverse Events Following Yellow Fever Mass Immunization Campaign — Katsina State, Nigeria, 2019
Presenter: Amadu Lawal
2. A Cross-Sectional Survey of COVID-19 Vaccine Acceptance among Adults in Taiwan, 2021
Presenter: I-Ping Lin
3. Analysis of Death Cases and Adverse Events Following Immunization (AEFI) with Influenza Vaccines in the 2020–2021 Season in
the Republic of Korea — Focused on Social Panic and the Reported Rate of Adverse Events
Presenter: Hee Kyoung Kim
4. Epidemic Dengue Observed during COVID-19 Pandemic in Singapore, 2020
Presenter: Pui Li Teoh
Oral Presentation Session 18: More on Vaccine Preventable Diseases

1. Emergence of Circulating Vaccine-Derived Poliovirus Type 2 — Marogong, Lanao Del Sur, Philippines, September 2019
Presenter: Nolie Rimando
2. Serosurvey of SARS-CoV-2 Infection in Garment Workers of a Selected District in Bangladesh, 2020
Presenter: Shahta Zarab Salehin
3. Seroprevalence of COVID-19 among Healthcare Workers in Primary Healthcare Centers in Al-Sader City, Baghdad, Iraq, 2020
Presenter: Raheem Hussein Zayer
4. A Case Report of a Child with Immunodeficiency-Related Vaccine-Derived Poliovirus Type 2, Laguna, Philippines, September
2019
Presenter: Alethea De Guzman
Oral Presentation Session 19: Other Infectious Diseases

1. Recent Surge of Genital Chlamydia Disease among Young Male and Female in Japan
Presenter: Tomohiko Ukai
2. Prevalence and Predictors of Renal Dysfunction among People Living with Human Immunodeficiency Virus on Antiretroviral
Therapy in the Southern Highland of Tanzania: A Hospital-Based Cross-Sectional Study
Presenter: Mololo Noah
3. A Case-Control Study on the Melioidosis Outbreak in Isabela Province and Santiago City, Philippines, 2019
Presenter: Karla May Manahan
4. Antibiotic Prescription Pattern in Primary Health Care Centers - Bauchi State Nigeria, 2019: Experience from Nigeria State Health
Investment Project (NSHIP)
Presenter: Garba Mustapha Umar
5. Proximity in Work-Setting Leading to Transmission of COVID-19 in a Medical Research Institute- Chennai, Tamil Nadu, 2020
Presenter: Nuzrath Jahan
25
9:00 AM, Monday, November 1 - 12:00 PM, Thursday, November 4 (Online Conference Platform)
Poster Session: COVID-19
1. Characteristics and Risk Factors Associated with COVID-19 Infection Severity among Health Care Workers — Iraq, 2020
Presenter: Inam Hameed
2. COVID-19 Cluster in a Coastal Fishing Community: A Case Control Study ― Poonthura, Kerala, India 2020
Presenter: Lipsy Paul
3. Description of Cases of a COVID-19 Outbreak in a Care Home for Young People Living with Human Immunodeficiency Virus in
Mexico City, 2020
Presenter: Evelyn Guadalupe Pineda Lopez
4. Evaluation of Point of Entry Surveillance for COVID-19 — Mumbai International Airport, India, July 2020.
Presenter: Khyati Aroskar
5. Knowledge, Attitudes and Practices of Populations in 5 Regions of Burkina Faso on COVID-19, October 2020
Presenter: Ouedraogo Jean-Baptiste
6. Post-Recovery Symptoms and Rehabilitation Needs among COVID-19 Survivors — A Cross-Sectional Study from Puducherry,
India, 2020
Presenter: Ravivarman Lakshmanasamy
7. Role of Event-Based Surveillance (EBS) in Early Detection of COVID-19 — Egypt, 2020–February 2021
Presenter: Mohamad Fawzy
8. The First Month COVID-19 Cases in Indonesia: Epidemiology and Outcome
Presenter: Defi Amalia
9. Prevalence of Depression, Anxiety, and Stress and Associated Factors among Individuals Working at Military COVID-19
Quarantine Facilities in Northern Vietnam
Presenter: Dan Phan Tan
10. Evaluation, Challenges and Cost Analysis of the Thailand Global HEARTS Package on Healthy Lifestyle and Blood Pressure
Control among Hypertensive Patients, Angthong Province, 2019–2020
Presenter: Charuttaporn Jitpeera
Poster Session: Non-Communicable Diseases
1. Evaluation, Challenges and Cost Analysis of the Thailand Global HEARTS Package on Healthy Lifestyle and Blood Pressure
Control among Hypertensive Patients, Angthong Province, 2019–2020
Presenter: Charuttaporn Jitpeera
2. Identifying the Scope of Task Shifting for Delivering Community-Based Hypertension Control Program in the Bhopal District
Presenter: Ashish Krishna
3. Magnitude, Trend and Pattern of Hypertension among Adults Aged 15 and above — Dire Dawa, Ethiopia, from 2015 to 2019
Presenter: Dagmawi Abebe
Poster Session: Vector-Borne Diseases
1. Chikungunya in a Village: An Outbreak Investigation — Udupi, Karnataka, India, February 2020
Presenter: Prashant Bhat
2. Dengue Fever Outbreak Investigation in Al-Hurriya Village, Taiz Governorate, Yemen, 2020
Presenter: Sumia Alturki
3. Investigation of High lethality Associated with Severe Malaria in Children under 5 years at Dori Regional Hospital Center — Sahel
Region, Burkina Faso
Presenter: Berenger Kabore
4. Malaria Outbreak Investigation in Nono Benja Woreda, Jimma-Zone, Ethiopia, 2020
Presenter: Berhanu Abebe
5. Situational Analysis of Dengue in Perlis, Malaysia, 2015–2019
Presenter: Che Muzaini Che Muda
Poster Session: Potpourri
1. Clinical Manifestations, Laboratory Characteristics and Treatment of Toxocariasis Patients Treated with Albendazole: A
Cross-Sectional Study in Northern Vietnam
Presenter: Nguyen Thu Huong
2. Evaluation of the Human Immunodeficiency Virus Epidemiological Surveillance System at Outpatient Treatment Center —
Mauritania, 2020
Presenter: Mohamedou Hmeied Maham
3. Resilience Social Factor Index to Earthquake at West Halmahera District, North Maluku Province, Indonesia, 2019
Presenter: Febriyanti Abd Radjak
4. Seroprevalence of Hepatitis B Virus among Antenatal Clinic Attendees — Gamawa Local Government Area, Bauchi State, Nigeria,
2018
Presenter: Garba Mustapha Umar
26
Tueesday, No
ovember 2
Keyynote Sesssion: Anth
hropologyy and Diseease Conttrol
Prof. Sh
hao-hua L
Liu
Research
h Fellow, Insttitute of Eth
hnology, Accademia Siniica, Taiwan
Professor, Institute oof Anthropoology, Natio
onal Tsing H
Hua Universiity (Joint
appointm
ment)
Edu
ucation
Mayy 2007 Ph.D
D. Sociomedical Scienc es and Anth
hropology, Columbia
C Unniversity
Proffessional Po
ositions
2017/2–2019/22 Asssociate Profeessor, Instituute of Anth
hropology, National
N Tsinnghua Univeersity (Joint
Apppointment)
2011/9–2018/111 Asssociate Reseaarch Fellow,, Institute off Ethnologyy, Academia Sinica, Taiw
wan
2010–2013 Adjjunct Assistaant and Assoociate Profeessor, Deparrtment of Soociology, Naational Taiwwan
Uniiversity
20007/8–2011/99 Asssistant Reseaarch Fellow, Institute off Ethnology,, Academia SSinica, Taiw
wan
Acaddemic Servvices
Interrnational
2018/8–2020/112 Exeecutive Commmittee, Worrld Council of Anthropological Asssociations (WWCAA)
2016/11–2019//10 Boaard Memberr, Society forr East Asiann Anthropology (SEAA)A)
2015/10– Boaard Memberr, East Asiann Anthropollogical Association (EAA
AAA)
2015/7–2019/66 Co--editor, Asiaan Anthropoloogy
2012/7–2017/66 Ediitorial Boardd Member, M Medical Anthropology Quarterly
2012/7–2016/66 Ediitorial Memb ber, Public A
Anthropologgy Section of
o American A
Anthropologisst
2012/7– Ediitorial Boardd Member, H Human Organnization
Taiw
wan
20221/1– Disscipline Coordinator, Annthropologyy and Ethnicc Studies, Miinistry of Sccience and
Tecchnology
20221/1–2021/112 Advvisory Comm mittee Memmber, Researcch Institute for the Hummanities and
d Social
Scieences, Minisstry of Sciennce and Tech
hnology
20220/1–2022/112 R.O
O.C. Committee Membeer, Pacific Sccience Assocciation (PSA A)
20220/11–2022//11 Revview Commiittee Membeer, Dr. Hu Shih S Memorial Chair Proofessorship, Academia
Siniica
2019/5– President, Taiw
wan Society ffor Medical Anthropolo ogy
2018/8–2020/112 Dep puty Executtive Secretarry, Academiaa Sinica Whiite Paper onn Taiwan Rurral
Devvelopment
27
Anthropology: A Timely Discipline for Field Epidemiologists
In the 21st century, the emerging and pressing public health challenges humans face are mostly arising not in the
hospital, but at home (e.g., chronical diseases) and in the field. As such, social and cultural relevance is more
crucial than in the past in our understanding of people’s lifestyle, political environment, and relationship with
animals and the environment, as well as their responses to health interventions.
The main approach and mindset of infectious disease investigation, especially of new outbreaks, are to
understand and control the disease at source. However we define “source,” be it the origin of the outbreak, the
network of infection, or prevention of future transmission, to achieve the intervention goal, control at source
cannot be taken place only in the lab or office. It must also to be done “in the field.” Under the circumstances,
ethnographic, ethnological, or descriptive hypothesis and investigation are critical to confirm the problems under
study and intervention at source.
This ideal approach may sound pragmatic, yet it also requires an epistemic or perspective change to warrant its
application. Epidemiology and anthropology have appropriated key concepts and techniques from each other and
make them relevant to each other’s social investigation. In the current global health era when cultures, peoples,
diseases, and politics greatly influence social worlds beyond borders, collaboration between the two disciplines is
a timely and more critical endeavor than before. In the talk, I would like to begin with a philosophical thinking
related to such joint endeavor. Then, we can turn the more abstract ideas into methodological tools. Hopefully
through this mindset tuning process, we can see pragmatic implications out of conversation between the two
disciplines.
28
Wed
dnesday, N
Novembeer 3
Plen
nary Sessiion 1: Re--Emerging Vaccinee Preventaable Disea
ases
min Patell
Dr. Jaym
Epidemio
ologist, US C
Centers for Disease Con
ntrol and Prrevention
Edu
ucation and Experiencce:
20088, BS, Biologgy & BA, Ennvironmentaal Studies, U

University off North Caroolina at Chaapel Hill
2011, MPH, Gloobal Epidem miology, Emo ory Universiity School of
o Public Heealth
20166, PhD, Infecctious Diseaase Epidemiology, Unive
versity of Noorth Carolin
na at Chapel Hill
Preseent positionn – Surveillan

nce, Innovattion, and Reesearch Teamm Epidemiologist (20188–Present) in
n the Polio
Erad
dication Brannch, US Cen nters for Dissease Controol and Preveention
Glob
bal and R
Regional Update
U on
n Polio
The Global Polioo Eradicatio on Initiative and partnerrs, includingg ministries of

o health, coontinue to ad
ddress
challenges towarrd progress in i the global effort towaards polio eradication. Although
A thhe WHO Afrrican Region n
was certified
c as iinterrupting endemic wiild polioviruus transmissiion in 2020, two countrries in the Eastern
Mediiterranean R Region – Afgghanistan an nd Pakistan – continue to t have endeemic transm mission. The need to
mainntain high poopulation im mmunity to poliovirus
p reemains essen ntial throughhout the woorld but pockkets of
undeer-immunizeed children persist
p due to
t suboptim al vaccinatio on rates of children
c throough essentiial immunizaation
proggrams. Outbrreaks of circculating vacccine-derivedd poliovirus (cVDPV) have been deetected in ovver 30 counttries
acrosss the globe since 2019, including countries in aall WHO reggions except the Americcas. Within the Southeaast
Asia and Westerrn Pacific reggions, cVDP PV outbreakks affected the
t countriess of China, IIndonesia, Malaysia,
M
Myan nmar, Papuaa New Guin nea, and the Republic off the Philipppines since 2019.
2
Disclalaimer: The finndings and connclusions in thhis report are tthose of the auuthor(s) and doo not necessariilyy represent thhe official posittion
of thee Centers for D
Disease Controol and Preventtion/the Agenncy for Toxic Substances
S annd Disease Reggistry
29
Wed
dnesday, N
Novembeer 3
Plen
ases
Dr. Meeru Sheel
Senior Reesearch Felloow, Research
h School of Populationn Health, Co
ollege of Heaalth
and Medicine, Austraalian Nationnal Universitty
Edu ucation and Experiencce

Dr Meru
M Sheel is a senior reesearch fellow and infecctious diseases epidemio ologist at thee Australian National
Univversity. Dr Shheel is curreently also woorking with JJhpiego to support
s glob
bal efforts att COVID19 vaccine rolll
out. Dr
D Sheel’s eexpertise is in n health em
mergencies, innfectious disseases and im mmunizationn; and workks at the nexxus
of th
hese areas.
Dr Sheel holds a Bachelor of o Science in n Biotechnollogy from th he Manipal University
U inn India. Dr Sheel movedd to
Austtralia and earrned a PhD in life scien nces from thhe Queenslan nd Institute of Medical Research an nd the
Queeensland Uniiversity of Technology
T working
w on new vaccinees for bacterrial pathogenns (group A streptococccus).
Dr Sheel undertoook post-do octoral trainiing in parasiite immunollogy with a focus
f on maalaria and visceral
leishm
maniasis beffore transitio oning into public
p healthh. Dr Sheel completed
c the MPhil inn Applied Ep pidemiologyy
(Australia’s MAE E program) in 2017, folllowing whicch she workeed at the Naational Centrre for Immu unisation
Research and Suurveillance. Dr D Sheel hass worked in several dynaamic and challenging ennvironmentss in Australiaa
and in
i the Asia-P Pacific regio
on including India, Cambbodia, Samo oa, American n Samoa. D Dr Sheel has responded to t
severral internatioonal emergeencies in Fiji, Dominica,, Rohingya Crisis
C in Coxx's Bazar Baangladesh. In n January 20020,
Dr Sheel responnded to the Pacific
P measles outbreakk in Tonga, whenw she heelped the naational healthh teams pivo ot to
estab
blishing theirr COVID199 response plan.p Later inn the year, Dr
D Sheel dep ployed to Pappua New Guinea for
COV VID19.
Dr Sheel is a stroong advocatte for gender equity andd passionate about seein ng diverse leaadership parrticularly fro
om
the global
g south.. In 2019, Dr
D Sheel won n the Sciencee and Mediccine award forf the 40 Unnder 40 Most Influentiaal
Asiann-Australianns; and the ANU
A Vice Chancellor’s
C Awards for Impact and Engagemennt in 2020.
Meaasles — Iss the Tim
me to Act Now?
N AG
Global and
d Regiona
al Updatee
Receent years havve seen a gloobal resurgen

nce in measlles includingg in the Wesstern Pacificc Region. Wiith the
COVVID-19 panddemic leadin ng to disrupttion in routiine immunizzation progrrams globallyy, there is a greater risk of
meassles outbreakks globally. This
T talk willl provide a brief updatee on the global and regiional situatio on of measles,
and discuss
d the 22019-2020 measles
m outb
break in the Pacific islan
nd countries.. The talk wi
will also brieffly discuss
impliications on ppractice andd explore waays forward.
30
Wed
dnesday, N
Novembeer 3
Plen
ases
Assoc. Prof. Marrgie Dancchin
A/Prof Margie
M Dannchin MBBS PhD FRAC CP
Group Leader,
L Vacciine Uptake, Murdoch Children's
C Reesearch Instiitute
Paediatriccian, Departtment of General Mediicine, The R Royal Childreen's Hospitaal
Clinician Scientist Feellow and Honorary Prinncipal Felloww, Department of
Paediatriccs and Schoool of Popullation and Global
G Healthh, The Univversity of
Melbourn ne
Director Clinician Sccientist path
hways, The University
U off Melbournee
Chair, Coollaboration on Social Science and Immunisatio
I on (COSSI)
Eduucation and Experiencce
Marggie is a consuultant paediatrician at th
he Royal Chhildren’s Hosspital and an
n Associate P Professor an nd Clinician
Scien
ntist, Univerrsity of Melbbourne and Murdoch C Children’s Reesearch Institute (MCRI)). As leader of the Vacccine
Uptaake Group, M MCRI, her research
r focuuses mainly on vaccine confidence, acceptancee and uptakee, particularlyy
amon ngst high rissk-groups annd in low annd middle-inncome counttries. In Ausstralia, she iss the chair of the
Collaaboration onn Social Scieence in Immmunisation (CCOSSI) Gro oup, chair off the Social SScience Advvisory Boardd
and a member of the Scienttific Advisorry Committeee, National Centre for Immunisatioon Research h and
Survveillance (NCCIRS) and on the COVIID-19 ATAG GI working group. She works closeely with WH HO and Glob bal
Vacccine Demandd Hub and is i part of the Melbournne Children’ss Global heaalth Leadershhip team.
COVVID-19 VaVaccines: How
H can We W Achieeve Equitaable Distrribution aand Comb
bat Vaccin
ne
Hessitancy to Achieve High Vacccine Upt ake
COV VID-19 vacccines are the key solution n to controll the pandemmic and resu ume our prevvious way of life. Vaccin ne
rollouts have com mmenced gllobally with over 890 m million doses delivered so o far, but suppply issues are
a considerrable
for many
m countrries and equiitable distrib
bution remaiins a criticall issue. Additionally, withh serious vaaccine adversse
events being assoociated with h some COV VID-19 vacccines, effectiive risk communication,, communityy engagemen nt
with all sectors oof the comm munity, especcially vulnerrable and at--risk groups,, and strongg leadership from
goveernment are crucial to acchieve sustaiined vaccinee confidencee and uptakee. Overcomiing vaccine hesitancy
h an
nd
refussal and strateegies to achiieve high vaccine uptakee will be discussed, building on the current inteernational
experience.
31
Wed
dnesday, N
Novembeer 3
Plen
nary Sessiion 2: One Health Approachh to Outbbreak Resp
ponse
Prof. Martyn
M Daavid Kirk
NHMRC
C Career Devvelopment Fellow,
F Austtralian Natioonal Universsity

Profe
fessor Kirk hhas PhD andd Master’s deegrees in eppidemiology and works as a NHMRC C Career Devvelopment
Fello
ow at The Auustralian Naational Univversity. Previoously Professsor Kirk haas run the A
Australian Fieeld
Epiddemiology TTraining Proggram (FETP P) and coorddinated food dborne diseaase surveillan
ance for Australia. Profeessor
Kirk is the Actinng Chair of the TEPHIN NET Advisoory Board and a a membeer of the Strrategic Lead dership Grouup
for th
he FETP Ennterprise. Prrofessor Kirrk is a membber of the World
W Health
h Organizatiion Advisory body—thee
Fooddborne Diseease Burden Epidemiolo ogy Referencce Group.
A Recipe
R for Good Invvestigation of Food
dborne Disease
D Ou
utbreaks
Fooddborne diseaase outbreakks are a key indicator

i off a lapse or failure
f in sysstems designned to ensurre that food is
safe. Some foodbborne outbrreaks may bee due to conntamination of foods att the point w where it is prrepared, whiile
otherr relate to coontaminatio
on that has occurred
o wh ere foods arre grown or produced. IIt is importaant to rapidlyy
invesstigate foodbborne outbrreaks to iden
ntify the likeely source an
nd cause of contaminatiion to preveent further
spreaad and futurre outbreakss. Foodborne disease ouutbreak invesstigations caan range from m very simp ple
epideemiologic sttudies througgh to compllex multi-jurrisdictional undertaking
u gs that involvve extensive traceback of
o
foodd ingredientss and sophisticated laboratory testinng. In this prresentation, I will outlinne the key in
ngredients annd
stepss that make for a good foodborne
f disease
d invesstigation and d ultimately improve foood safety.
32
Wed
dnesday, N
Novembeer 3
Plen
nary Sessiion 2: One Health Approachh to Outb
break Resp
ponse
h Premash
Dr. Sith hthira
Veterinarrian, Senior P
Professionaal Level and R-FETPV P Project Man
nager, Region
nal
Field Epiidemiology T Training Proogram for Veterinarian,
V , Departmen
nt of Livesto
ock
Developm ment, Thailaand
Eduucation:
2012 Doctor of Phillosophy (Vetterinary Epiidemiology),, Departmennt of Clinicaal Sciences,
Colllege of Veteerinary Meddicine and Biiomedical Scciences, Colo
lorado State University,
Forrt Collins, CO
O, USA
2014 Masster of Sciennce (Tropicaal Medicine)), Mahidol University,
U D
Department ofo Tropical
Hyggiene, Facultty of Tropiccal Medicinee, Bangkok, Thailand
20000 Doctor of Veteerinary Medidicine, Facultty of Veterin
nary Medicinne, Kasetsarrt Universityy,
Ban
ngkok, Thailland
Experience:
20220–Present Pro
oject Manageer, Regional Field Epideemiology Training Progrram for Veterinarian
20001–2020 Graaduate Reseaarch Assistannt at Coloraado State Un
niversity, USSA
20006–2011 Vetterinarian at Departmennt of Livestoock Develop pment, Thailland
Successes an
nd Challen
nges of One
O Health
h Approaach to Aniimal Dise ase Contrrol
The outbreaks oof SARS andd HPAI sentt alarms to tthe world reggarding the pandemic thhreats that human h beinggs
are confronting.
c Similar casees, but moree obviously aare repeated dly warned by
b the covid--19 pandemiic. Thailand
facedd animal andd zoonotic diseases
d thatt must be coontrolled in global,
g regio
onal, and dommestic aspeccts. One Health
approach develooped in Thaiiland before the word onne health waas widely used. An exa xample of jo oint responsee,
Depaartment of L Livestock Development
D t and Deparrtment of Communicab ble Diseases set a small war
w room to o
guard d the introduction of Nipah
N virus during
d its em
mergence in Malaysia in 1999. Sincee 2005, earlyy one health
activvities involveed joint train
nings that alllowed manyy sectors to learn
l to solv
ve Emergingg Infectious Diseases (E EID)
prob blems togethher. A contin nuing support to epidem miological “O
One Health”” teams in 5 provinces and a then exp pand
into 14 provincees. Thailand has develop ped Nationall Strategic Plan
P for EID D Preparedneess, Preventtion and Con ntrol
sincee 2013. Interrdisciplinaryy and multi-ssectoral collaaboration fo or zoonotic disease conttrol and prevention has
been n assembled during the plan.
p Curren ntly, Thailandd One Heallth MoU wass signed by oorganization ns in ministrry
level. There are sseveral exam mples that sh how the succcess of usin ng one health
h approach tto control th he animal
diseaases such as Nipah viruss, rabies, HP PAI, Brucelloosis, etc. An
nimal diseasee control thaat uses one health
h approoach
are usually
u zoonosis. Non-zo oonosis casees also have challenges in i using onee health. Thaailand is drivving veterinaary
workk force devellopment to be a force th hat enhancees the functioning of on ne health andd to better control
c anim
mal
diseaases.
33
Wed
dnesday, N
Novembeer 3
Plen
nary Sessiion 2: One Health Approachh to Outb
break Resp
ponse
Dr. Cheen-Chih C
Chen
Associatee Professor, Institute off Wildlife Co
onservation,, College off Veterinary
Medicinee, Pingtung UUniversity of
o Sciences and
a Technollogy, Taiwan n

2019–Present Asssociated Professor, Instiitute of Wild dlife Conserrvation, Colllege of Veteerinary
Meddicine, Pingttung Univerrsity of Scien nces and Technology, T Taiwan
2015–2019 Asssistant Profeessor, Instituute of Wildliife Conservaation, Collegge of Veteriinary Mediciine,
Pingtung Univeersity of Sci ences and Technology,
T Taiwan
2013–2015 Posstdoctoral Feellow, Instituute of Wildllife Conserv
vation, Colleege of Veteriinary
Meddicine, Pingttung Univerrsity of Scien nces and Technology, T Taiwan
20004–2009 Chiief Veterinarrian, Endanggered wild animals
a rescuue center, N
National Pinggtung
Uniiversity of Science
S and T Technologyy
20009–2013 Ph.DD. Program, Departmennt of Large Animal Clin nical Sciencee, WCVM, University
U of
Saskkatchewan
20000–2003 Masster of Biolo ogical Sciencce, Departmment of Biollogical Sciennce, Nationaal Sun Yat-Seen
Uniiversity, Kao
ohsiung, Taiw wan
19998–2000 Bacchelor of Sciience, Depaartment of Wildlife
W Connservation, N National Pin
ngtung
Uniiversity of Science
S and T Technology,
y, Pingtung County,
C Taiw
wan
Inteegrating th
he Knowlledge of Epidemio
E ology and Wildlife Ecology
E ffor Underrstanding the
Ecoology of WWildlife Origin
O Path
hogens
Patho ogens distribbuted in thee populationn of wildlife are considered as a majjor threat too wildlife pop pulation andd
prim
mary source oof emergingg infectious diseases.
d Thherefore, for recognizingg and managging the riskk, it is essentiial to
undeerstand the eepidemiologgy of wildlifee diseases. T The objectives of disease surveillancce are to dettect the
distriibution of ddisease occurrence, iden ntify the facttors affect th
he distributio
on, and to aassess its imppact on a
speciific populatiion. Due to the hiding natural
n of w
wild animals in i their habiitat and carccasses removved rapidly by b
scaveengers, the mmajority of disease
d occu
urrences in w wild animalss are invisiblle and unreccognized. Fu urthermore,
altho
ough we cann sometimes notice the disease-indu
d uced mass diie-offs on th he populationn of wild an nimals,
evaluuation of thee disease im
mpact in a specific geograaphic region n or time period is usuallly a challengge. This
situation is comm monly seen especially inn the passivee surveillance program. Wildlife
W diseease surveilllance is essen
ntial
inforrmation for managing th he wildlife mediate
m zoonnotic diseasees and conseervation straategies. How wever, witho out
the in
nput from thhe disciplinee of wildlifee ecology, thhe puzzle of wildlife diseease would bbe impossib ble to complete.
In th
his talk, I preesent studiess focus on wildlife
w diseaase surveillannce and explant how thee research methods
m ado
opted
fromm wildlife ecoology be inteegrated intoo the researcch of wildlifefe diseases.
Keyw
words: wildliife diseases, epidemiolo
ogy, populatiion dynamiccs, wildlife eccology
34
Thu
ursday, November 4
Plen
nary Sessiion 3: Field Epidem
miology T Training Developm
D ment Strateegies
Dr. Carrl Reddy
Director,, TEPHINE
ET
Eduucation
20004 t College oof Public Health
Felllowship of the H Mediccine.
20000–2002 MSc. (Epidemiology) at thee National Institute
I of Public
P Healtth (INSP), Cuernavaca,
C
Méxxico
19998 Dipploma in Heealth Servicees Management, Universsity of Natalal, Durban, South
S Africaa,
in thhe Departm
ment of Com mmunity Health
19995 Dipploma in Annaesthetics, U
University of Natal
19887 MBBChB – Nelsson R Manddela School of o Medicinee, Universityy of Natal, South
S Africaa
Experiences
2016–2019 Dirrector – South African FField Epidem
miology Traiining Prograamme (SAFETP),
Nattional Institu
ute of Comm municable Diseases
D (NIICD), JHB
2011–2013 Dirrector Technnical Panel – UNAIDS Technical
T Su
upport Facilility (TSF), Health
H
Devvelopment Africa,
A Johannnesburg
2010–2011 Tecchnical Officcer, UNAID DS, Geneva
20009–2010 Sen
nior Technical Officer, GGlobal Fundd, Geneva
Dr. Kip
p Baggett
Medical Officer,
O Cennters for Dissease Contro
ol and Preveention, Atlan
nta, USA
Eduucation and Experiencces

2016–Present Chiief, Workforrce and Instiitute Develoopment Brannch, Divisionn of Globall Health
Pro
otection (DG GHP), CDC
20004–2005 Prevventive Med dicine Resideency, CDC
20003–2004 Masster of Publlic Health, E
Epidemiologgy, Univ. Waashington Scchool of Pu ublic Health
andd Communitty Medicine, Seattle, WA A
20000–2002 Epiidemic Intellligence Servvice, CDC
19997–2000 Peddiatric Intern
nship and Reesidency, Johhns Hopkins Children’s Center, Balltimore, MDD
19992–1997 Doctor of Med dicine, Univeersity of No
orth Carolina School off Medicine, Chapel
C Hill,
NCC
19887–1991 Bacchelor of Sciience, Dukee University, Durham, NCN
35
The Global Field Epidemiology Roadmap—From concept to Action
In 2018, key leaders and partners in field epidemiology capacity building developed the Global Field
Epidemiology Roadmap to address longstanding challenges to field epidemiology training programs (FETPs) and
accelerate growth of the global FETP partnership. A second meeting in February 2019 generated an
implementation plan for the Global Field Epidemiology Roadmap. Formation of a Strategic Leadership Group
(SLG) was the first of eight recommendations set forth in the Roadmap. The SLG serves to provide high-level
leadership and accountability for the Roadmap and will drive progress toward the Roadmap vision that “every
country in the world has the applied epidemiology capacities needed to protect and promote the health of its own population, and to
collaborate with others to promote global health.” The SLG is comprised of 14 global health leaders and is co-chaired by
senior leaders in CDC and WHO, with TEPHINET serving as Secretariat. After pandemic-related delays, the
SLG was launched in April 2021 and has convened quarterly. Eight working groups (WGs) have been established,
one for each of the eight Roadmap recommendations. The WGs have developed goals and begun to map
activities to achieve these goals. In this session, we will describe the Global Field Epidemiology Roadmap and the
progress to date through the SLG and its WGs.
36
Thu
ursday, November 4
Plen
miology T
Training Developm
D ment Strateegies
Dr. Maanickam P
Ponnaiah
Scientist E (Epidemiiology), ICM
MR-Nationall Institute off Epidemiology,
Departmment of Heallth Researchh, Indian Ministry of Heealth and Faamily Welfarre,
Chennai, Tamil Naduu, India
Eduucation
2012 PhDD, Epidemio ology, Sree C
Chitra Tirunnal Institute for Medical Sciences an nd Technolo
ogy,
Thiiruvananthap puram, Indiia
2010 Cerrtificate of Advanced
A Sttudies ‘Healtth District Management
M t: Priority Seetting,
Plan
nning and Programme
P D
Design’, Swiiss Tropical and Public H
Health Instiitute;
Uniiversity of Basel,
B Basel, Switzerland
d
19999 Masster of Scien nce in Epideemiology (MMSc), Christiian Medical College (CM MC) and
Hospital, Vellorre, Tamil Naadu, India, The
T Tamil Nadu N Dr. MGGR Medicall University,
Tam
mil Nadu, In ndia
19997 Bacchelor of Sidddha Mediciine and Surggery (BSMS)), Governmeent Siddha MedicalM
Colllege, Palayammkottai, Tammil Nadu, Inndia, The Taamil Nadu DDr. MGR Medical
M
Uniiversity, Tammil Nadu, Inndia
<Sidddha system of meedicine is one of the
t two Indian syystems of medicin
ine, the other beinng Ayurveda >
Experiences
ICMMR-Nationaal Institute of
o Epidemio ology (ICMR R-NIE), Cheennai, India
2016– Scieentist E (Epidemiology)); Head, Divvision of Onnline Coursees; Core facuulty, ICMR
Sch
hool of Publlic Health
2012–2016 Scieentist D (Ep
pidemiology)
y); Core facuulty, ICMR School of Puublic Health h
20008–2012 Scieentist C (Epidemiology)); Core facullty, ICMR Scchool of Puublic Health
20003–2008 Scieentist B (Epidemiology)); Core facullty, ICMR Scchool of Puublic Health
20002–2003 Ressearch Officer (WHO leeprosy chem motherapeutiic trial)
20000–2002 Ressearch Assocciate (WHO O leprosy cheemotherapeu utic trial)
Chrristian Mediccal College and
a Hospitaal (CMCH), Vellore, Tam mil Nadu, In
ndia
20000 Asssociate Reseaarch Officerr (Health Information System)
S
19999 Ressearch Felloww, IndiaCLE
EN-Nationall pulse polio o programm me evaluation
n
Leaarning in tthe Globaal FETP Communi
C ity: FETP
P Learning
g Strategyy Implem
mentation
Upddates and Strategiees during the Pandeemic
Whille the new nnetwork-wide TEPHINE ET 2020-20030 Learningg Strategy is well-timed iin light of much
m neededd
COV VID-19 publlic health ressponse workk and traininng/learning needs, the strategy
s is buuilt on foundational
strateegic guidancce for both TEPHINET
T T and the FEETP Enterp prise, developed in respoonse to the goals
g set forrth
by th
he TEPHIN NET Strategiic Plan (20211-2026) and that of Glo obal Field Epidemiologyy Roadmap with inputs
from
m a wide rangge of stakeh holders. Und der the TEPPHINET’s guuidance, thee FETP Learrning Advisory Councill
(FLAAC) and its L Learning Wo orking Grou ups have commpleted a prrioritization process to iidentify initiial key initiattives
relateed to each oof the strateggy’s goals an
nd thus beguun creating implementat
i tion plans.
Emeerging key innitiatives of the
t FETP leearning strattegy includee: FETP stafff professionnal developm ment, learnin ng
outco omes measuurement, mo odernized learning soluttions and exxperiences, leearning quallity criteria and
a guidelinees,
37
continuous learning for alumni, and network learning technology updates. The aim of the session is to provide an
update since the launch of the Global Learning Strategy in October 2020 and engage programs and other
stakeholders in a discussion about the key initiatives and related implementation plans. The session will include
discussions on the impact of the pandemic on programs and their training priority areas at the regional/national
levels.
38
Thu
ursday, November 4
Plen
miology T
Training Developm
D ment Strateegies
Dr. Tam
mbri Houusen
Infectiou
us Disease E
Epidemiologgist, Field Ep
pidemiologyy in Action
Edu
ucation and Experiencce
PhD
D, MPhil (Appplied Epidemiology), MPH&TM,
M D
Dip Tropicaal Nursing, BSc
B (Nursingg)
20177–2021 Currriculum Con nvenor of th

he MAE proogram
20133–2017 Natioonal Epidem miologist, Medecins
M Sanns Frontieress India
Priorr to this rolee I worked in
n a number of applied ppublic health
h roles and as
a a paediatrric registered
d nurse
Berry Ropa
R
Acting Manager,
M Dissease Controol & Surveilllance Branchh
Program Manager, SSurveillance & Emergen ncy Responsee
Focal Perrson: Internnational Heallth Regulatio
ons
Field Epiidemiology T Training Diirector, Division of Pubblic Health, Department
D t of
Health, Papua
P New G Guinea
Com
mpleting tthe Journey—Field
d Epidem
miology Trraining Prrogram in
n Papua New
N Guinea
Duriing this sessiion we will discuss

d the history
h of thhe field epid
demiology trraining progr
gram in Papu
ua New Guin nea,
curreent developm ments in thee program annd the futurre vision forr a compreheensive trainiing program
m with a focuus on
trainees, faculty aand alumni.
39
Frid
day, Noveember 5
Plen
nary Sessiion 4: Com
mmunicaation, Ethiics, and Equity
E in Public H ealth Em
mergenciess
Dr. Kum
mnuan U Ungchusak k
Advisor to
t Departm
ment of Disease Control, Ministry off Public Heealth, Thailan
nd
Eduucation:
19773–1979 M.DD., Siriraj Faaculty of Meedicine, Mah
hidol Univerrsity, Thailannd
19884–1986 Cerrtificate, Fielld Epidemioology Trainin
ng Program, Thailand. ((FETP)
19886–1987 M.PP.H., Facultyy of Public HHealth, Mahhidol Univerrsity
19991– Thaailand Board d of Preventtive Medicin
ne (Epidemiology), Meddical Counciil, Thailand
Experiences:
19990–2001 Dirrector, Field Epidemioloogy Trainingg Program (FFETP), Thaailand
20001–2008 Dirrector, Bureaau of Epidemmiology, Deepartment ofo Disease CControl, Thaailand
20005–2008 Inteernational Health
H Regullation, Focall Person, Th
hailand
20008–2015 Sen
nior Advisorr, Departmennt of Diseasse Control, Ministry
M of Public Heallth
2015–2020 Boaard Memberr, Thai Healtth Foundatio on, Thailandd
2018– Mem mber, WHO O STAG-IH H (Strategic Technical
T Ad
dvisory Grooup, Infectious Hazard)
Thee Many Asspects of Policy Co
ommuniccation in Health
H Em
mergenciees
Resppond to publlic health em mergency off national annd internatio onal scale neeeds supportt from policcy makers at
Miniistry or Govvernment levvel. Policy makers
m at higgher level need timely an nd good situuation assesssment to deccide
on policy optionns. To convin nce policy makers
m at theese levels, heealth professsional need to consider at least two
impo ortant aspectts, ie, propo
osing policy options
o andd understand ding policy decision
d proccess. In term
m of propossing
policcy options, hhealth professsional focus on techniccal and ethiccal aspects an nd want to ddo it transpaarency. But for
f
policcy makers at political levvel, they are more conceerned on eco onomic impact, social im mpact and political
p impaact
or th
heir populariity. In term of
o understan nding policyy decision prrocess, key decision
d makkers and thee normal
process are not aalways straigghtforward as a we see in the organoggram especiaally in panicc or crisis ph hase. They arre
bothh internal andd external players that exercise
e theirr role openlyy and secrettly. Health prrofessional normally use
internal and techhnical-basedd advising prrocess whichh may not en nough. It is necessary too understand d the public
mood, identify ppartners thatt can lead pu ublic opinionn in supportt of the proposed policy cy option. Thhey also neeed to
workk with trusteed and credib ble social leaader/activistt to put presssure on pollicy makers bby emphasizzing value-b based
approach. The age of sociall media is in favored of health profe fessional to share
s internaal informatioon to publicc and
proppose approprriate policy option
o for public
p suppoort. In this presentation
p we will sharre some exaamples from
COV VID-19 in Thailand.
40
Frid
day, Noveember 5
Plen
mergenciess
Assoc. Prof. Stevven Peng--Lim Ooi
Senior Coonsultant, Innfectious Disease Reseaarch and Traaining Officee, National
Centre fo
or Infectiouss Disease
Associatee Professor, Saw Swee Hock
H School of Public H Health, Nattional University
of Singappore
Eduucation and Experiencces:

Asso
oc. Professorr (Dr.) Steveen PL is a medical
m epideemiologist an
nd senior co onsultant at the Nationaal Centre forr
Infecctious Diseaases, and proogramme dirrector of thee Singapore field epidem miology trainining prograamme which h is
admiinistered joinntly with thee School of Public Heallth. His speccialist interests are in urrban health security,
s
outbreak manageement, and communicaable diseasess control. Steeven previou usly served iin past appoointments ass
head
d of surveillaance, epidem miology and response inn the Ministrry of Health h, senior assiistant commmissioner of
publiic health in tthe Ministryy of the Envvironment, aand deputy director
d of the
t Institutee for Enviro onmental
Epid
demiology, a WHO Colllaborating CenterC for ennvironmentaal epidemiolo ogy. His bassic degree annd postgraduuate
mediical training were at the National University of Singapore and a the John ns Hopkins University. He H has beenna
long--standing felllow of the Academy off Medicine, Singapore, member of the New Yoork Academ my of Sciences,
and honorary
h member of Delta
D Omegaa, the US Naational Publiic Health Honor Society ty.
Em
mergency R
Response: Commu
unicationss, Ethics, and FETP’s Role
This session shaares case studdies and praactical experiiences in Sin ngapore’s ep
pidemic intellligence servvice with
emerrgency respoonse and ouutbreak manaagement, buuilding on th he key conceepts of publlic health surrveillance annd
diseaase control. UUnwelcomee events as th hey are, outbbreaks occuur from time to time andd represent natural
n
experiments whiich afford op pportunitiess for us to dderive valuab ble informatiion about heealth threatss. In respondding
to th
hese emergenncies, we can n learn a wh hole lot abouut field epidemiology ass applied to rrisk assessmments on the
grouund - the exttent and patttern of publlic health prroblems, souurces of exposure, modees of transm mission,
perioodicity, whicch neighborhhoods, and which
w groupps of peoplee are most att risk. Outbrreak investiggation formss a
cruciial element iin the contro
ol of comm municable disseases and en nvironmental hazards. IIt enables th
he identificattion
of diisease source, and infor ms subsequ uent managem ment steps to prevent additional
a sppread. In a world
w rockedd by
the Covid-19
C panndemic, cappacity buildinng of investitigative skillss becomes more
m relevannt than ever. This session n
will also
a touch oon FETP’s ro ole in risk co
ommunicatioons and som me ethical coonsiderationns, such as appplying the
precaautionary prrinciple wheen there is rissk of ongoinng transmission.
41
Frid
day, Noveember 5
Plen
mergenciess
Prof. Nina
N T. Caastillo-Carrandang
Health So
ocial Scientiist and Profeessor in the Departmennt of Clinicaal Epidemiollogy,
College of
o Medicinee, University of the Philiippines Mannila
Edu ucation and Experiencces:

Ninaa T. Castillo--Carandang’ss career as a sociologist in the Univversity of thee Philippinees began in the agricultuural
scien
nces campuss (Los Bañoss) before shee joined the health scien nces campuss (Manila) annd went into o the fields of
o
healtth social scieence, clinicall epidemioloogy, and globbal health. She
S has look ked into sociiocultural dimensions off
healtth and healthh care—the perceptionss of laypersoons, patientss, health care providers, policymakeers, and how w
such can affect hhealth-seekin ng behavior,, clinical praactice, as welll as policy (clinical,
( pubblic health). Her
H currentt
workk looks at diffferent facetts of qualityy of life, andd the Filipino
os’ search fo or Kagalingann (well-beingg, happiness,, and
healtth), and livinng well and being
b well. She
S and her colleagues have h studied
d the impact of cardiovaascular diseaases,
malaaria, tubercullosis, and asthma and alllergies on thhe lives of Filipino
F commmunities, faamilies, and individuals.
Ninaa is a practitiioner and an

n advocate for
f transdisciiplinary teacching, educaation, researcch, advocacyy and policyy
workk. She believves that achieeving a goodd quality of life and goo od health ou utcomes are only possib ble if
team
mwork/collabboration andd constant dialogue
d are done within n and across:
 professionss (physicianss & allied heealth professsionals, policcy and comm municationss experts, soccial scientistts,
epidemioloogists, agricuultural & phyysical scientiists, engineers, etc.) in so
olidarity with
th the publicc (lay peoplee and
communitiees, and civil society)
 sectors (heaalth, agricultture, environ nment, businness, etc.)
 organizatioons (governm ment/publicc, private, acaademe, NGO, industry, etc.) at the llocal, region nal, national &
global levells.
From
m February 22020 to September 20211, Nina has given over 50 5 talks, inteerviews for vvarious grou
ups (includin
ng
mediia outfits) onn the socio-ccultural aspeects of COV
VID-19; vacccine confideence in the PPhilippines; and promotting
healtth behaviorss amidst the threat of th he pandemicc.
As of end August 2020, Nin

na has been a member oof the World
d Health Orrganization’ss Social Scien
nce Workingg
Grouup for COV
VID-19.
In December
D 20020 she was appointed as
a a memberr of the Rep
public of thee Philippiness’ National Immunizatio
I on
Tech
hnical Advisoory Group (NITAG)
( fo
or the COVIID-19 Vaccin
ne.
Ninaa has a Bachhelor of Artss degree in Sociology

S (U
University off the Philipppines Los Baaños, Philipp
pines), a Maaster
of Arts
A major inn Sociology degree
d (Aten neo de Mannila Universitty, Philippin
nes), and a M
Master of Sciience in Clin
nical
Epid
demiology (M McMaster University,
U Caanada). Her PhD in Soccial Sciences and Globall Health wass from the
Univversity of Ammsterdam, The
T Netherlaands.
42
It’s a Small World After All: Health Equity in Public Health Emergencies
In most parts of the world our current circumstances are marked by various crises. The continuing COVID-19
pandemic (amidst other health concerns); and emergencies due to climate change, environmental degradation,
and socio-political and economic upheavals have caused much suffering for people across all walks of life. It is a
small world after all.
Health is a fundamental human right. “Health equity is defined as the absence of unfair and avoidable or
remediable differences in health among population groups defined socially, economically, demographically or
geographically”1. People and groups who experience health inequities lack power (political, social, economic).
Interventions such as vaccination programs need to be effective & sustainable as access to the vaccine alone is
insufficient. Systemic changes (e.g., policy reforms, changes in economic or social relationships) are imperative to
help empower marginalized groups & ensure that No one is left behind! in public health emergencies and
beyond.
1 World Health Organization. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_3 (accessed 07 Oct 2021)
43
Characteristics and Risk Factors Associated with Severe Coronavirus Disease 2019
(COVID-19), Taiwan, January–June 2020
Yang Li, Chia-ping Su, Wan-Chin Chen
Background
COVID-19 has caused more than 2.4 million deaths globally. Early identification of patients at risk of severe
COVID-19 is important for prevention and resource allocation. We aimed to describe characteristics of
COVID-19 patients in Taiwan and identify risk factors associated with severe disease.
Methods
Public health authorities investigated patients tested positive for SARS-CoV-2 using RT-PCR within 24 hours and
collected patients’ demographics, symptoms, comorbidities, and epidemiological information. All COVID-19
patients were hospitalized for isolation and treatment. We monitored their clinical courses and recorded
outcomes at COVID-19 clinical database. We enrolled COVID-19 patients aged ≥ 20 years who were diagnosed
during January to June 2020. We defined severe cases as COVID-19 patients who had severe pneumonia or acute
respiratory distress syndrome based on WHO criteria. We reviewed investigation reports and clinical database.
We conducted univariate and multivariate analyses to identify risk factors associated with severe cases.
Results
Of the 422 COVID-19 patients, 213 (50%) were male. The median age was 33 (IQR, 25–51) years. We identified
one or more comorbidities in 104 (25%) patients; cardiovascular disease (n = 42, 10%) was the most prevalent
comorbidity. Thirty-eight (9%) were severe cases and seven (1.7%) died. Severe cases were significantly older than
patients with mild illnesses (median age, 61 vs. 31 years, p < 0.05). Univariate analyses adjusted for age showed
severe cases were more likely to have fever (aOR = 4.3, 95% CI: 1.9–9.9) and comorbidities (aOR = 5.3, 95% CI:
2.2–12.9). In multivariate analyses, fever (aOR = 4.0, 95% CI: 1.7–9.5) and cardiovascular disease (aOR = 5.6,
95% CI: 2.2–14.1) were associated with severe cases.
Conclusions
COVID-19 patients with older age, fever and cardiovascular disease were prone to develop severe disease. We
recommend implementing targeted prevention and control measures, including vaccine prioritization, early
identification and treatment for these populations.
44
COVID-19 Vaccine Acceptance among Health Care Workers: A Cross-Sectional Survey in
North Sumatera, Indonesia, 2020
Frans Yosep Sitepu
Background
Our world is still facing and fighting the COVID-19 pandemic. The COVID-19 vaccine is intended to provide
acquired immunity against the disease. In Indonesia, health workers are among the first group to receive the
vaccination. Therefore, the study aimed to determine the acceptability of COVID-19 vaccine by the health
workers.
Methods
A cross-sectional online survey was conducted between October 8 and November 9, 2020, among the health
workers in North Sumatera province, Indonesia. Data were collected through a self-administered questionnaire. It
required 8–10 minutes to complete the survey. A two-step logistic regression analysis was employed to assess the
association of participants’ demographic data, length of work, perceived risk of infection and perception of
government measures and efforts to prevent of COVID-19 with COVID-19 vaccine.
Results
A total of 360 respondents were collected. Age ranged 22–66 year (median = 31 year), length of work 1–40 year
(median = 9 year), male was 63.9%. We found that 298 respondents (82.8%) would like to be vaccinated. Fifty
out of 62 respondents (80.6%) stated that the vaccine safety was the main reason for not being vaccinated. In
multivariate model, we found that those who having perception that COVID-19 is a serious disease and those
who having higher perceived risk of infection were the most related factors (adjusted PR 3.24 (95% CI = 1.62–
6.49) and adjusted PR 0.43 (95% CI = 0.24–0.77)), respectively.
Conclusions
The level of acceptability of COVID-19 vaccine was high. Findings from the study will be useful for
policy-makers to make decision of COVID-19 vaccination in Indonesia especially for the health workers.
45
Impact of COVID-19 on Diagnosis and Treatment of Pulmonary Tuberculosis in
Tianjin, China, 2020
Guoqin Zhang, Mingting Chen, Fan Zhang
Background
During the emergency response to COVID-19 in Tianjin, China, tuberculosis (TB) patients faced inconvenience
in care-seeking. This study was to understand the impact of COVID-19 on TB diagnosis and treatment.
Methods
An anonymous survey was conducted for TB patients conveniently selected from all 11 TB clinics in Tianjin
during June to November in 2020. Characteristics were compared between patients with and without
self-reported delay for care-seeking due to COVID-19 using conventional tables and tested by 2 test.
Multivariable logistic regression was used to identify factors associated with the delay by calculating adjusted odds
ratios (aOR) and 95% confidence intervals (CIs) (α = 0.05).
Results
A total of 518 TB patients completed the survey. Among 358 (69.1%) patients diagnosed with TB during the
COVID-19 response, 61 (17.0%) delayed their care-seeking visit, of whom 39 (63.9%) cited fear of COVID-19
infection as the reason. Patients who were female (aOR = 2.0, 1.1–3.7), previously treated for TB (aOR = 3.2,
1.4–7.6) and diagnosed during the highest-level emergency response (January 24–April 29) (aOR = 3.2, 1.7–6.2)
had higher risk of delay for care-seeking. Among all 518 patients in treatment, 57 (11.0%) reported delay for a
scheduled visit to TB clinic, of whom, 34 (59.6%) were because of fear for COVID-19; 197 (38.0%) had no
supervision by healthcare providers; 32 (6.2%) reported interruption of anti-TB treatment. Patients diagnosed
before COVID-19 response (aOR = 10.4, 4.2-25.5), during the highest-level response (aOR = 3.5, 1.1-11.0), and
without in-person supervision (aOR = 2.0, 1.1-3.6) were more likely to delay for scheduled visits due to
COVID-19.
Conclusions
The COVID-19 epidemic caused delay of care-seeking and interruption of treatment for TB patients, mainly due
to patients’ fear and lack of adequate treatment supervision. We suggest to strengthen health education, avoid
repurposing TB service for COVID-19, ensure treatment supervision and anti-TB drug supply, to minimize the
impact of COVID-19 epidemic.
46
Oral Presentation Session 1: Effects of COVID-19
Assessment of Functional Health Status and Persistence of Symptoms among Recovered
COVID-19 Individuals, Tamil Nadu, India 2020
Suganya Barani, Tarun Bhatnagar, K Gayathri, Harshal Sonekar
Background
The lingering effect of COVID-19 on health status of individuals that lasts weeks to months after initial recovery
is termed as ‘long COVID’. Our objectives were to describe the functional health status and associated factors
and estimate the incidence of persistent symptoms at multiple time points following recovery from COVID-19.
Methods
We conducted a cross sectional study based on structured telephone interviews on a sample of 749 individuals
(190, 196, 175 and 188 across 15, 30, 45 and 60 days post-recovery, respectively) selected by simple random
sampling from list maintained by the health department. We administered the Post-COVID-19 Functional Status
(PCFS) scale developed by Klok et al and defined poor PCFS as below median of the calculated PCFS score. We
used logistic regression to calculate crude and adjusted odds ratio (OR) with 95% confidence interval (CI) to
determine factors associated with poor functional health status.
Results
In all, 26.8%, 24.5%, 20.6% and 13.3% individuals reported persistent clinical symptoms at 15, 30, 45 and 60 days
respectively. Fatigue (10%, 11.7%, 4.3% at 15, 30, 60 days respectively) and headache (5.1% at 45 days) were the
most commonly persistent symptoms. Poor PCFS was seen in 48–57.1% across four time points. ICU stay was
significantly associated with poor PCFS in days 15, AOR 10.3 (2.3–46.8) and days 30, AOR 5 (1.04–24.1).
Pre-existing co-morbidity was significantly associated with poor PCFS in 45 days, AOR 3.9 (1.7–9.2). Persistent
symptom was significantly associated with poor PCFS in 60 days, AOR 3.3 (1.05–10.14) and in 15 days, AOR
3.25 (1.35–7.79).
Conclusions
Persistence of clinical symptoms decreased over time. Half of recovered individuals had poor PCFS. We
recommend that COVID-19 affected individuals with persistent symptoms, admission in ICU for COVID-19
and pre-existing comorbidity to be prioritized for follow-up post-recovery and managed actively to improve their
functional health status.
47
Oral Presentation Session 1: Effects of COVID-19 Late Breaker
Estimation of Out-of-Pocket Expenditure on COVID-19 Treatment among Patients
Managed at Home, Iraq, 2020
Falah A. Saeed, Faris Lami
Background
There is a global consensus that the socio-economic impact of the COVID-19 crisis has a devastating effect on
health programs, health insurance, and healthcare systems. Also, the losses of jobs and rising prices that have
accompanied the pandemic are causing growing poverty. Due to the exhausted Iraqi healthcare system and the
lack of trust in its efficiency, many COVID-19 patients are choosing to be treated at home, exerting even more
financial pressure on Iraqi families. The objective of this study is to estimate the out-of-pocket expenditure spent
on the management of COVID-19 patients exclusively treated at home, Iraq, 2020.
Methods
This is a cross-sectional study that involved patients who were diagnosed by the physician as a COVID-19 based
on clinical manifestations, real-time PCR, CT of the lung, and who were exclusively managed at home. A
snowball sampling technique was used to enroll COVID-19 patients during November and December 2020. A
questionnaire was developed to collect data on basic demographics, clinical manifestation, severity, disease
duration, and the estimated total expenditure on consultation fees, radiological and laboratory investigations,
medicines, disinfectants, personal protective equipment, oxygen device, and other direct costs.
Results
The total number of participants was 589; 328 (55.7%) were women. The average total expenditures calculated in
Iraqi Dinars was 643,304 (range: 505,096–5,595,000). The highest average expenditure was for medicine cost
(191,138), followed by the consultation fees (117,951), CT scan (102,084), laboratory investigations (70,000),
medical devices (58,285), personal protective equipment (50,388), chest x-ray (mean=39,437), and disinfectants
(37,849). The average expenditure was significantly higher among governmental employees (p=0.024), married
patients (p<0.001), and patients who reported inadequate monthly income (p<0.001). Patients’ gender, residence,
and having comorbidities did not affect the average expenditure (p>0.05).
Conclusions
The management of COVID-19 patients at home imposed a significant financial burden on them and the
government should consider measures that mitigate this burden like financial support.
48
Surveillance of Vaccine-Preventable Diseases in Iraq during the COVID-19 Pandemic:
How much were They Affected?
Aqeel Ismaeel, Hanan Abdulghafour, Faris Lami
Background
The COVID-19 pandemic has a serious negative impact on all essential healthcare services including, but not
limited to, the surveillance of vaccine-preventable-diseases (VPDs) and provision of immunization services.
Negative consequences on both services can lead to future outbreaks of VPDs. Therefore, maintaining a
sensitive surveillance system is essential in preventing and controlling such outbreaks and evaluating the impact
of the pandemic on the surveillance of VPDs is a first step in that direction. In Iraq, there was no analysis of
how COVID-19 affected surveillance of VPDs. The objectives of the study were to assess and map the impact
of COVID-19 on the reported incidence, completeness, and timeliness of surveillance of seven VPDs in 2020 in
all Iraqi governorates.
Methods
We conducted a descriptive desk review of secondary data at the surveillance section in the Iraqi Ministry of
Health. We calculated and compared incidence of seven VPDs (hepatitis B, measles, mumps, rubella, diphtheria,
pertussis, and tetanus) in 2020 with the median incidence for 2017–2019. In addition, we compared the
completeness and timeliness of the surveillance reports of these VPDs in 2020 with 2019.
Results:
In 2020, the VPDs with highest decline in the reported incidence were pertussis (-91%), measles (-81%), mumps
(-76%), and hepatitis B (-64%). The range of decline in reported incidence among Iraqi governorates varied from
0% to -100%. The governorates mostly affected were Dahuk, Kirkuk, and Baghdad-Rusafa. At the national level,
the change in completeness and timeliness were -8.4% and -16.2% respectively. The decline in completeness and
timeliness were highest in Dahuk, (-94.7%, -95%), Erbil (-36.7%, -41.1%) and Kirkuk (-14.9%, -43.43%).
Conclusions
There was a clear decline in the surveillance reporting of VPDs in all governorates with varying severity over the
course of 2020, during the COVID-19 pandemic. Risk assessment and enhanced surveillance and vaccination
activities are necessary to mitigate the potential of VPDs outbreaks for years to come.
49
Understanding COVID-19 ‘Infodemics’: An Analysis of User-Generated Online
Information about Public Health Interventions during a SARS-CoV-2 Outbreak in
Vietnam, July–September 2020
Ha-Linh Quach, Ngoc-Anh Hoang, Khan Cong Nguyen, Thai Quang Pham, Dinh Cong Phung, Son Hong Le,
Thanh Cong Le, Florian Vogt
Background
Misinformation about COVID-19 has been spreading widely on the internet since the beginning of the
pandemic. A better understanding of these ‘online infodemics’ is crucial to improve public health interventions
and communication.
Methods
We conducted a longitudinal analysis of publicly available user-generated online information about five distinct
public health interventions that were implemented in response to a large COVID-19 outbreak in Da Nang,
Vietnam between July and August 2020. We compared the volume, dynamics, sentiment polarity, engagements,
and influence scores of online posts across the before, during and after outbreak periods using negative
binominal and logistic regression, and assessed the content validity of the 500 most influential posts.
Results
Most of the 54,528 online posts included in this analysis were generated during the outbreak (46,035; 84.42%)
and online newspapers were the dominant medium (32,034; 58.75%). Among the 500 most influential posts, 316
(63.20%) contained genuine information, 10 (2.00%) were classified as misinformation, 152 (30.40%) were
non-factual opinions, and 22 (4.40%) contained unverifiable information. All misinformation posts were made
during the outbreak, mostly on social media, and were of predominantly negative sentiment. Higher numbers of
engagement were observed for unverifiable information (incidence rate ratio [IRR] 2.83, 95% confidence interval
[CI] 1.33–0.62), information posted during the outbreak (IRR before the outbreak 0.15, 95%CI 0.07–0.35; IRR
after the outbreak 0.46, 95%CI 0.34–0.63), and information with negative sentiment (IRR 1.84, 95%CI 1.23–
2.75). Negatively-toned posts were more likely to be misinformation (odds ratio [OR] 9.59, 95%CI 1.20–76.70) or
unverified information (OR 5.03, 95%CI 1.66–15.24).
Conclusions
The overall volume of misinformation and unverified information was low and clustered in the outbreak phase,
with social media platforms being particularly affected. This first in-depth assessment of user-generated online
information demonstrates the value of analyzing ‘online infodemics’ during a COVD-19 outbreak to inform
real-life public health interventions.
50
Self-Care Practice and Predicting Factors among Hypertensive Patients in Debre Tabor
Referral Hospital, Northwest Ethiopia
Shegaw Gelaw
Background
Globally hypertension is a major public health problem and the leading cause of mortality and disability in
developing countries. Self-care practice is a dynamic and active process that hypertensive patients undertake
intending to improve their health. Uncontrolled hypertension is higher in South Gondar Zone patients attending
at Debre Tabor Referral Hospital. The purpose of this study was to assess self-care practice and associated
factors among hypertensive patients in Debre Tabor Referral Hospital, Northwest Ethiopia.
Methods
An institution-based cross-sectional study was conducted at Debre Tabor Referral Hospital from October
5/2020 to November 15/2020. A total of 392 participants were recruited through an interview administered
structured questionnaire using a systematic random sampling technique. Descriptive statistics were expressed as
percentage, frequency and tables. Finally, multivariable logistic regression was used to identify factors associated
with good hypertension self-care practice with a p-value of < 0.05.
Results
Self-care was practiced in 54.1% (95% confidence interval [CI]: 49.1%–59%) of the study participants. Basic
knowledge on hypertension control was 48.5%. Urban residency (adjusted odds ratio [aOR]: 2.17, 95% CI: 1.2–
3.9], social support (aOR: 2.12, 95% CI: 1.13–3.39), knowledge, aged 40–64 years (aOR: 3.15, 95% CI: 1.19–8.3,
age ≥ 65 years (aOR: 3.8, 95% CI: 1.35–10.7), and stress control (aOR: 1.6, 95% CI: 1.06–2.67) were predictors
of hypertension self-care practice.
Conclusions
In this study, the prevalence of good hypertension self-care practice and knowledge on hypertension control was
low. Good social support age greater than 40 years, urban residency, good basic knowledge, and having stress
control were positively associated with hypertensive self-care practice. Healthcare providers and hypertensive
patients could benefit from establishing institutions like hypertensive association and building teams to learn
lifestyle counseling.
51
Surveillance Data Analysis of Severe Acute Malnutrition in East Hararghe Zone, Oromia
Region, Ethiopia, 2011–2015
Biniyam Teshome, Gudina Egata, Melake Demena
Background
Malnutrition is one of the leading causes of childhood deaths in developing countries like Ethiopia. The Federal
Ministry of Health of Ethiopia has included malnutrition as one of the reportable diseases in the surveillance
system. Routine analysis of surveillance data is a key function for detecting outbreaks, monitoring disease trends,
and evaluating the effectiveness of disease control programs and policies. Objectives of this study is to assess the
magnitude of severe acute malnutrition (SAM) and describe the distribution in East Hararghe Zone, Oromia
during 2011–2015.
Methods
A cross-sectional study design was used to collect surveillance data. A case of SAM was defined as a child aged 6
to 59 months with MUAC < 11cm and/or a child with bilateral edema of feet regardless of his or her MUAC.
We collected data by TPP. Data were analyzed using MS excel 2010.
Results
A total of 147,169 SAM cases were reported in 2011–2015. Among these cases, 145,544 (98.9%) of them were
newly-admitted. Children aged 6–59 months constituted 145,412 (99.9%) of all new admissions. Admitted SAM
cases increased from 2011 to 2015, from 25,863 to 34,228. Among all districts, the highest SAM incidence was in
Fedis (19.6%). The zonal incidence was (6.3%). From 2011–2015, 382 deaths were reported, with a case-fatality
rate of 0.26%. The annual case-fatality rate declined from 0.95% in 2011 to 0.10% in 2015.
Conclusions
Malnutrition is a major public health problem of the East Hararghe Zone; SAM cases had increased over the past
five years. However, the annual case-fatality rate had declined. To reverse this trend, the case management of
MAM should be improved. The programs should consider women empowerment and child feeding practice.
Partners working on Nutrition Program should be mobilized to supply feeding nutrients with scarce areas.
Further study is required in order to find risk factor associated with malnutrition specifically in the most affected
area.
52
Assessment of the Availability and Readiness of Hypertension Management Services at
Primary Healthcare Facilities — Central Highland region, Vietnam, 2020
Thang Hoang, Thuy Nguyen Phuong, Phuong Mai Pham, Sandra Jackson
Background
In 2018, Vietnam Government set ambitious goals that by 2025 up to 95% of commune health stations (CHSs)
will have functional hypertension management program. However, with limited resources, it would be challenging
for the health system in the Central Highland Region to achieve such goal without careful planning and
preparation. We aimed to assess the availability and readiness of hypertension management services at primary
health facilities in the region to facilitate evidence-based planning for the program in the future.
Methods
Availability and readiness of hypertension management services was assessed using WHO’s service availability
and readiness assessment (SARA) tools. We conducted the self-administer SARA questionnaire at all 579 CHSs in
the region. We also conducted 20 in-depth interviews of key informants (hypertension program focal points at
communal, district and provincial level) in all 4 provinces. Descriptive analysis of quantitative data was done
using Epi-Info 7.1. Qualitative data were analyzed using NVivo.
Results
General hypertension diagnosis and management services were available at 65% of CHSs. Only 41% of CHSs
had all medicines and commodities or trained staff available; 86% of CHSs had all basic amenities; and 93% had
all essential equipment. On the day of assessment, 63% of CHSs had hypertension diagnosis and management
services ready, of which 33% CHSs had all medicines and commodities ready. The qualitative results showed that
hypertension services at primary healthcare facilities were not sufficient due to lack of financial support, lack of
doctors at CHSs, insufficient supply of basic medicines and program guidelines.
Conclusions
The overall availability and readiness for hypertension diagnosis and management service at CHSs in Central
Highland was low, reflecting the weak capacity of primary healthcare facilities. To strengthen hypertension
program in the region, health authorities should increase financial support, ensure adequate supply of basic
medicines, and issue more specific guidelines.
53
Estimation of the Relapse Time to Drug Use in Adolescents — San Jose, Costa Rica,
2018
Jose Diaz
Background
The New Horizons Rehabilitation Program began at the National Psychiatric Hospital in 2006, its goal is
detoxification and induction of change in underage drug users. The high relapse rate is one of the most
important problems for the program, with great social and economic impact. The objective of this research was
to determine the time elapsed until relapse to drug use in adolescents, who participated in this rehabilitation
program.
Methods
We conducted a cohort study in a population of adolescents, who participated in the New Horizons
Rehabilitation Program from 2014 to 2018; adolescents were defined as a case if they completed rehabilitation.
Descriptive statistics and a survival analysis were performed using the Kaplan-Meier method, 95% CI. The
response variable was the time, which elapses from the moment of completion of rehabilitation, until the
occurrence of relapse to drug use. The censoring variable was defined by adolescents, who did not relapse to
drug use until the end of the period
Results
Of 215 rehabilitated adolescents, 140 (46%) met the case definition; the average time of drug use, for which they
received the treatment, was 32 months; minimum consumption was 6 months and the maximum was 96 months.
80% presented relapses to drug use; 75% relapsed three months after completing their rehabilitation; 50% at six
months and 25% at 12 months. Relapse in 61.3% was due to cannabis use; 35% for multiple drugs and 4% for
cocaine. Male sex predominated (75%). Aged 16–17 years consisted of 65%, and 42% had incomplete schooling.
Conclusions
Relapses to drug use occur during the first year after rehabilitation and a relationship is established with the use
of cannabis and cocaine It is recommended to consider relapses as a determining factor to achieve abstinence and
to monitor the adolescent who completes their rehabilitation, reinforcing multidisciplinary care, in the periods of
time with the highest risk of relapse.
54
Dengue Outbreak in a Coastal Municipality in Catanduanes, Philippines, 2019
Richelle Abellera, Nolie Rimando, Francis Guimpatan, Alethea De Guzman
Background
In July 2019, the Department of Health received reports of clustering of dengue cases in San Andres, a coastal
municipality of Catanduanes. We conducted an investigation to determine the existence of an outbreak, identify
source of transmission, and determine risk and protective factors
Methods
An unmatched 1:1 case-control study was done. We reviewed medical records and interviewed residents of San
Andres. A suspect case was any previously well resident with sudden onset of fever and two or more of the
following: rashes, headache, retro-orbital pain, myalgia, body malaise, nausea, vomiting, anorexia, and abdominal
pain from April 1 to August 1, 2019. Sera were collected for dengue confirmatory testing via IgM ELISA and/ or
PCR. Controls were asymptomatic residents who tested negative. We conducted entomological and
environmental surveys.
Results
Of 139 suspect dengue cases, 73 (53%) were male. Ages ranged from 1 to 51 years (Median: 13). Twenty-six
(58%) of 45 cases with specimen were confirmed dengue. Two local areas were classified as dengue high risk
[Breteau index of 28 and 39]. We saw uncovered water containers and garbage around the area (e.g., used tires,
coconut shells). Having history of travel (OR = 19.96; 95% CI =1.85–214.81) and being a student (OR = 8.60;
95% CI: 3.82–19.35) were among the significant risk factors identified. Being usually at home (OR = 0.09; 95%
CI: 0.02–0.46), emptying water container not in use (OR = 0.22; 95% CI: 0.09–0.52), and emptying garbage
containers (OR = 0.22; 95% CI: 0.09–0.56) were found to be significantly protective.
Conclusions
There was dengue outbreak in San Andres. There were mosquito breeding sites in the community. High Aedes
indices demonstrated proliferation of vectors that transmit dengue. School had unscreened and open windows.
We recommend strong community engagement to practice regular search and destroy of breeding sites and
adherence to self-protection measures against mosquito bite in dengue prevention.
55
A Case-Control Study on the Measles Outbreak in Mati City — Davao Oriental, January
2020
Karla May Manahan, Ludina Insigne, Alethea De Guzman, Agnes Benegas-Segarra, Ma. Nemia Sucaldito, Vikki
Carr de los Reyes
Background
On January 3, 2020, the Department of Health received report on clustering of measles cases in Mati City.
Investigation was done to verify measles outbreak, gaps on immunization program and identify risk and
protective factors.
Methods
We conducted a 1:1 case-control study. We interviewed cases from Mati City, reviewed records, and collected
specimen for Measles IgM antibody on enzyme linked immunosorbent assay (ELISA) or by Polymerase Chain
Reaction (PCR) testing. Cases were those positive for measles confirmatory test. Controls were well residents of
Mati City.
Results
Of 83 cases identified, forty-three (52%) were males. Age ranged from one month to 44 years old (Median = 2
years old). Forty-six (55%) were under 5-year-old. There were two deaths (CFR = 2.4%). In 2018 there were
outbreaks in selected areas within Davao Region. Mati City had the lowest coverage in the same year. Starting
August 2019, due to armed conflict from neighboring municipality, some internally displaced person moved to
Barangay Matiao, Mati City. Also, in the third quarter of 2019, there was a stock out of MCV. Among 32
respondents interviewed, reasons for non-vaccination were child was not eligible, fear of side effects, child was
sick, and religious belief. In Barangay Matiao, most of the houses are close to each other with poor ventilation.
Significant risk factor was living with infected person (OR: 10.3, 95% CI: 3.07–36.81, p-Value: < 0.0001) while
protective factor was at least 1 dose of MCV. (OR: 0.06, 95% CI: 0.01–0.28, p-Value: 0.00001).
Conclusions
There was a measles outbreak in Mati City. The low vaccination coverage, refusal to vaccination of some group,
transient dwellers from area with low MCV coverage, congestion in the community led to the outbreak. We
recommended to ensure that there will be no stock out of MCV vaccine to improve EPI coverage and conduct
health promotion activities.
56
The Effectiveness of Class Suspension on Containing Enterovirus Infection Clusters in
Preschools — New Taipei City, Taiwan, 2013–2017
Yu-Neng Chueh, Wei-Liang Shih, Chia-ping Su
Background
Enterovirus infection (EVI) could cause severe complications and deaths in children, which poses significant
threat. Class suspension is considered for controlling EVI clusters in schools given that limiting contact among
children could prevent transmission. However, the effectiveness is controversial. We aimed to evaluate the
effectiveness of class suspension on containing EVI clusters in preschools.
Methods
We identified EVI clusters during 2013–2017 from school-based surveillance system in New Taipei City, Taiwan.
We defined an EVI cluster as ≥ 2 children in the same class diagnosed with EVI within 7 days, and class
suspension as class activities cancelled ≥ 1 day. We reviewed the cluster reports and recorded several
epidemiological characteristics, including class size, attack rate (AR), time to notification and cluster period. We
conducted bivariate analysis to compare these factors of clusters with and without class suspension then used
multiple linear regression to model the association between explanatory variables and AR and cluster period. The
p value < 0.01 was considered statistically significant.
Results
Of 5,485 EVI clusters, 3,457 implemented class suspension. The median number of infected children in clusters
was 3 (range: 2–22). Class suspension was more likely to be implemented in public preschools (OR= 2.3, 95% CI:
2.1–2.6), with larger class size (median: 25 vs 24, p < 0.01) and higher AR at notification (12.0% vs 10.7%, p <
0.01). We found class suspension had no significant effect on reducing AR (β coefficients: -1.87–0.63, p > 0.01)
and cluster period (β coefficients: -0.88–0.16, p > 0.01). Larger class size, higher AR when notified, longer
decision-making time of class suspension were associated with increase of AR (β coefficients: 0.1–2.5, p < 0.01)
and cluster period (β coefficients: 0.1–0.6, p < 0.01).
Conclusions
The effectiveness of class suspension on containing EVI clusters might be limited. Preschools should
simultaneously consider other interventions, including personal hygiene enhancement, environment disinfection,
and timely notification for containing EVI cluster transmission.
57
Oral Presentation Session 3: Outbreak Investigation and Response Late Breaker
Food Poisoning Outbreak at Night before Eid-Al-Fitr at Islamic Boarding School —
Gunungkidul Regency, Indonesia, May 2021
Nadiyah Kamilia, Widia Adiratna, Riris Andono Ahmad, Sidiq Herry Sukoco
Background
On May 14, 2021, Playen I Health Center (PHC) reported an alleged outbreak of food poisoning on May 13,
2021, at the Al-I'tisham Islamic Boarding School, after eating the takbiran dinner. Investigation was done to
ensure outbreak, identify the risk factors and prevention measure.
Methods
We interviewed whole people of Islamic boarding schools and observed a restaurant in Gunungkidul Regency
who served food at the event. Analytical study was carried out with case-control study by a person experience
symptoms of food poisoning such as diarrhea, nausea and vomiting after consuming meal package at takbiran
night during May 12 -15, 2021 as a case while the control was an asymptomatic person who consuming meal
package at takbiran night and calculated odds ratio (ORs) to determine food with highest risk of getting ill. The
food samples that were obtained were checked by Yogyakarta Health Laboratory.
Results
Of the 480 people on the list, 406 were successfully interviewed. There were 226 cases (AR 57.30%) with the
main symptoms of watery diarrhea (77.43%) and nausea (48.23%). The incubation period was 1–54 hours with
an average of 12 hours. Of all types of food served, only chili sauce on a meal package associated with food
poisoning (O.R. 3.19, 95% CI 1.75–5.83). Proteus mirabilis bacteria were found in the chili sauce. The chili sauce
was already stale for some people, and environmental investigation found unsanitary process of storing foodstuff.
Conclusions
Proteus mirabilis was found in chili sauce which can cause diarrhea in this outbreak and the process of storing
foodstuffs can also lead to bacteriological contamination. We encourage local governments to emphasize proper
hygiene certificates for restaurants in accordance with the Gunungkidul Regency Regulation Number 3 of 2016.
58
Data Analysis of the Nutrition Surveillance System, Yemen, 2019
Sumia Alturki, Abdulfattah Al-Mahdi, Nosiba Al-Sharafy, Abdulwahed Al Serouri
Background
Yemen is currently facing an increasing trend of poverty and nutritional deficiencies due to war, conflict and
siege since 2015. The Nutrition Surveillance System (NSS) was launched in 2018 to monitor malnutrition trends.
We analyzed 2019 NSS data to describe the pattern of malnutrition in children under five years.
Methods
NSS Data that contains demographic, anthropometric, anemia and breast-feeding variables was obtained in excel
format. After cleaning, data was analyzed where odds ratio (OR) with 95% confidence interval (CI) and p value <
0.05 were calculated.
Results
A total of 100,155 under five children from seven governorates were screened during 2019. While the prevalence
of global acute malnutrition (GAM), stunting and underweight were 20%, 40% and 48% respectively, the
prevalence of severe acute malnutrition (SAM), severe stunting, and severe underweight were: 5%, 18% and 21%
respectively. Males had significantly higher GAM (OR = 1.4, CI: 1.3–1.4, p < 0.0001), stunting (OR = 1.2, CI:
1.17–1.23, p < 0.0001) and underweight (OR = 1.3, CI: 1.25–1.32, p < 0.0001). Furthermore, children 24–59
months had significantly higher GAM (OR =: 1.13, CI: 1.11–1.17, p < 0.0001), stunting (OR = 1.94: 1.89–1.99, p
< 0.0001) and underweight (OR = 1.04, CI: 1.01–1.06, p < 0.01). GAM, SAM and underweight were highest in
Al-Hodaidah (33%, 10%, 61% respectively), while stunting was higher in Dhamar (55%). One quarter of the
screened children had anemia where females had significantly higher prevalence (OR = 1.1, CI: 1.04–1.12, p <
0.0001). Among under six months children, 42% was exclusively breastfed and among under 24 months children
28% was still breastfeed.
Conclusions
In the NSS targeted governorates, the severity of the nutritional situation is considered of high public health
concern as GAM and stunting are exceeding the very high cutoff prevalence of 15 % and 30%. Both immediate
and long-term interventions such as provision of complementary feeding together with encouraging appropriate
breastfeeding practices must be considered.
59
Consistency of Mobile or Email-Based Reporting to Surveillance System by Private
Health Facilities, Poonamallee Health District, Tamil Nadu, India: A Parallel Group,
Exploratory Randomized Open Trial
Abishek Stanislaus, Manickam Ponnaiah
Background
Notification of communicable diseases to surveillance system by private facilities was limited by traditional
methods of reporting in Poonamallee health district, Tamil Nadu, India. We determined consistency of mobile
and email-based methods of reporting to daily disease surveillance system (DDSS) from private health facilities
Methods
We randomly allocated private reporting units to two methods of reporting with inclusion criteria as reporting
units with admission and laboratories testing at least one notifiable disease. The data handlers from these units
were assigned to mobile [through Open data kit (ODK) application] or email based reporting. We trained them
on surveillance system operations and invited to report using DDSS. Both groups received weekly reminders to
report daily. The primary endpoint was consistency of reporting to DDSS. We calculated proportion of
consistency and tested significance by chi-square. We measured secondary outcomes of proportion completeness,
timeliness, sensitivity, simplicity, acceptability and usefulness. We used repeated measures ANOVA (Greenhouse
Geiser) to analyze time trend of reporting methods. Ethics Committee of ICMR, National Institute of
Epidemiology approved the trial
Results
We randomized 43 willing reporting units of 48 reporting units to mobile (n = 22) or email (n = 21) based
reporting. The consistency of reporting through mobile (77%) was higher than that of email (62%) based [p =
0.33]. As compared to email method (94%), completeness of reports was almost equal to mobile based reporting
(96%) [p < 0.05], whereas timeliness (92% Vs. 88%) and sensitivity (96% vs 93%) were higher in mobile based
method. There was no difference in weekly reporting (p = 0.43). Reporting by mobile was reported to be easier
(82%); favoured repeated use (96%) and useful (64%) than email-based units (62%, 81% and 57% respectively)
Conclusions
Both reporting methods were similar in terms of consistency of reporting by private health facilities. Reporting by
ODK method was found to be more complete and maintained timely than email reporting.
60
Leptospirosis in Seberang Perai Utara Penang 2015–2019 — The Need to Improve
Investigations
Wye Lee Chiew, Saraswathi-Bina Rai, Sharol-Azmi Tarmizi
Background
Leptospirosis, a potentially fatal zoonosis, but preventable with adequate protection, is endemic in Malaysia. With
incidence rate of 30.2/100,000 and fatality rate 0.31/100,000 population respectively, mortality is high in Penang,
yet least studied. Every notified case of leptospirosis needs to be investigated. Only those that meet the case
definition are registered. The objective here is to describe the trend of leptospirosis in Seberang Perai Utara,
Penang from 2015–2019 to determine shortfalls in investigation with aim for overall better management of cases.
Methods
This is a cross-sectional study using secondary data from the online disease notification system, investigation
reports, laboratory records and fatality records from 2015–2019. The demographic, clinical presentation,
laboratory result and clinical outcomes data were analyzed using SPSS v25. Data calculated in frequencies and
percentages. Chi square tests used for categorical data. Significance is at p<0.05.
Results
From 364 cases notified between 2015–2019, 63(17.3%) were registered. The IR showed an increasing trend and
in 2019, the IR was 3.53. Cases were mainly among those in the working age group. IR for male was 4.9 and
female 1.7. The ethnicity-specific rates for Malay, Chinese and Indians respectively were 5.4, 5.3 and 3. Cases were
more among Malaysians (IR 3.2) than non-Malaysians (IR 2.8). There were 6 mortalities (9.5%). No specific risk
factor was identified. Mortality data was reported from public hospitals and was limited despite every case
undergoing mortality review. Mortality records were incomplete.
Conclusions
The increasing trend suggests increasing importance of the disease. There was wasted effort in investigation of
non-cases. It is recommended that better record keeping and training, including to the private sector would
improve notification and wasted resources on investigations. Investigators to ensure completeness of data.
Training to private sector is done annually but halted during the pandemic. This is expected to continue soon.
61
Oral Presentation Session 4: Surveillance Late Breaker
Enhanced Event-Based Surveillance for Infectious Diseases during the Tokyo 2020
Olympic and Paralympic Summer Games in Japan, 2021
Ayu Kasamatsu, Tomoe Shimada, Masayuki Ota, Manami Nakashita, Miho Kobayashi, Munehisa Fukusumi,
Takuya Yamagishi, Anita Samuel, Tomohiko Ukai, Katsuki Kurosawa, Miho Urakawa, Kensuke Takahashi,
Keiko Tsukada, Akane Futami, Hideya Inoue, Shun Omori, Hiroko Komiya, Takahisa Shimada, Sakiko Tabata,
Yuichiro Yahata, Hajime Kamiya, Fumi Yoshimatsu, Tomimasa Sunagawa, Tomoya Saito
Background
The 2020 Tokyo Olympic and Paralympic Summer Games (the Games) were held from 23rd July to 5th
September 2021. A large number of participants from around the world might have increased the potential for
importation and spread of COVID-19 as well as other infectious diseases. Enhanced event-based surveillance
(EBS) for international mass gatherings is widely acknowledged as a useful tool for early detection and response.
However, its implementation could be challenging under the COVID-19 pandemic due to the overwhelming
burden on the national surveillance and response team. Here, we describe how we managed the enhanced EBS
for the Games.
Methods
The emergency operation center was set up for the Games at the National Institute of Infectious Diseases in
Japan. As part of its work, three staff members and 15 fellows of the Field Epidemiology Training Program
(FETP) conducted EBS from July 1 to September 19, 2021. In addition to pre-existing national surveillance
systems and EBS, EBS aiming at evaluating non-COVID-19 infectious diseases and importation risk were
enhanced in collaboration with the World Health Organization Western Pacific Regional Office and BlueDot's
surveillance and risk assessment platform. Detected signals were verified when needed. Events and risk
assessments were published in daily reports and distributed to local governments and stakeholders.
Results
During the provisional period of July 1 to September 5, 240 domestic events (COVID-19: 228, non-COVID-19:
12) and 32 international events (COVID-19: 16, non-COVID-19: 16) were screened and assessed. Among these,
95 domestic and zero international events were published in daily reports. Twenty events detected were
monitored, one of which was investigated in the field.
Conclusions
Integrated EBS and information sharing with stakeholders provided confidence in risk assessments, even during
a pandemic. Collaborating with other organizations overseas for surveillance of non-COVID-19 infectious
diseases enabled us to focus our resources on COVID-19 surveillance and response.
62
The Detection and Management of Coronavirus Disease 2019 (COVID-19) Outbreak
Caused by Imported Cases to Thailand and Identification of Potential Risks in the
Origin Country
Kanokkarn Sawangsrisutikul, Teerasak Chuxnum, Pitiphon Promduangsi, Nipapan Saritapirak, Chuleeporn

Jiraphongsa, Rapeepong Supanchaimat
Background
During 8–25 August 2020, the Department of Disease Control (DDC), Ministry of Public Health (MOPH) was
notified about a cluster of Coronavirus disease 2019 (COVID-19) patients from India. This study aimed to
describe the characteristics of the cases and identify possible risks of infection.
Methods
We conducted a cross-sectional study on all 209 passengers on the flight from India to Thailand on 8 August
2020. A case was any person on this flight with positive SARS-CoV-2 detection from RT-PCR from
nasopharyngeal/ -throat swabs. We reviewed medical records, interviewed the passengers, and conducted an
environmental survey at the state quarantine to determine infection risks after arrival. Multivariable logistic
regression was applied to determine the association between COVID-19 infection and potential risks.
Results
There were twenty-three patients with positive SARS-CoV-2 test (attack rate = 11%). The cycling time (CT)
varied between 16.01 and 39.45 (median, 34.76). Twenty-two cases were Thai (95.65%), while the rest was Indian.
The patients’ ages ranged from 11 to 72 years (median, 35). The male-to-female ratio was 1.09. Seventeen cases
(73.9%) were asymptomatic. There were no deaths. Visiting crowded areas in India was significantly associated
with COVID-19 infection (adjusted odds ratio = 3.63; 95% confidence interval, 1.22–10.80). The management
of quarantine centers strictly followed the standards of the MOPH, which brought no further transmission. The
risk of infection on board was minimal as there was no clustering pattern of infectees sitting close to each other
and the CT value of most patients was quite high.
Conclusions
It was likely that the patients contracted the disease before arriving in Thailand. Supporting evidence comprised
high CT values in most patients, indicating that the infection was not recent; and that the strict quarantine
procedure prevented in-country transmission. The campaigns that raise awareness of overseas Thais to avoid
crowded areas were recommended.
63
Timeliness of Contact Tracing among Flight Passengers during the COVID-19
Epidemic in Vietnam
Ngoc-Anh Hoang, Thai Pham Quang, Ha-Linh Quach, Khanh Nguyen Cong, Florian Vogt
Background
International air travel plays an important role in the global spread of SARS-CoV-2, and tracing of close contacts
is an integral part of the public health response to COVID-19. However, evidence about contact tracing
performance is scarce. We aimed to assess the timeliness of contact tracing among airline passengers arriving in
Vietnam on flights containing COVID-19 cases and investigated factors associated with timeliness of contact
tracing.
Methods
We included data from 2,228 passengers on 22 incoming flights between 2–19 March 2020. Contact tracing
duration was assessed separately for the time between the date of index case confirmation and date of contact
tracing initiation (interval I), and the date of contact tracing initiation and completion (interval II). We used
log-rank tests and multivariable Poisson regression models to identify factors associated with timeliness.
Results
The median duration of interval I and interval II were one day (IQR: 1–2) and three days (IQR: 2–5),
respectively. The contact tracing duration was shorter for passengers from flights where the index case was
identified through mandatory entry testing directly upon arrival (median = 4; IQR: 3–5) compared to flights with
index case detection through self-presentation at health facilities after arrival (median = 7; IQR: 5–8) (p-value =
0.018). Cumulative hazards for successful tracing were higher for Vietnamese nationals compared to
non-Vietnamese nationals (p < 0.001), and for passengers arriving on flights with smaller numbers of passengers,
compared to flights with larger passenger volumes (p < 0.001).
Conclusions
Contact tracing was timely overall but slower on high workload days and for international passengers. Mandatory
SARS-CoV-2 testing at arrival may reduce contact tracing duration and should hence be considered as an
integrated screening tool for flight passengers from high-risk areas when entering low-transmission settings with
limited contact tracing capacity. We recommend a standardized risk-based approach for tracing flight passengers
during the COVID-19 epidemic.
64
Oral Presentation Session 5: COVID-19 Transmission Late Breaker
COVID-19 Risks in a Restaurant Superspreading Event — Singapore, July 2021
Gao Qi, James JR Chan, Vincent Junxiong Pang, Yee Leong Teoh
Background
The Delta variant is predominant in Singapore and identifying preventable risk factors for superspreading events
is critical for COVID-19 control. Between 21 July and 9 August 2021, 62 COVID-19 cases were identified in
staff, visitor-patrons and close contacts of a restaurant in Singapore. All visitor-patron cases had visited the
restaurant on 19 July 2021. A thorough investigation was conducted to determine preventable risk factors
contributing to the event.
Methods
A mixed-method study comprised a case-control study, a qualitative study through phone interviews and
environmental field visits. Cases were defined as staff or patrons with SARS-CoV-2 positive who worked at or
visited the restaurant between 19–23 July 2021, the exposure and infectious period. SARS-CoV-2 negative staff
or patrons with exposure between 19–23 July 2021 were selected as controls. Logistic regression analysis was
used to estimate the odds ratios (ORs) and 95% confidence intervals (95% CIs) of association between
underlying risk factors and COVID-19 infection.
Results
Of 37 cases and 62 controls, COVID-19 infection was significantly associated with mask-off activities when not
eating or drinking (adjusted OR 7.4, 95% CI 2.2–25.1, p=0.001), lack of social distancing between staff and
patrons (adjusted OR 4.4, 95% CI 1.4–13.9, p=0.011) and being not fully vaccinated (adjusted OR 4.0, 95% CI
1.2–13.2, p=0.021). Among 84 patrons (26 cases and 58 controls), significant environmental risk factors included
visited the food display counter (adjusted OR 16.3, 95%CI 1.6–162.5, p=0.017) and exposure to items associated
with seafood dishes (adjusted OR 5.8, 95% CI 1.5–23.3, p=0.013). In addition, discreet observations and
interviews reported lapses in standard precautionary measures and hygiene practices.
Conclusions
The findings confirmed a point source outbreak on 19 July with sequential infection among staff prior to the
event. Environmental fomites probably served as vehicles in the superspreading event. The study support
differentiated COVID-19 measures for dining in based on vaccination status in Singapore.
65
Oral Presentation Session 5: COVID-19 Transmission Late Breaker
The Impact of Arbaeenia Mass Gathering on the Trajectory of COVID-19 in Iraq, 2020
Mohammed S. Abdulwahid, Faris Lami, Bashar Abdullateef
Background
Religious mass gatherings like Arbaeenia are common in Iraq and usually attracts millions from within and
outside Iraq. According to World Health Organization, mass gatherings have the potential to amplify the
COVID-19 infection in countries with community transmission. The objectives of this study are to determine the
impact of the Arbaeenia mass gathering on the pattern of COVID-19 morbidity and mortality in Iraq, 2020.
Methods
A descriptive desk review study of secondary data obtained from the Ministry of Health and compiled from all
the governorates except Kurdistan region. The following COVID-19 morbidity and mortality indicators were
calculated: daily new cases, daily PCR tests, daily rapid tests, daily active cases, admitted inpatient cases, intensive
care unit admissions, average daily cases, average recovered cases, and the ratio of positive cases. These were
calculated for the two months before and the two months after the event and were also compared between the
involved and the non-involved governorates in the Arbaeenia mass gathering.
Results
There was a significant decrease in daily number of new and active cases (p<0.001), a significant decrease in
number of patients admitted to the hospitals and in the intensive care unit (p<0.001), a significant decrease in the
average deaths (p<0.001) and a significant decrease in the ratio of positive cases to all PCR tests (p< 0.05) in the
involved governorates. Although there was a significant increase in a number of indicators in some of the
non-involved governorates (p<0.05), the overall results for the indicators were significantly decreased (P<0.001).
Conclusions
Although the risk assessment forecasted an increase in the morbidity and mortality following the Arbaeenia mass
gathering, the study findings did not reveal any effect of the mass gathering on the COVID-19 trajectory in the
country. However, we recommend adhere to World Health Organization recommendations on prohibition of
activities that interfere with physical distancing.
66
Epidemiological Features of Human Brucellosis — Georgia, 2015–2019
Mariam Pashalishvili, Angeliki Lambrou, Giorgi Chakhunashvili, Nana Mebonia, Khatuna Zakhashvili, Paata
Imnadze
Background
Brucellosis, a zoonosis caused by ingestion of unpasteurized milk or undercooked meat from infected animals, or
close contact with their secretions, is endemic to Georgia. According to the National Center for Disease Control
and Public Health of Georgia (NCDC), the median annual incidence rate is 4.7/100,000 population. Vaccination
campaigns in regions with livestock have been held since 2015. We aimed to describe the epidemiology of
brucellosis for the years 2015–2019 in Georgia to prioritize public health interventions.
Methods
We extracted case-based information on brucellosis during the years 2015–2019 from the NCDC’s Electronic
Integrated Disease Surveillance System (EIDSS). We conducted a descriptive analysis of demographic and
possible exposure data using STATA16.
Results
During 2015–2019, 999 cases (17 confirmed, 982 probable) of brucellosis were reported. The median annual
incidence was 5.5/100,000 population (range: 4.6–5.7/100,000). The median age of cases was 36 years (IQR =
30), and the highest median annual incidence was observed in the 15–19 (7.6/100,000) and 30–59 (7.0/100,000)
age-groups. Among cases, 76% (757) were male. The highest incidence was found in the region of Kakheti
(26/100,000), Kvemo Kartli (12/100,000), and Mtskheta-Mtianeti (7.5/100,000), where livestock is farmed.
Among cases with known exposure information, 64% (516/802) reported consuming unpasteurized milk/dairy
products and 40% (295/732) undercooked meat; 94% (345/368) reported direct contact with sick animals.
Occupation was reported in 27% (n = 269) of cases and 63% (169/269) worked in agriculture.
Conclusions
During the 5-year period, brucellosis annual incidence remained rather stable and infection was more frequent in
young adults aged 15–19 years, males, and among individuals residing in regions where livestock is farmed. More
than half of the cases consumed unpasteurized dairy products. Evaluating high-risk population groups’ awareness
and educating them on brucellosis and risk factors are recommended. Public health professionals need retraining
for data quality improvement, and enhancing vaccination campaigns would be beneficial.
67
Case Investigation of Animal Rabies Near Thai-Myanmar Border, Northern Thailand,
February–March 2020
Suwitcha Panchakhan, Paisin Lekcharoen, Sith Premashthira, Surapong Wongkasemjit
Background
Animal rabies cases sporadically occur in Chiang Rai, a province located nearby Thai-Myanmar border. On
February 20, 2020, a district livestock office was notified of a suspected rabid dog attacking students. The dog’s
brain tested positive for rabies using fluorescent antibody test. An investigation was conducted to identify
exposed animals and humans, determine extent of the event, and identify possible source of rabies infection.
Methods
Villagers and local livestock officers were interviewed about index case presence’s history. Sets of definitions were
used for addressing animal and human cases and in-contacts. Existing rabies investigation reports, post-exposure
prophylaxis (PEP) records, and surveillance database were reviewed to determine related epidemiological data
and current situation. Epidemiological characteristics were described using descriptive statistics. Relevant
spatio-temporal information was visualized in Google Maps.
Results
The only animal case between February to March 2020 was a female stray dog with unknown history and, found
3.6 kilometers from the border. The dog was recognized on February 19, when it showed aggression and attacked
people. Spatio-temporal extent of the dog’s wandering was 1.42 square kilometers, along 5.93 kilometers of
distance, within 24 hours. Considering high population density in urban area, 23 free-roaming owned dogs and 15
people, of which, 40% (6/15) had Category III exposures, from 3 villages were exposed to the index case and
received complete PEP. Control measures included a declaration of 5-km radius epidemic area around the
outbreak site, animal movement restriction, and ring vaccination. However, sources of this dog and rabies
infection were inconclusive.
Conclusions
Due to a movement of rabid dog, the magnitude and extent of affecting people and animals is considerably high
and required timely response and control intervention. In spite of only immunization and population control,
effective management to determine and prevent possible sources of dog and rabies infection across border is
highly recommended.
68
Epidemiological Profile of the Rift Valley Fever in Ruminants — Mauritania, 2002–2014
Yacoub Ould Sidi Moctar, Mohamedou Hmeied Maham, Nicolas Meda, Yanogo Pauline, Sidi Mohamed Hama,
Djibril Barry, Nah Tolba, Bezeid Ould El Mamy
Background
Rift Valley Fever (RVF) is a zoonotic arbovirus that severely affects ruminants as well as humans. This disease is
characterized by high mortality rates in young animals and abortions in pregnant ruminants. The disease occurs
during heavy rains followed by heavy outbreaks of vector mosquitoes. The objective of the present study was to
analyze the database of Rift Valley Fever in ruminants in Mauritania, 2002–2014.
Methods
We conducted a retrospective cross-sectional study on RVF epidemiological surveillance data in ruminants in
Mauritania from 2002 to 2014. The study population consists of suspected cases of RVF in ruminants recorded
on the database in Mauritania, 2002 to 2014. We analyzed the data in time, place, and animal using Epi Info.
Proportions, frequencies, and rates were calculated.
Results
A total of 3,897 suspected cases of RVF were reported in ruminants in Mauritania from 2002 to 2014. The age
group of 10 to 12 years old was the most affected with (17/43) positive RVF cases (39.5%) followed by
(221/664) confirmed RVF cases (33.3%) in the 5 to 10 years old age group. The frequency of Rift Valley Fever
appears to be higher in females (24.45%) than in males (19.18%). Hodh Chargui and Adrar regions recorded the
highest number of RVF cases, 55.88%, and 32.58% respectively in this study. The highest prevalence by species
was recorded in dromedaries at 67.5%, followed by goats at 30.8%. The highest abortion and mortality rates were
recorded in 2002 respectively at 46.85% and 35.95%.
Conclusions
Our study shows that Rift Valley Fever is endemic in Mauritania. Despite the completeness of the data, there are
some useful data that have not been filled in such as geographical coordinates, animal density, and mosquito
pressure.
69
Investigation of Tuberculosis in Captive Asian Elephants, Kanchanaburi Province,
Thailand, November 2018
Kirana Noradechanon, Paisin Lekcharoen, Monaya Ekgatat, Porathip Trinuson, Tippawon Prarakamawongsa,
Karoon Chanachai, Wasinee Thepaphichaikul
Background
Mycobacterium tuberculosis complex (MTBC) can cause disease in various species including human and elephants.
On 15 November 2018, a captive Asian elephant from an elephant camp located in Kanchanaburi died and was
diagnosed with tuberculosis based on necropsy and PCR results. An investigation was conducted to describe and
control the outbreak.
Methods
We used questionnaires to collect data of all animals (index case, 6 elephants, 8 dogs, a monkey and a goat),
owner and workers (n = 17) in this camp and collected blood samples from all elephants for antibody tests;
elephant interferon gamma release assay (elephant IGRA) and multi-antigen print immune-assay (MAPIA). All
camp workers were screened using clinical criteria and the suspected was subjected to laboratory investigation.
Probable elephant TB case was an elephant positive either by elephant IGRA or MAPIA and human was
classified as presumptive, probable or confirmed TB case.
Results
Index case was a 62-year-old elephant kept with other 6 female elephants. These remaining elephants were
apparently healthy; however, 33.3% (2/6) of them were probable cases, and 16.7% (1/6) was positive by both
methods. Any elephant could share aerosol-generating activities with workers and tourists during elephant
feeding and bathing. The cohabitating dog had close-contact with elephants, but did not have any clinical sign,
and had a negative TB ELISA result. A total of 17 camp workers (70.6%) had a history of contract with
elephants, 6 (35.3%) of them had contract with the index. Three workers (17.7%) showed TB-like symptoms
(presumptive TB) but no evidence consistent with TB was detected based on chest X-ray results and sputum
culture.
Conclusions
Although the source of the disease was unable to be identified, corresponding authorities were emphasized to
monitor both human and elephant health accordingly. The probable elephants should be confirmed by culture
and PCR from trunk wash samples.
70
Measles Elimination Program Progress in Madhubani District, Bihar, India, 2015–2018
Sambit Pradhan, Anoop Velayudhan, Pankaj Bhatnagar, Pauline Harvey
Background
India has targeted measles elimination by 2023. To achieve the target, sub-district analysis of measles surveillance
and immunization program data is necessary for prioritizing activities. We analyzed measles surveillance data of
Madhubani district, Bihar, India, to describe the epidemiological characteristics of measles outbreaks and cases.
Methods
We reviewed the Integrated Disease Surveillance Program’s measles surveillance data for 2015–2018 and analyzed
WHO monitoring data for measles-containing-vaccine (MCV) coverage status. We conducted key informant
interviews using an open-ended questionnaire and performed a strengths, weaknesses, opportunities, and threats
(SWOT) analysis for the elimination program.
Results
During 2015–2018, Madhubani District reported 34 suspected outbreaks, increasing from five in 2015 to 15 in
2018. Among these 34 outbreaks, 19 (56%) were laboratory-confirmed as measles, and 16 (47%) were reported
by frontline health workers. Among the 19 laboratory-confirmed outbreaks, 312 cases (52% female) and six
deaths were reported; 303 (97%) cases were < 15 years; 193 (62%) belonged to the Muslim community, and 38
(12%) received at least one dose of measles-containing-vaccine (MCV). The average coverage of MCV1 and
MCV2 was 80% and 63%, respectively. The most common reasons for non-vaccination with MCV (n = 8679)
were awareness gap (40%) and adverse effect apprehension (19%). In the SWOT analysis, the strengths identified
were the high proportion (95%) of children receiving vaccination at the public health facility and the ready
availability of updated immunization microplans. The vacant positions (45% medical officer and 28% nurse
position) were a weakness. Opportunities include training for health staff to support new vaccines like rotavirus
and tetanus-diphtheria. Low MCV coverage and non-reporting of outbreaks from 5/22 (23%) sub-districts are
potential threats.
Conclusions
Madhubani measles surveillance facilitates outbreak reporting. However, low MCV coverage and the silent
sub-districts indicate the need for additional support to achieve the elimination targets.
71
Diphtheria Outbreak in Sahar District, Sa’adah Governorate — Yemen, 2020
Elham Zeehrah, Mohammed Al Amad, Labiba Anam, Abdul Wahed Al Serouri, Awad Thabat, Idriss Al-Mosawa,
Hassan Almoharem, Ahmed Almurtadha
Background
Diphtheria is a vaccine preventable disease, reemerged in Yemen at the end of 2017, and many governorates were
affected. On 19 September 2020, an increased number of diphtheria cases from Sahar district, Sa'adah
governorate was reported. On 23 September 2020, a team from Yemen field epidemiology program (YFETP)
was sent to confirm the existence and determine the magnitude of the outbreak, vaccination status of affected
people and recommend control measures.
Methods
A descriptive study was carried out, active search from house to house was performed by using case definition for
diphtheria (any person from Sahar district of Sa’adah governorate who had suffered from adherent membrane of
the tonsils, pharynx and/or nose and suffered from laryngitis, pharyngitis, or tonsillitis) since 1 September 2020.
A pre prepared line list was used. Data was collected through face-to-face interview with doctors and household
of cases. Frequency was used for proportions and rates calculation.
Results
Thirty-eight cases met the case definition. Of these, 61% were females; 82% were aged 5–15 years; 99% had
tonsils adherent membrane, 24% and 18% of the cases were from Al-Talh and Waid-Allaf sub-districts
respectively. The overall attack rate was 17/100,000 population and the case fatality rate was 8%. The majority of
cases (95%) were unvaccinated and 87% lived in remote area that located in the third level of health facilities
catchment area.
Conclusions
Diphtheria outbreak was clinically confirmed in in Sahar district of Sa’adah governorate. Unvaccinated children
were more affected. The case fatality was low compared to standard WHO estimate (10%). An urgent vaccination
campaign against diphtheria is crucial. Reactivation of vaccination outreach activities in remote areas, raising
community awareness for the importance of vaccination are recommended for long-term intervention.
72
Using Epidemiological Data on a Vaccine-Derived Poliovirus Type 1 (VDPV1) Polio
Event in a Southern Mindanao Island to Guide Outbreak Response — Philippines,
November 2019
Ma. Ivy Rozeth Saavedra-Iturralde, Jessica Cagadas, Vikki Carr de los Reyes, Alethea De Guzman, Ma. Nemia
Sucaldito, Ferchito Avelino
Background
Despite the Philippines being certified polio-free in 2000, since 2014 it has been at high risk for polio virus
re-infection. Since July 2019, environmental samples (ES) positive for vaccine derived polio viruses (VDPV) have
been reported in Metro Manila and Mindanao. Several VDPV type 2 cases were reported in Mindanao. Response
measures include mass vaccination of children <5 years with monovalent oral polio vaccine (OPV) 2 and
enhanced acute flaccid paralysis (AFP) surveillance. On November 26, a VDPV type 1 case was detected in a
southern Mindanao Island. We conducted an investigation.
Methods
We conducted detailed case investigation, community AFP surveillance through active case finding and stool
collection among healthy children in nearby households, health facility retrospective records review, and
environmental survey.
Results
The case is a nine-year-old unvaccinated girl. Sudden onset of paralysis was noted three days after fever onset.
No additional AFP case was identified on community surveillance. Two previously unreported AFP cases seen in
health facilities were found. Only 14 (24%) of 58 under-five surveyed had three OPV doses; one (2%) had
inactivated polio vaccine. Open defecation is practiced. Households are on stilts along the coast. Human waste is
deposited directly into the river below. Genetic sequencing showed that this case is not closely related to the
positive ES samples reported in another region. Laboratory results of healthy children stool survey were negative.
Conclusions
There is a polio event in Southern Mindanao. This is the first VDPV1 case aged > 5 years. The event is due to
prolonged circulation of the poliovirus because of poor hygiene and environmental sanitation in an area with low
immunization coverage. Our investigation results led to immediate provision of bivalent OPV among those aged
up to 10 years in the affected municipality. Sustained AFP and environmental surveillance will establish whether
there is circulation.
73
Measles Cases in Conflict Areas, Yemen, 2018–2019
Yasser Ghaleb, Dhikra Shikh, Waleed Hasan Al-Marrani, Mohammed Al Amad, Abdul Wahed Al Serouri
Background
Measles is a highly contagious vaccine-preventable disease. In Yemen, it is endemic, recurrent outbreaks are
occurred and the last Immunization campions was implemented in February 2019. This study aims to describe
the epidemiology, magnitude of measles and determine the immunization status of affected patients.
Methods
We used a descriptive analytical study. Secondary data of confirmed measles covering 2018–2019 was obtained
from Measles and Rubella Surveillance Program. Variables for age, sex, district, date of onset, vaccine doses and
outcome were included. Population from Central Statistical Organization was used for calculating rates per
100,000 population, P value < 0.05 was used as cutoff point for significant.
Results
Out of 22,828 confirmed measles, 13,554 (59%) were reported in 2018 and 9, 274 (41%) were in 2019, two-thirds
(65%) were < five years, 52% were females and 76% were not vaccinated, more in 2018 than 2019 (85% vs 64%,
P < 0.001). The incidence rate (IR) was significantly higher in 2018 (50 vs 32, p < 001). The overall case fatality
rate (CFR) was 1%. It was significantly higher in 2018 (1.7% vs 0.6%, p < 0.001), among < 1 year (7% vs 0.08%,
P < 0.001) and patients with zero dose vaccination (1.5% vs 0.3%, p < 0.001) compared to the relevant groups.
After the immunization campaign in 2019, 14 governorates reported lower IR (33 vs 71, P < 0.001), and eighth
governorates reported higher IR (30 vs 21, P < 0.001) than IR in 018, respectively.
Conclusions
Measles is an important health problem in Yemen with a high mortality among those aged < 1 year. Therefore,
strategies to increase measles vaccination coverage, targeting children < 9 months of age, increase public health
awareness regarding measles vaccination and encouraging research for the risk of infection after vaccination
campaign are recommended.
74
COVID-19 Pandemic: Understanding the Trend, Distribution and Surveillance of
COVID Cases in Udupi District, Karnataka, 2020
Prashant Bhat, Mohankumar Raju, Ravikumar K, Sudheerchandra Sooda, Premananda K, Jagadish H S,

Prabhdeep Kaur
Background
COVID-19 is an unprecedented pandemic affecting 213 countries. Udupi (1.3 million population) is one of the
five districts in Karnataka having highest number of COVID-19 cases. We analyzed surveillance data of
COVID-19 in Udupi District.
Methods
We did a cross-sectional study among persons tested for COVID-19 in Udupi from May 2020 to January 2021.
Data source included COVID-19 laboratory reports, cases and death registers maintained electronically at district.
We described the cases by person, place, time, and analyzed the positivity rate, exposure history, testing delays and
outcomes.
Results
Among 309,755 (238,273/million) tested in Udupi, 7.5% (n = 23,177) were positive for COVID-19 (incidence:
17,828/million). Of 23,177 positive patients, 56.6% (n = 13,126) were male, 50.3% (n = 11,664) aged 15–44
years, and 20.7% (n = 4,808) were symptomatic. Of the seven administrative blocks, Udupi contributed 27% (n =
6,224) of the cases. About 14% (n = 3245) of the cases reported co-morbidities (hypertension-55%, diabetes:
45% and cardiac disease: 10%). Seven-day running-average confirmation rate peaked in July 2020 (28%), which
declined to below 1% after Nov 2020. Overall, 10.3% (2,385) of the cases reported travel history. Among cases
reported before 15 June, 99.5% (1,014/1,019) had travel history compared to 6.2% (1375/22,158) thereafter. The
average daily testing was 1,122 (863/million) during the study period. Median delay in time-to-result improved
from 5 days (IQR: 1–20) before 15 June to 1 day (IQR: 0–3) thereafter. By 31 January 2021, 99% (22,944) of the
cases recovered and 0.8% (189) died, of which 97% (183/189) had comorbidities. Case fatality increased with
age; patients above 55 years had higher case fatality (2.5%, 144/5745) compared to those below 35 (0.04%,
4/9,536).Pre-existing liver disease, renal disease, and malignancy had much higher mortality (47%, 30% and 24%
respectively).
Conclusions
Case fatality was more among higher age-groups and co-morbid patients. While the pandemic was initially driven
by travelers, community transmission is evident later. We recommended targeted screening among elderly and
co-morbid suspects.
75
Assessment of Dengue Disease Surveillance in One of the High Prevalent Districts in
Maharashtra, India, 2020
Rahul Shimpi, Valan Siromany, Ismeet Kaur, Kevisetuo Dzeyie, Pankaj Bhatnagar, Tran Minh Nhu Nguyen,
Pradip Awate
Background
Severe dengue is one of the leading causes of serious illness and death in India due to high endemicity. India
formulated its mid-term plan for prevention and control of dengue in 2011. In November 2020, we evaluated
dengue surveillance system in Pune district, Maharashtra, which reported the highest number of dengue deaths
and third highest number of cases, to define the surveillance system’s functioning and its usefulness.
Methods
We assessed simplicity, acceptability, data quality, representativeness, timeliness, and the stability of dengue
surveillance system in Pune using updated US CDC guidelines for evaluation of surveillance systems. We
conducted interviews of staff members working in the National Vector Borne Disease Control Programme and
clinicians who treated dengue cases. Attributes were rated as good (> 80%), fair (60–80%) and poor (< 60%)
based on the performance score. We reviewed dengue surveillance data of 2017–2019 reported from two
municipal corporations and rural area of the district.
Results
All 8 (100%) staff members interviewed knew dengue case definition, reporting protocol and reported system as
simple and acceptable. Demographic details were present in 99% of cases, clinical manifestation was missing in
100% cases in the line list. Representativeness was poor; only 26% of facilities in the Pune district reported in all
quarters. Of the 33% cases reported from private hospitals, laboratory confirmation was available only for the
critical cases. Stability was poor; 27% of the positions were vacant; 25% were untrained. Data from 2015–17
showed an increasing trend in the number of dengue cases in rural areas; 40-50% cases and deaths due to severe
dengue among 20–40 years of age.
Conclusions
The system is functional in case detection and reporting, contributing to meeting the objectives of mid-term plan
for prevention and control of dengue. However, severity of illness could not be assessed. We recommend
ensuring critical staffing, training and periodic monitoring, evaluation to improve usefulness.
76
Surveillance System Evaluation of COVID-19 National Health Portal — Maharashtra,
India, March–April 2020
Bomto Riram, Suneet Kaur, Valan Siromany, Sanket Kulkarni, Himanshu Chauhan, Tanzin Dikid, Sudhir Kumar
Jain
Background
In response to COVID-19 pandemic the Central Surveillance Unit (CSU) of the Integrated Disease Surveillance
Program, Government of India, introduced the COVID-19 National Health Portal (COVID-19 nhp) in February
2020. We evaluated the usefulness of the COVID-19 nhp, a new system, to make recommendations to strengthen
it.
Methods
We assessed surveillance units of Maharashtra and Mumbai City which had reported maximum number of
COVID-19 cases for simplicity, flexibility, data quality, acceptability, representativeness, stability and timeliness
attributes from updated Centers for Disease Control and Prevention, Atlanta, USA guidelines for surveillance
system evaluation. We conducted stakeholders’ interviews using semi-structured questionnaire. We calculated
proportions and interpreted them using allocated values: good (80–100%), moderate (70–79%), poor (< 60%).
We compared extracted data using COVID-19 Case Investigation Forms (CIF) to calculate proportions of
mismatch of six selected critical fields and missing values to assess data quality. Timeliness was assessed for lag
between data entry and receipt of CIF.
Results
Simplicity, flexibility, acceptability, representativeness, and stability were ‘good’. Data quality was poor due to
missing critical fields and data mismatch. Least filled field was ‘date of onset of symptoms’ (0.85%, 89/10498).
No variable for time of data entry found in portal, hence stakeholders were interviewed for the lag. Timeliness
was moderate in CSU, but poor in SSU and DSU.
Conclusions
Data quality issues and delayed reporting could compromise the ability of the COVID-19 nhp to provide reliable
data for monitoring trends and initiate public health action. We recommend: auto-capturing date of entry of data,
making critical fields mandatory and routine validation of COVID-19 data.
77
Importance of COVID-19 Surveillance and Health Profiling of Filipino Repatriates from
MV Diamond Princess, Capas, Tarlac, Philippines, 2020
Richelle Abellera, Ma. Nemia Sucaldito, Vikki Carr de los Reyes, Alethea De Guzman, Ludina Insigne, Karla May
Manahan, Ma. Kasmira Maramag
Background
In February 2020, the MV Diamond Princess cruise ship docked in Yokohama, Japan. Had 14-day quarantine
after detection of SARS-CoV-2 among 10 passengers and crew. Several others onboard tested positive during
quarantine. On February 25, 2020, the Philippines sent government team to facilitate repatriation of Filipino
workers and passengers. Upon return, repatriates and government team went on quarantine from February 26 to
March 10, 2020, in Capas, Tarlac. We established disease surveillance to detect COVID-19 cases.
Methods
Repatriates and government team were categorized as person under monitoring (PUM). We profiled PUM
through a self-administered questionnaire. All PUM were monitored daily for signs and symptoms. A patient
under investigation (PUI) was any PUM with sudden onset of fever, or any of the following: cough, colds, sore
throat, or diarrhea. Nasopharyngeal and oropharyngeal swabs were collected for SARS-CoV-2 confirmatory
testing via PCR.
Results
Of 458 PUM quarantined, 440 (97%) were crew. Age ranged from 22 to 64 years (median: 40). Thirty-nine (9%)
PUIs were referred to hospital. All tested negative for SARS-CoV-2. On day 12 of quarantine, all PUM were
swabbed. On day 14, results showed two (0.04%) confirmed COVID-19 cases. Both were brought to hospital for
monitoring. Aside from quarantined PUM, four medical staff in the quarantine facility were identified as contacts.
Medical staff went into quarantine and tested negative.
Conclusions
Two asymptomatic repatriates were confirmed COVID-19 cases. They were only discharged upon negative
laboratory result; hence, introduction of COVID-19 in the community by infected repatriates was averted.
However, not all asymptomatic business travelers were tested. Hence, importance of maintaining physical
distance, hand hygiene, and masking to prevent infection must be emphasized. Strengthened disease surveillance
through systematic investigation on exposure history aside from signs and symptoms, is essential to facilitate
isolation, testing and treatment of every case, and tracing every contact.
78
Effects of Hydroxychloroquine with or without Azithromycin on SARS-CoV-2 Clearance
in COVID-19 Patients, Taiwan, March–June 2020
Yi-Ting Yang, Tsung Pei Tsou, Yang Li, Meng-Yu Chen
Background
Hydroxychloroquine (HCQ) with or without azithromycin (AZI) was found to have antiviral activities against
SARS-CoV-2 in vitro. In Taiwan, all COVID-19 patients are hospitalized till viral clearance. We evaluated the
effects of these drugs on shortening the time to viral clearance in COVID-19 patients.
Methods
We conducted a retrospective cohort study among all laboratory-confirmed COVID-19 patients confirmed
during March–June 2020 in Taiwan. Demographic, clinical, epidemiological and laboratory data were extracted
from case review forms and the National Notifiable Disease System. Disease severity of patients was determined
following WHO guidance. Patient treatments were classified into: hydroxychloroquine alone (HCQ),
hydroxychloroquine with azithromycin (HCQ + AZI), and neither. Outcome was days from symptom onset to
viral clearance as determined by first RT-PCR negativity on two or three consecutive negative swabs. We
compared the outcomes between the three treatment groups using survival analysis with Kaplan-Meier estimates.
Results
Of the 353 patients included (median age 30 years, 52% men): 117 (33%) received HCQ, 137 (39%) received
HCQ + AZI, and 99 (28%) received neither. Among 353 patients, 331 (94%) had mild to moderate disease;
disease severity did not differ between treatment groups. All patients achieved viral clearance, with median of 24
days (IQR 18–34) from symptom onset. One patient in HCQ + AZI group died 52 days after disease onset (18
days after viral clearance) from complications. Compared to other groups, patients in HCQ group had a shorter
time to viral clearance (median: HCQ: 23 days, HCQ + AZI: 25 days, neither drug: 25 days, P = 0.50). The
probability of viral clearance at 30 days was 66% in HCQ group, 67% in HCQ + AZI group, and 69% in neither
(p = .61).
Conclusions
Among COVID-19 patients in Taiwan, the use of hydroxychloroquine, alone or with azithromycin, did not
shorten time to viral clearance. This result does not support recommending the use of these drugs in COVID-19
patients.
79
Anti-Retroviral Therapy for People Living with Human Immunodeficiency Virus —
Yemen, 2018–2020
Ehab Al-Sakkaf, Mohammed Al-Dawla, Mohammed Al Amad
Background
Antiretroviral therapy (ART) is the core of Acquired Immunodeficiency Syndrome (AIDS) care and treatment.
ART saves the lives of people living with the Human Immunodeficiency Virus (HIV) and prevents the
development of opportunistic infections and transmission of HIV from mother-to-child. Yemen is one of the
low prevalence countries for HIV/AIDS. ART initiated in 2007, and limited information is available. This study
aims to describe the ART cases, enrollment, retention, and attrition rate among ART cases.
Methods
A retrospective descriptive analysis for the data of ART cases who were treated at ART sentinel centers in Sana’a
Capital and Al-Hodeida city. Hard copies of the ART cards covering the period from January. 2018 to October.
2020 were obtained. Proportion, retention and attrition rates were calculated and p-value < 0.05 was used as the
significant cutoff point.
Results
A total of 946 cases were enrolled in the two ART centers and 3% of them were pre-ART. Out of 920 ART
cases, 629 (68%) were males, 600 (65%) were between 25–49 years old, 51% were married, 224 (24%) had a
family member infected with HIV, and 433 (47%) presented with unknown clinical stage. 40 % of all cases
enrolled to ART within 3–7 days (43% in Sana'a Vs 24% in Al-Hodeida, pP < 0.001). 52% were treated with
tenofovir/lamivudine/dolutegravir and 30% substituted the initial regimen within the 1st line. The ART retention
rate was 92% and 83% at 12 and 24 months compared to 8% and 17% attrition rate, respectively.
Conclusions
The ART retention rate is high in Yemen. Increase the pre-ART counseling, improve recording data based on
updated ART guidelines, and further study for defaulter risk factors is highly recommended.
80
Survey of Accessibility, Availability, Price and Affordability of Essential Medicines and
Diagnostic Technologies for the Clinical Measure and treatment of Hypertension on
Primary Health Care Units of West Gojjam Zone, Northwest Ethiopia, 2020
Zelalem Yirga
Background
Hypertension is a key risk factor for cardiovascular disease and around a third of people with hypertension are
undiagnosed, and of those diagnosed, half are not taking antihypertensive medications. Access to medicines is a
universal right and this right denied by low availability and low affordability of medicines. In Ethiopia, lack of
access to essential drugs is major challenge.
Methods
Facility-based cross-sectional survey was conducted from March 16, 2020–March 30, 2020 at 40 primary health
care unit drug outlets of West Gojjam. Data was collected with an interviewer administered structured data
collection tool and analyzed using SPSS version 23 ad Microsoft Excel 2016. Medicine prices were compared with
facilities and sectors. The daily wage of the lowest paid government worker was used to measure affordability.
Results
The mean availability of essential drugs and diagnostic technologies at the primary health care units of West
Gojjam was 62.5% and 67.5% respectively. The number of days wage needed for getting essential
antihypertensive medications was two or more working days. All the available essential antihypertensive
medications were in generic brands and not affordable for one month course of treatment. The private sector
median price was two and more than two times the public sector price. The mean availability of essential
diagnostic technologies at public and private sector was 69.3%, and 65.7% respectively.
Conclusions
Essential antihypertensive medications and diagnostic medical technologies for the clinical measure and treatment
of hypertension are available at fairly high, but unaffordable for the wage of unskilled government worker, and
for many peoples living under the poverty line of the country. The national NCD program should give an
emphasis on improvement of access to affordable essential antihypertensive medications and diagnostic
technologies for the diagnosis and treatment of hypertension at primary health care units.
81
Evaluation of Community Pharmacists’ Involvement and Barriers to Their Participation
in Public Health Activities, Assiut, Egypt, 2019
Azza Badry, Salma Afifi, Sahar El Shourbagy, Hanaa Abuelseoud, Alaa Eid
Background
Community pharmacies can play a major role in public health services owing to their wide geographical
distribution and location in the heart of community. Little is known about community pharmacists' role in public
health in Egypt. This study aimed to determine the extent of community pharmacists’ involvement in Assiut and
identify barriers to their participation in public health activities.
Methods
Study was conducted in 150 randomly selected pharmacies, June–August 2019. Pharmacists working in the
selected pharmacies were debriefed about the study objectives, asked to fill a self-administered questionnaire that
include socio-demographic information, involvement, and barriers to providing public health services.
Descriptive and inferential statistical data analysis was performed using SPSS.
Results
Overall 150 pharmacists filled the questionnaire; their mean age was (32.1 ± 7.7); 52.0% were males, and 62.7%
had experience > 5 years. Overall level of involvement was (82.7%); it was higher for patients counseling (97.3%),
dental health (90.0%), measuring blood pressure (83.4%), family planning (83.3%), measuring blood glucose
(79.4%), normal body weight (77.8%), smoking cessation (77.4%) and infectious disease prevention (74.6%).
Level was low for vaccination campaign (15.3%) and infectious disease surveillance (10.6%). Higher level of
involvement was found in experienced compared to relatively new pharmacists (62.7% vs 37.3%, p < 0.01). Lack
of knowledge (76.7%) and lack of profit (73.3%) were the most reported barriers for participation in public
health services. Most of participants (90.6%) expressed their willingness for participation in future vaccination
campaigns and 84.6% in infectious disease surveillance if requested.
Conclusions
Study showed that community pharmacists are playing important roles in public health services in Egypt
especially in counseling and screening services. Training and motivation are required to better integrate
community pharmacists into future public health programs especially in infectious disease surveillance and
vaccination campaigns.
82
Oral Presentation Session 10: Severe Illnesses and Deaths Late Breaker
Investigation of COVID-19 Deaths among the Staff of a University in Aligarh, Uttar
Pradesh, India, May 2021
Mukesh Kumar Prasad, Davendra Kuma, Sushma Choudhary, Vikasendu Agrawal, Tanzin Dikid
Background
Following multiple casualties at a University in Uttar Pradesh and 18 of the 20 COVID-19 positive samples
randomly selected, had B.1.617.2 lineage, a team of two India Epidemic Intelligence Service Officers was
deployed for epidemiological investigation of deaths in the university and to guide public health response based
on findings to prevent deaths.
Methods
A COVID-19 death was defined as the death of an Aligarh university employee between 1 April to 14 May, 2021,
who presented with symptoms of COVID-19 preceding death. We obtained a line-list of deceased university
staff and reviewed their hospital records. We did verbal autopsies of COVID-19 deaths from their family
members and collected information on co-morbidities, hospitalization, vaccination, and COVID-19 testing
during illness. We collected information on monthly targets and achievements of COVID-19 vaccination in the
University campus.
Results
We identified 29 COVID-19 deaths of university staff, all were males with a median age of 54 years (range: 37–
62), 29/29 (100%) were symptomatic with 26/29 (90%) having fever, and 17/25 (68%) had comorbidities. The
mean duration between onset of illness to sample collection and hospitalization was 7 days and mean oxygen
saturation at the time of hospitalization was 78%; 26/29 (90%) of the deceased were on oxygen support; 16/29
(55%) availed ventilatory support; 5/29(17%) were vaccinated with a single dose of COVID-19 vaccine.
COVID-19 vaccination coverage was 11%, 37%, and 58% during March, April, and May 2021 respectively. Two
of the deceased were healthcare staff and none were vaccinated. 14/21 (67%) were positive for COVID-19 by
RT-PCR and 7/10(70%) had B.1.617.2 lineage.
Conclusions
COVID-19 deaths among the University staff during April–May 2021 affected males and mostly those not
vaccinated for COVID-19 and having pre-existing co-morbidity. We recommend prioritizing high-risk groups for
vaccination and early diagnosis and timely hospitalization of COVID-19 suspects.
83
Oral Presentation Session 10: Severe Illnesses and Deaths Late Breaker
Sex-Based Variations in Clinical Manifestations, Co-morbidities, and Outcome of
COVID-19 Patients in Baghdad, Iraq, 2020
Nameer A. Ali, Faris Lami
Background
A higher incidence of COVID-19 in males has been widely reported. However, whether clinical manifestations,
comorbidities, severity, and outcome differ between males and females remains an area of active investigation.
The objectives of this study are to compare the clinical features, comorbidities, severity, and outcome between
male and female COVID-19 patients, Baghdad, Iraq, 2020.
Methods
We performed a records-based cross-sectional study by extracting sociodemographic, clinical manifestations,
severity, and outcome data from the records of COVID- 19 patients who tested positive for SARS-CoV-2 using
the RT-PCR test and admitted to two COVID-19 hospitals (AlKarkh and AlFurat General Hospitals) in
Baghdad, Iraq between June and August 2020.
Results
We reviewed a total of 2111 patient records with a history of COVID-19, and 1175 patients (55.7%) of them
were males. We found that the following manifestations were significantly more common in females than males:
respiratory symptoms (90.5% vs 87.6%; p = 0.034), sore throat (14.0% vs 10.7%, p = 0.023), and gastrointestinal
manifestations (11.5% vs 7.2%; p = 0.002). No significant difference was noted for fever, nasal congestion,
conjunctival congestion, headache, and musculoskeletal manifestations. Generally, female patients had a
significantly higher proportion of comorbidities than males (42.7% vs 36.0%; p = 0.002). The proportion of
severe and critical cases was not significantly different between males and females (p >0.05). The mean time from
diagnosis to the outcome was significantly longer in females (p = .034), but the duration of the hospital stay
showed no significant difference between males and females (p >0.05). Finally, the case fatality ratio was higher in
males (16.1%) than females (13.2%) (p = 0.022).
Conclusions
Patients’ sex affects the clinical course and outcome of COVID-19 patients. Male patients may need more
attention considering the higher case fatality ratio.
84
COVID-19 Mortality, Kerala, India 2020: A Descriptive Study
Ajan M J, Sarita R L, Ganeshkumar P, Meenakshy V
Background
Kerala, India’s southern state, reported the first case of COVID-19 in India at Thrissur district on 30 January
2020. Till 28 February 2021, Kerala reported 1,059,403 cases of COVID-19 and 4,197 deaths. Clinical
manifestations of COVID-19 range from asymptomatic to acute respiratory distress syndrome and death. There
is a lack of understanding of the epidemiology of COVID-19 deaths. We described the COVID-19 deaths in
Kerala by time, place, and person.
Methods
We did a secondary data analysis of the deaths reported among the case-patients who tested positive for
COVID-19 using rt-PCR. WHO definition for COVID-19 deaths was employed for the study. We collected the
demographics and clinical information from the medical bulletins reported by the District Surveillance Units to
the State Surveillance Unit between January and December 2020. We plotted the distribution of COVID-19
deaths by age, gender, comorbidity, hospitalization duration, and estimated deaths per million population by the
district. Data was entered in MS Excel and analyzed using Epi Info version 7.2.3.1.
Results
Total COVID-19 deaths between January and December 2020 were 3,072. The maximum number of deaths
occurred during October (821, 26.7%). Thiruvananthapuram District reported the maximum (21.4%) deaths.
Among the reported deaths, 2,063 (67.2%) were males. The case fatality rate was highest during May 2020 (1.1%)
and above 80 years of age (3.45 %). Population mortality rates were also highest among above 80 years of age
(593 per million). Of the COVID-19 deaths, 2,904 (95%) had comorbidities, with diabetes mellitus being the
commonest comorbidity (54%). Also, 73% of the patients had category-C symptoms at the time of
hospitalization.
Conclusions
The case fatality rate was higher among males and during May 2020. We recommend that early diagnosis and
management of cases, especially in persons with comorbidities, is to be ensured.
85
Diseases and Mortality Representation among Children of the Uitoto Indigenous People
of the Colombian Amazon, 2019–2020
Marcela Benavides
Background
An indigenous baby born in a developing country is 14 times more likely to die in the first month of life than a
baby born in an industrialized country. Infant mortality of indigenous children all over the world is higher than
non-indigenous children. Geographical distance, access to biomedical services and healthcare practices are the
main causes. This study describes children’s diseases and mortality representations in indigenous communities
living in the Colombian Amazon. It aims to understand the meanings and representations of the disease/sickness
and the “native diseases” in children, and how these representations lead families to use or not biomedical
services or being treated by shamans, specifically in three symptoms: diarrhea, fever, and respiratory problems.
Methods
This study presents findings based on participant observation in Uitoto, an Amazon native community and
qualitative interviews with three groups of actors: pediatric healthcare professionals, three families from the
Uitoto community and two shamans.
Results
Besides the reasons of indigenous infant mortality, another important factor is that the system does not include
the Uitoto indigenous representations. Therefore, the community finds within their traditional medicine answers
that biomedicine does not offer. Healthcare practices with the shaman are holistic and consider the different
components of what they judge to be the origin of the disease: the individual, the family, the society, the jungle,
and the spiritual world; consequently, indigenous population express to suffer from diseases that are not known
by biomedicine and cannot be cured. They distrust biomedical practices and are more confident of their shaman.
In addition, they state that ignorance of their health practices from health professionals is considered as
discrimination.
Conclusions
The study shows the urgency of providing an adequate mediation between their representation of biomedicine
and traditional medicine to provide an inclusive healthcare system, more so in the context of the COVID-19
pandemic.
86
Kluang Prison Acute Gastroenteritis Outbreak — February 2020
Jeyanthini Sathasivam, Thilaka Chinnayah, Harishah Talib, Shaharom NorAzian Che Mat Din, Noorhaida Ujang,
Linayanti Rosli
Background
Prisons or correctional facilities offer fertile settings for the transmission of diseases due to over-crowding, lack
of hygienic conditions and poor health care systems. On the 4 February 2020 at 3:00 pm, Kluang District Health
Office received the first notification of a surge of acute gastroenteritis cases in the prison. After verification an
outbreak investigation was done to identify the risk factors and institute appropriate control measures.
Methods
The clinic outpatient registry was reviewed, and active case detection (ACD) done to identify cases. Data was
collected through interview and observation. Any person with history of three or more episodes of loose stools
in a day AND fever or abdominal pain or headache or vomiting or nausea was included. A case control study
with 3 cell mate contacts to a case was carried out. Logistic regression analysis was done to identify food habits,
water habits and/or hygiene practices that contributed to the outbreak. Clinical samples, environmental samples
were taken to determine the causative pathogen.
Results
Amongst 1494 prisoners in the affected blocks, 242 (16.2%) were ill. All reported diarrhea with 69.4% and 67.8%
reporting fever and abdominal pain, respectively. Sharing drinking water with cell mates (OR = 2.77, CI: 1.41–
5.46) and washing the water vessel twice daily (OR = 7.47, CI: 2.92–19.14) was associated with illness. Storage of
water only in drinking cups was protective (OR = 0.27, CI: 0.12–0.61). Six stool samples were positive for
rotavirus. Concurrent leptospirosis infection detected among three cases. Clinical samples, environmental samples,
food and water samples detected Escherichia coli and Staphylococcus aureus.
Conclusions
This acute gastroenteritis outbreak was a mixed event of a rotaviral outbreak and a concomitant leptospirosis
outbreak highlighting poor hygiene and sanitation practices contributing to the outbreak. Actions taken by
elevating the level of hygiene and empowering the inmates to be responsible for own health.
87
Norovirus Foodborne Outbreak in a Buffet Restaurant — Yilan, Taiwan, August 2020
Ching-Hui Huang, Angela Song-En Huang, Chia-ping Su
Background
During August 2–5, 2020, Taiwan CDC was notified of > 120 travelers with gastroenteritis after dining at a
buffet restaurant in Yilan. We investigated to identify implicated foods and causative pathogen.
Methods
We conducted a case-control study using an online questionnaire among two groups that ate on July 30 (group A)
and August 1 (group B), with 111 and 65 diners, respectively. We defined cases as diners having any of the
following symptoms ≤ 72 hours after eating at the restaurant: diarrhea, abdominal pain, nausea or vomiting. We
conducted univariate and multivariate analyses of 103 foods consumed. We inspected restaurant and interviewed
food handlers. Stool specimens from cases and restaurant workers, and environmental specimens were tested.
Results
Of the 78 and 42 respondents from two tour groups, 18 (23%) and 28 (67%) met case definition. In groups A
and B, the most common symptoms were vomiting (n = 11, 61%) and diarrhea (n = 27, 96%), and median
incubation periods were 43 (rang: 2–62 hours) and 13 hours (range: 2–55 hours). Illness was associated with
French fries (n = 9, OR = 10.5, 95% CI: 2.0–54.5) and apple juice (n = 9, OR = 5.1, 95% CI: 1.1–23.7) for group
A; no associated foods were found for group B. Environmental investigation found daily chlorine levels of
chlorinated groundwater sources used by the restaurant were < 0.2ppm during July 9–August 4; water samples
were negative for norovirus. Eight restaurant employees were positive for norovirus; six were symptomatic (onset
during July 28–August 3); seven diners tested positive for norovirus; all viruses were genogrouped GI.4.
Conclusions
Because few diners ate the epidemiologically implicated foods, transmission of norovirus most likely resulted
from cross-contamination by sick restaurant employees. We recommend ensuring sick food handlers do not
work, to maintain food safety.
88
An Outbreak of Food Poisoning after Consumption of Chicken Curry Contaminated with
E. coli in an Old-Age Home, Kannur District, Kerala, India, 2019
Sachin KC, Rubeshkumar Polani, Deepak Rajan, Shaj MK, Mohankumar Raju, Prabhdeep Kaur
Background
WHO South-East Asia Region reports 150 million cases and 175,000 deaths of foodborne illness a year.
Escherichia coli is one among the 31 organisms causing the foodborne disease. On December 31, 2019 medical
officer of a Primary Health Centre in Kannur District Kerala, notified a cluster of food poisoning cases
following reunion in an old-age home. We investigated the cluster to identify potential exposures and propose
recommendations.
Methods
We defined a case as occurrence of loose stools (≥ 3 episodes) or vomiting in any attendees of the reunion party,
December 30–31, 2019. We searched cases actively and described the cases by time, place, and person. We
interviewed key informants to generate hypothesis. We conducted retrospective cohort study of the attendees of
reunion party and computed relative risk (RR), 95% confidence interval (CI) and population attributable risk
(PAR). We sent the food samples for laboratory analysis of microorganisms and synthetic food colors.
Results
Reportedly, 102 attended the reunion party, among them 40 (39%) developed food poisoning. Median age of the
cases was 40 years (range: 8–92 years). Attack rate of food poisoning was 39% (40/102). Attack rate was higher
among males [48%; (29/60)] than females [26%; (11/42)]; and among residents of orphanage [81%; (25/31)].
Among the cases, 25 (63%) were hospitalized and 2 (5%) died. Loose stool (95%) and vomiting (53%) were the
most common symptoms reported by cases. Attack rate was higher among those who ate chicken curry [95%;
(38/40)] than others [3%; (2/62); RR = 29.2; 95% CI = 7.5–115.3; PAR = 92%]. Chicken curry food sample was
positive for Escherichia coli. During the investigation, we found that attendees ate the leftover chicken curry for
dinner.
Conclusions
Outbreak of food poisoning among the attendees of reunion party was due to consumption of chicken curry
contaminated with E. coli. We recommended to consume freshly prepared food items.
89
Oral Presentation Session 11: Foodborne Diseases Late Breaker
Clostridium Perfringens Suspected as Causative Pathogen of Foodborne Outbreak in a
Wedding Party-Bantul District, Indonesia, March 2021
Fitriana Puspitarani, Yampa Eksa Daidella Ghilari, Samsu Aryanto, Riris Andono Ahmad
Background
Foodborne disease still counts as one of morbidity and mortality in Indonesia. On 30th March 2021, Jetis 2
Public Health Center (PHC) was notified of 3 suspected food poisoning cases with diarrhea after eating packaged
food at a wedding party. Investigation was initiated to confirm the outbreak and identify risk factors for control
measures.
Methods
A 2:1 case-control study was conducted. Case was a person with one or more following symptoms: diarrhea,
abdominal pain, and nausea after eating packaged food from a wedding party on 30th March 2021. Control was
those who did not develop any symptoms after eating packaged food from a wedding party on 30th March 2021.
Interview was conducted using structured questionnaires to the wedding guest, food handlers and those received
food based on the distribution list. Environmental observation was done on the kitchen and delivery point of
catering N. Food samples were collected and sent to the laboratory.
Results
There were a total of 400 packaged food distributed, of which only 109 people can be interviewed. A total of 72
cases identified with symptoms that mostly occur were diarrhea (88%), abdominal pain (57%) and nausea (19%).
The incubation period was 3–23 hours with median 11 hours. Stir fry beef tongue (OR=4.33; 95% CI: 1.43–
13.51) was the food item with the highest risk. We suspected Clostridium perfringens as the main pathogen according
to incubation period and mode of transmission, however laboratory result indicated otherwise due to improper
food sample processing. Contamination might have occurred as a result of poor processing practices, such as
inappropriate food storage
Conclusions
There was a food poisoning outbreak following a wedding party caused by stir-fry beef tongue that contaminated
with Clostridium perfringens. Implementation and training regarding standard health and safety food handling
need to be done for food caterer by district health office.
90
Nairobi Fly Dermatitis Outbreak — Boditi, Southern Ethiopia, April 2019
Mesay Gunta Gutulo
Background
Nairobi fly dermatitis is an unusual form of contact dermatitis caused by pederine, a secretion of insects
belonging to the genus Paederus, which has higher concentration in tropical and subtropical areas. In Ethiopia,
more particularly in Wolaita, Nairobi fly dermatitis is uncommon previously. Hence, the current study was to
describe and identify the clinical characteristics and risk factors prone to the disease.
Methods
We conducted an unmatched case-control study (ratio 1:2). Individuals were defined as a case if he/she
developed localized skin lesion in at least one or more exposed areas of the body from April 5 to 14, 2019.
Controls were randomly selected asymptomatic lesion-free households during the outbreak period in the village.
We interviewed participants and reviewed medical records for exposure and calculated odds ratios (ORs) for the
association between illness and potential exposures. The environmental assessment had been carried out.
Results
A total of 45 cases of Nairobi fly dermatitis were identified, of which 27 (60 %) were females. The commonly
affected age groups were 8-15 years (n = 14, (31%)). The common clinical manifestations were the
erythmatovesicular lesions (18, 40%), burning sensation (32, 71%), and pruritus (28, 62%) respectively. Use of
light during sleep (aOR = 8.5, 95% CI: 1.03–64.8), disposing of wastes near vicinity (aOR = 5.44, 95% CI: 2.09,
14.12) and proximity of dense ventilation or fruit in the vicinity (aOR = 7, 95% CI: 1.143–43.78) were
independent predictors to contract Nairobi fly dermatitis.
Conclusions
Light on while sleeping, disposing of wastes near vicinity, and proximity of dense vegetation and/or fruits in the
garden were the most likely risk factor for Nairobi fly dermatitis outbreak. We recommend organized vector
control and light off while sleeping, clean excess vegetation and/or fruits, and disposing of wastes properly away
from the accommodation.
91
Evaluation of Scrub Typhus Surveillance System — Alwar District, Rajasthan, India,
July–August 2020
Surendra Mohan Prajapati, Kanica Kaushal, Simmi Tiwari, Ajit Shewale, Tanzin Dikid, Sujeet Kumar Singh
Background
Scrub typhus (ST), a rickettsial disease, is an under reported and fatal illness accounting for 23% of all febrile
illnesses. Sixteen Indian states reported ST outbreaks under central Integrated Disease Surveillance Programme
(IDSP) between 2015–2019. After Mizoram, Rajasthan reported maximum cases (4,904) during 2018–2019 in
their state reporting system. We described and evaluated the ST surveillance system in Alwar district, Rajasthan
for selected attributes, descriptively analyzed lab confirmed cases and provided evidence-based recommendations.
Methods
To describe and evaluate the system, we reviewed IDSP records and conducted key informant interviews at
district and block level. We framed the indicators for selected attributes using US Centers for Disease Control
guidelines. Based on average performance of indicators, attribute score was ranked as excellent (90–100%), very
good (80–89%), good (70–79%), average (60–69%) and poor (< 60%). We analyzed ST cases reported by state
IDSP from 2017–2019.
Results
Suspected cases were referred to district hospital by passive or active surveillance for diagnosis and treatment.
Line list of diagnosed cases was shared at block level for preventive measures. On reviewing records and
conducting 26 key informant interviews, system scored flexibility (100%), acceptability (92%) and usefulness
(100%), simplicity (79%) and stability (79%), data quality (48%), representativeness (48%) and timeliness (33%).
Median age of cases was 35 years (range: 4 months to 93 years) with 70% males and maximum cases were
reported between August to November 2019.
Conclusions
Active and passive surveillance are core interventions of ST surveillance system. We recommend regular
monitoring of surveillance reports and registers at block and district level and ensure timely reporting of ST cases
through IDSP. Preventive measures and active case search should be strengthened for high transmission months
between August to November.
92
Case Series: SARS-CoV-2 and Dengue Virus Coinfection in Mexico
Noé Hernández Valdivia, Daniela Valdez Hernández, Diana Vidal Aguirre
Background
The COVID-19 pandemic represents the greatest public health challenge in the last century. As SARS-CoV-2
spread around the world, its circulation overlapped with that of other pathogens, including the dengue virus. The
outcome of the coinfection by these two viruses, in terms of diagnosis, treatment and prognosis, is not clear yet.
Methods
In this case series, patients with a positive result for SARS-CoV-2 and dengue virus, by RT-PCR, were identified
in the special surveillance systems of the General Directorate of Epidemiology, between February 28 and July 23,
2020.
Results
Three cases are presented, with clinical manifestations ranging from mild to death. All three cases required
supplemental oxygen and hospital management. The case that ended in death had a history of obesity and
diabetes.
Conclusions
In Mexico, SARS-CoV-2 coexists temporally and geographically with dengue virus, the simultaneous infection of
both viruses constitutes a diagnostic and therapeutic challenge. Knowing the clinical presentation of this
coinfection represents the first step in proposing a clinical approach and a public health response to this
challenge.
93
Dengue Outbreak — Ipil, Zamboanga Sibugay Province, Philippines, 2019: A
Case-Control Study
Ma. Kasmira Maramag, Ludina Insigne, Ma. Ivy Rozeth Saavedra-Iturralde, Alethea De Guzman
Background
On July 16, 2019, the Department of Health received report on dengue clustering in Ipil, Zamboanga Sibugay.
Investigation was done to determine the existence of an outbreak, identify source and mode of transmission, and
determine risk factors.
Methods
Unmatched 1:2 case-control study was done. We conducted active case finding and entomologic survey in two
barangays with high attack rate. We collected blood specimens from cases/controls to test for dengue polymerase
chain reaction and enzyme-linked immunosorbent assay. Suspect cases were residents with fever for 2-7 days plus
two of the following: rashes, flushed skin, headache, nausea/vomiting, body pain, abdominal pain, mucosal
bleeding, and low platelet count from May 1 to July 25, 2019. Controls were asymptomatic residents and negative
for confirmatory test.
Results
Cases started to increase in January and peaked in May. We identified 243 cases. Age ranged from 1–61 years
(Median: 13). Majority (53%) were females. Three mortalities (CFR: 1.23%) were < 10 years old. Cases had fever,
160 (66%) headache, 159 (65%) abdominal pain, and 114 (47%) vomiting. Ipil had dry season (March–April)
followed by intermittent rains (May). Water stored were uncovered. Garbage were collected weekly. Uncollected
trash was left in backyards. Two barangays were dengue high risk: 60%–67% house index, 85–102 Breteau index,
and 20–24 pupae per person. On multivariate analysis, top factors with increased odds of getting ill were: < 18
years old, 41.94 (95% CI: 7.44–236.60, p-value: < 0.0001); students, 21.15 (95% CI: 3.91–114.35, p-value: <
0.0001); and lived with suspect dengue cases, 18.22 (95% CI: 3.21–103.50, p-value: 0.0010). Twenty-two of 65
specimens were dengue IgM positive. Ten were PCR positive (Dengue 1–3).
Conclusions
There was a dengue outbreak. Intermittent rains, uncovered water containers, and uncollected trash contributed
to increased mosquito breeding sites. Students were susceptible because they are usually out when Aedes spp. are
active. We recommended protective measures‒wearing long sleeves, using mosquito repellant, and strictly
implementing mandatory clean-up drive.
94
Outbreak Investigation of Early Coronavirus Disease Cases — Maharashtra, India,
March 2020
Bomto Riram, Khyati Aroskar, Sushma Choudhary, Sanket Kulkarni, Tanzin Dikid, Sudhir Kumar Jain
Background
By 15 March 2020, India recorded 105 COVID-19 cases and 2 deaths. The first COVID-19 cases in Maharashtra
were a couple with history of international travel. As the disease was new in India, we investigated to describe the
epidemiology of initial case clusters.
Methods
We defined confirmed case as any person residing in Maharashtra from 1–23 March, 2020, with history of
international travel in last 14 days or severe acute respiratory infections (SARI) of unknown cause or contact of
confirmed case; and one nasopharyngeal swab test positive for SARS-CoV-2 by Reverse Transcription
Polymerase Chain Reaction (RT-PCR). Contact was defined by National Centre for Disease Control India
guidelines. We identified cases and contacts through Integrated Disease Surveillance Programme COVID-19 case
investigation forms and telephonic interview.
Results
We identified 89 COVID-19 cases (median age = 38 years, range = 3–75; males = 65%, CFR = 2.2%) in
Maharashtra from March 9 to 23, 2020. Of the cases, 64% were symptomatic and 17% had comorbidities.
Mumbai district had the highest number of cases (36, 40.4%). Among cases, Mumbai airport was point of entry
(PoE) for 66.3% (59/89) and 70% (62/89) were international returnees. Median days of symptom onset after
arrival was 2 days (0 to 15 days). Contacts were traced for 46% (41/89). No exposure (history of international
travel/contact with COVID-19 patient) was found in 4.5% (4/89). Mean contacts traced per case was 5 (range =
0–33) among 41 cases. Nearly half of the cases (53%) were from15 clusters (size: 2 to 16).
Conclusions
The initial COVID-19 cases in Maharashtra were among adults, mostly international returnees landing in
Mumbai. The case fatality rate was low. Contact tracing was incomplete. We recommended strengthening
surveillance at PoE and initiate early contact tracing for all cases. No identified exposure in few cases raised the
possibility of community acquired infection.
95
Comparison of COVID-19 Outbreak Cases in Two Different Call Centers
Sangeun Lee, Hyeyoung Lee, Shin Young Park, Young-Man Kim, Seonju Yi, Young Joon Park
Background
Call centers are vulnerable settings to spread of COVID-19; due to employees’ main jobs being calling and
talking during their whole working hours. However, two call center outbreaks in March 2020 in Korea displayed
different outcomes; one came to be the biggest outbreak during the time period while the other came out much
smaller. It was absolutely necessary to analyze the cause of difference between two events.
Methods
With analysis of the records obtained through investigations and outbreak control measure review, attack rates
were analyzed by individual working seats, symptoms, age, and sex, and period of office-wide exposure to
COVID-19 was estimated. Infection prevention and control measures implemented in each call center prior to
outbreaks were assessed and individual seats were illustrated.
Results
In one call center (call center A), there were 94 confirmed cases of COVID-19 among a total of 216 workers
(43.5%) and 84 confirmed cases among 109 workers working in a big room as part of teleworking group (77.1%).
In the other center (call center B), there were 5 confirmed cases among a total of 69 workers and 5 confirmed
cases among 66 workers in teleworking department. Exposure period of the teleworking department in call
center A to COVID-19 was more than 4 times longer than that of call center B due to relatively late detection of
the index case. Based on ‘Field Risk Assessment Checklist for COVID-19’, call center A was assessed to have
higher risk compared to call center B in terms of prevention measures in business settings.
Conclusions
Active monitoring for COVID-19 and appropriate and timely infection prevention and control measures need to
be implemented accordingly to business characteristics to prevent mass outbreaks of COVID-19.
96
Descriptive Epidemiology of COVID-19 in Pathanamthitta District, Kerala, India,
March–September 2020
Amjith Rajeevan, Manikandanesan Sakthivel, Saritha R.L, Sheeja A L
Background
Pathanamthitta, a southern district in Kerala, reported 7,834 cases and 46 deaths due to COVID-19 between
March and September 2020. To understand the spread and to guide the further course of action, we described
the COVID-19 cases and deaths reported in Pathanamthitta district by time, place and person.
Methods
We extracted data on COVID-19 from the surveillance system of Pathanamthitta from March to September
2020. We defined a COVID-19 positive individual as a person tested positive for COVID-19 using
RT-PCR/CBNAAT/Rapid Antigen test, irrespective of clinical symptoms. We calculated test positivity
percentage (TPP) as the proportion positive among samples tested. We estimated the incidence of COVID-19
per million population and case fatality rate (CFR) by age, gender and local self-government (LSG) area.
Results
Of 7,834 COVID-19 positive individuals, the mean (SD) age was 38 (18) years, 60% were males, 16% travelers.
The overall incidence of COVID-19 in Pathanamthitta was 234 per million population. The incidence was ten
times higher in urban areas (13,210 per million) than in rural areas (1398 per million). CFR was 0.5% (46/7,834),
higher among males (0.7%) than females (0.4%) and highest among individuals > 70 years (7%). Diabetes (67%)
was the most common comorbidity among individuals who died due to COVID-19, followed by hypertension
(65%). During the last week of September, TPP was 8%. However, TPP among the LSG areas varied between
4% and 40%.
Conclusions
Higher incidence in the urban area than in rural area could be due to high population density in the urban area
and a well-established public health system in the rural area. Hence, increasing the workforce in urban areas and
training them for surveillance and contact tracing can reduce transmission. Regular analysis of TPP at the LSG
level will help identify the high transmission areas and priority areas for increased testing.
97
Assessment of Baseline Knowledge and Attitude of COVID-19 among Hotel Staff in
Kigali, Rwanda, 2020
Aphrodis Hagabimana, Olivier Nsekuye, Noella Benemariya, Jared Omolo, Albert Ndagijimana
Background
The World Health Organization declared coronavirus disease 2019 (COVID-19) a global pandemic on 11 March
2020. By 17 July 2020, there were over 13, 616,593 cases and 585,727 deaths had been reported worldwide. Hotels
and other public establishments have been associated with higher transmission rates. Sensitization of staff and
strengthening of Infection Prevention and Control (IPC) practices in such settings are important interventions.
This study assessed the baseline knowledge and attitudes on COVID-19 among staff in selected hotels in Kigali,
Rwanda.
Methods
This cross-sectional study was conducted among hotel staff during the third week of July 2020. A structured
questionnaire was self-administered to 104 consenting participants. Knowledge and attitudes were determined
using a number of questions and mean scores used to dichotomize participants’ responses as satisfactory or
unsatisfactory. Data were entered into Epi info software and analyzed in Stata v13. Findings were summarized
using frequencies and bivariate and multivariate analyses performed to identify predictors of satisfactory
knowledge and attitudes.
Results
All 104 hotel staff completed the questionnaire. Sixty-seven percent (n = 70) were male, 58% (n = 60) were aged
30–44 years, and 35% (n = 36) worked in food and beverage. The overall score for satisfactory knowledge was
63% (n = 66) with SD of 6.75 and overall satisfactory score for attitude was 68% (n = 71) with SD of 7.
Compared to those with secondary education or less, participants with university education were more likely to
have satisfactory knowledge (AOR: 2.6, 95% C.I: 1.07–0.658). While those working in the front office (AOR: 0.5;
95%, C.I: 0.006–0.541) and housekeeping (AOR: 0.09; 95% C.I: 0.01–0.8) were less likely to have satisfactory
attitudes compared to administrative staff.
Conclusions
Hotel staff with unsatisfactory knowledge and attitudes need to be trained on appropriate infection prevention
and control practices in order to mitigate the risk of COVID-19 transmission in such settings.
98
An Outbreak of Acute Seizure Illness ─ Eluru, Andhra Pradesh, India, December 2020
Sahil Sharma, Purvi Patel, Sukarma Tanwar, Rajesh Yadav, Tanzin Dikid, Joshi Roy Dolla
Background
Approximately 300 persons were hospitalized in Eluru city district hospital in West Godavari district with seizures
or sudden loss of consciousness (LOC) in early December 2020 soon after the area was hit by cyclone Nivar. We
conducted a public health investigation to describe the epidemiology, identify the cause and recommend
preventive measures.
Methods
We defined a suspect case-patient as a West Godavari district resident with an episode of seizure or LOC during
December 1–15, 2020. We reviewed medical records and performed home visits to identify cases. We conducted
a 1:1 case-control study among Eluru city cases. A control was an Eluru City resident aged > 1 year with no
history of LOC or new-onset seizure during December 1–15, 2020. We also reviewed blood, urine, and
household water sample tests conducted by state reference laboratories as part of a separate investigation.
Results
The first case was reported on December 1, 2020, with 545 cases (56% males) reported during December 1–15,
including one death. Cases rapidly increased, peaked on December 5 and gradually declined thereafter. The
median age was 27 years (range: 1–80), and 88% (478) were from Eluru city (59 of 62 wards affected). Among
cases, 90% (491) reported seizures, 10% (54) LOC; 90% (310) reported complete recovery. Case-patients (90%)
were more likely than controls (66%) to report only drinking municipal water (OR = 4.8, CI: 2.2–10.3). Test
results revealed the presence of organophosphorus/organochlorine in 74% (67) of collected blood samples, 89%
(8) urine samples, and all 20 household water samples.
Conclusions
Our investigation revealed an outbreak of self-limiting, acute neurological illness associated with drinking
municipal water contaminated with organophosphorus/organochlorine following Cyclone Nivar. We
recommended continued surveillance for acute neurological illness, routine water testing, and future protection of
municipal water supplies following natural disasters.
99
Emergence of Schistosomiasis in a Previously Non-Endemic Area, Leyte, Philippines,
December 2018
Francis Guimpatan, Eugenia Mercedes Cañal, Alethea De Guzman, Ma. Nemia Sucaldito, Ferchito Avelino
Background
Leyte has several schistosomiasis endemic areas. On November 26, 2018, the Epidemiology Bureau received a
report of confirmed schistosomiasis cases in a non-endemic area in Leyte Province. An FETP team was sent to
verify the diagnosis, identify source, and determine risk factors.
Methods
A 1:2 case-control study was done. A suspect case was any previously well individual of Baybay City with
non-specific abdominal symptoms, blood in stool or hepato(spleno)megaly from June to December 2018. A
confirmed case is an individual of Baybay City with presence of eggs in stool (Kato Katz test) and were included
in the analytic study. Controls were asymptomatic individuals with negative Kato Katz test results. We conducted
malacological and environmental surveys.
Results
There were sixty-eight cases identified. Thirty-six (53%) were males. Age ranged from 5 to 77 years (Median: 47).
Cases started to appear on August 15, 2018, and peaked by end of November. Open defecation was practiced.
Farmers usually go to nearby schistosomiasis-endemic municipalities for trade. Residents engaged in farming,
gardening, and domestic and recreational activities in nearby rivers without using personal protective equipment.
Oncomelania quadrasi snails infected with schistosomiasis were identified in marshland and streams. Bathing in
open water sources (OR = 5.11, 95% CI = 1.99–13.07) and history of travel to endemic areas (OR = 2.51, 95%
CI = 1.02–6.18) were risk factors.
Conclusions
There was emergence of intestinal schistosomiasis in a previously non-endemic area. Most of cases were farmers
who were probably exposed to bodies of water positive for infected snails when they engaged in agricultural
activities in schistosomiasis-endemic municipalities. Infected individuals practicing open defecation in their
hometown increased the risk for schistosomiasis transmission. Cases found have been treated. We recommended
that sanitary toilets be built in the area, and residents be educated about the disease. Surveillance is being
continued in the area.
100
Sudden Deaths due to Leakage of Lindane, a Hazardous Chemical, Jalalpur Village,
Sitapur, Uttar Pradesh, India, 2020: A Field Epidemiological Investigation
Piyush Jain, Alka Sharma, Vikasendu Agrawal, Amit Kapoor, Prashant Bhat, Mohankumar Raju, Rubeshkumar
Polani, Prabhdeep Kaur
Background
Accidental chemical leakages cause devastating effects on humans and animals. On February 6, 2020, seven
deaths were reported following a hazardous chemical leakage in Jalalpur village. We investigated this event to
identify the reasons for its occurrence.
Methods
We defined a case as sudden onset of breathlessness/headache/nausea/death in Jalalpur, February 6–7, 2020. We
conducted a house-to-house case search, collected information on demographics and symptoms. We calculated
attack rate and case-fatality rate (CFR) by age and gender. We conducted an environmental investigation and
interviewed a few key informants about the sequence of events. We sent the chemicals from the leakage site for
forensic analysis. We obtained the cause of death through autopsy reports.
Results
Out of 2,942 residents, we identified 23 cases (attack rate = 8 per 1,000). The median age of the case was 42
years (range: 2–64 years), and the attack rate was higher among males [13 per 1000, (19/1,402)]. Predominant
symptoms were breathlessness (65%), headache (52%), nausea (52%), and metallic taste (43%). Among the 23
cases, seven were deceased (CFR = 30%). Among the deceased, five were males, and three were aged < 15 years.
Attack rate was higher among those who slept/present at the leakage site <4 hours [100%, (23/23)] than others
[0%, (0/2919), p < 0.001]. Death was higher among those who slept within 150 meters of leakage [100%, (7/7)]
than others [0%, (0/16), p < 0.001]. Environmental investigation revealed leakage of chemicals from the
chemical waste storage tank and also identified the death of three dogs. Forensic analysis confirmed the leaked
chemical as Lindane (gamma-hexachlorocyclohexane), and autopsy reports confirmed the cause of death as
asphyxia
Conclusions
The sudden deaths in Jalalpur were due to asphyxia following leakage of Lindane from the chemical waste storage
tank. We recommend the usage of leak-proof tanks for the storage of chemical waste.
101
COVID-19 Outbreak in Health Workers, Hospital Nacional Psiquiátrico, Costa Rica,
2020
Jose Diaz
Background
The COVID-19 pandemic has shown that the protection of health workers is key to guaranteeing the proper
functioning of the hospital system. The National Psychiatric Hospital has a population of 1,318 health workers,
and is one of the national hospitals specialized in mental health in Costa Rica. During epidemiological week 27
the first case of SARS-CoV-2 was detected in one of the officials, initiating an outbreak that lasted until week 45,
despite the use of protective measures. The objective of the study was to analyze the factors associated with the
presence of the outbreak in order to contain it.
Methods
We conducted a case-control study with 140 cases and 280 controls. Characteristics of the outbreak are
described, the OR 95% CI was obtained for the main associated epidemiological factors, and the risk attributable
(RA) to the exposed of the significant variables is calculated.
Results
A total of 140 positive cases of SARS-CoV-2 were recorded during the 19 weeks. The index case was contagious
at home, 40% of the cases were nursing personnel, 26% were security personnel, 14% were cleaning, 12% were
maintenance, 8% were others. Mean age was 38 ± 9 years, 34% were asymptomatic, 67% had one or more
symptoms. No significant differences were found regarding age and sex. Associated factors were sharing
consumption of food (OR = 37; 95% CI [21–67], RAexp = 97 p ˂ 0.05), use of informal spaces for feeding (OR
= 21, 95% CI [13–37], RAexp = 95), and distance (OR = 4, 95% CI [2–7], RAexp = 76%). The highest
concentration of cases occurred in epidemiological week 33; attack rate was 0.10.
Conclusions
Sharing food and the use of informal spaces for food were the means of spreading the outbreak. The elimination
of informal spaces and redesign of the employee dining room to maintain social distancing during mealtimes
were recommended, and sharing food was prohibited. The outbreak was controlled and its spread to patients was
prevented.
102
Descriptive Epidemiology of COVID-19 Affected Health Care Personnel (HCP), from a
Tertiary Care Cancer Hospital of Delhi, March–May 2020
Nishant Nirwan, Arvind Kamboj, Vaisakh TP, Sushma Choudhary, Tanzin Dikid, Sudhir Kumar Jain, Sujeet
Kumar Singh
Background
Health Care Personnel (HCP) constitute a high-risk group for acquiring and spread of COVID-19. We
investigated a cluster of COVID-19 affected HCP in a tertiary care cancer hospital (TCCH) of Delhi in March
2020, to describe the epidemiology and identify exposures.
Methods
A case was defined as nasopharyngeal swab positivity for SARS-CoV-2 by Reverse Transcription Polymerase
Chain Reaction in an employee of TCCH from March 1–May 2, 2020. We interviewed index case for exposures
and identified cases from a list of laboratory confirmed SARS-CoV-2 positive HCP. We collected information on
demographics, exposures and PPE use in TCCH. PPE use was categorized as always, and others (sometimes or
never) depending on reported usage frequency. We stratified cases into aerosol generating procedure (AGP) and
non-AGP group. We analyzed data using EpiInfo-7, calculated median, interquartile range and proportions.
Results
Index case was a 33-year male physician working in TCCH, a non-COVID hospital. He was exposed to persons
from COVID-19 affected countries and a patient admitted with respiratory distress. During physical examination,
index case used standard precautions. We interviewed 25 HCPs. Cases (median age = 35 years, interquartile range
= 31–39; 14 (56%) females) comprised of nurses (15, 60%), non-technical staff (5, 20%), physicians (4, 16%) and
lab technician (1, 4%). Among cases, 18 (72%) worked in general ward and eight (32%) in emergency. Eighteen
(72%) cases were symptomatic and 7(28%) were asymptomatic. Of 25 HCPs, 18 (72%) were involved in AGPs.
AGPs were done under standard precautions (16/18, 64% followed hand hygiene and wore gloves and mask;
14/18, 56% wore aprons), face-shields/goggles and N95 masks were not used. In non-AGP group, 7/7 (100%)
followed hand hygiene and wore masks, 6/7 (86%) wore gloves and 2/7 (33%) wore apron.
Conclusions
To minimize occupational transmission of COVID-19, there is an urgent need to strengthen infection control
practices in non-COVID hospitals.
103
Clusters of Hepatitis C Virus Infection among Patients Receiving Chronic Hemodialysis
in Three Hemodialysis Facilities — Northern Region, Taiwan, 2019–2020
Pei-Yuan Wu, Ju-Hui Lin, Wei-Lun Huang, Chia-ping Su
Background
Hepatitis C virus (HCV) transmission in hemodialysis facilities has been reported. However, the transmission
route of sporadic cases is difficult to clarify. Taiwan CDC received reports of 4 patients with acute HCV
infection from facility A in May 2019, and a patient from facility B in March 2020. Preliminary investigation
revealed that three of them had been hospitalized in hospital C during their incubation periods. To prevent
further transmission, we conducted an investigation to identify possible cause for infection.
Methods
We defined cases as hemodialysis patients with anti-HCV antibody seroconversion within 12 months. Facilities
with cases were required to screen anti-HCV antibody of all HCV negative patients every 3 months until 6
months after identified the last case. We checked HCV RNA for case patients then used gene sequencing and
phylogenetic analysis to evaluate the similarity between patients’ viral genomes. Public health authorities
interviewed patients and staff, reviewed medical records, and made multiple on-site observations to identify
possible epidemiological link and infection control lapses.
Results
Facility A identified additional five cases (attack rate [AR] 1.2%) during August 2019–November 2020. Two of
nine cases of facility A were linked with a case in facility B because their RNA similarity was > 95%. They had
been hospitalized and dialyzed in the same inpatient hemodialysis facility of hospital C during their incubation
periods.
Facility B identified two additional cases (AR 3.5%) in June 2020. Viral sequencing revealed that these two cases
were genetically linked (RNA similarity > 97%) to a patient with chronic hepatitis C on the same shift. On-site
inspections found nonadherence to safe injection practices, hand hygiene, and environmental cleaning protocols.
Conclusions
The investigation confirmed two different sources of infection among patients from three facilities. Gene
sequencing for patients with acute HCV infection in hemodialysis facilities can help identify transmission linkage
and recognize potential outbreaks.
104
Epidemiology of Traumatic Injection Neuropathy among Acute Flaccid Paralysis Cases
in Yemen, 2013–2018
Khaled Al-Jamrah, Mutaher Al-Qassimi, Khaled Almoayed, Labiba Anam
Background
Traumatic injection neuropathy (TIN) is an injection induced paralysis; it can occur due to unsafe intramuscular
(IM) injection practices into the buttock. However, the IM injection is a continuing problem and the incidence of
TIN in Yemen was unknown from 2013–2018. Therefore, this study aimed to describe the epidemiological
characteristics of the TIN and suggest recommendations for prevention.
Methods
This a descriptive study was based on the case records of acute flaccid paralysis (AFP) surveillance data collected
between 1 January 2013 and 31 December 2019, which reviewed to identify the reported cases of TIN.
EPI-INFO version 7.2 was used for data analysis.
Results
Out of 3,887 cases of AFP were reported, 1,049 cases were TIN. The most affected group by TIN was 1–5
years, males were significantly more than females (P = 0.00004) (male/female rate ratio, 1.8: 1). The overall
incidence rate was high (13.6/1000,000 of population) and the highest rate was in Souqatra followed by
Alhudaidah and Hajjah governorate (35, 33, 30/1000,000 of population), respectively. Some seasonality was
observed with 29% of cases occurring in winter and the peak was in January. Residual paralysis 60 days after the
onset of paralysis was more common in 40% of TIN cases.
Conclusions
In conclusion, this study showed TIN is the most common cause of AFP in Yemen followed by Guillain-Barré
Syndrome. Increasing community awareness on the dangers of unnecessary and unsafe injection is
recommended.
105
Malaria in Cambodia: A Retrospective Analysis of a Changing Epidemiology, 2006–2019
Srean Chhim, Patrice Piola, Tambri Housen, Vincent Herbreteau, Bunkea Tol
Background
Malaria remains a serious public health issue globally, even though it is preventable and curable. In 2018, there
were an estimated 228 million cases of malaria, with 405,000 deaths worldwide. In Cambodia, malaria has been
endemic since the 1950s, and improvements in control and access to care have reduced its burden. However,
malaria persists with changing epidemiology and resistance to antimalarials. This study aimed to describe how
malaria has evolved spatially from 2006 to 2019 in Cambodia.
Methods
We undertook a secondary analysis of existing malaria data from all government healthcare facilities in
Cambodia. The epidemiology of malaria was described by sex, age, seasonality, and species. Spatial clusters at the
district level were identified with a Poisson model.
Results
A total of 737,210 malaria cases were notified to the HMIS between 2006 and 2019. Overall, incidence decreased
from 7.4 cases/1000 population in 2006 to 1.9 in 2019. The decrease has been drastic for females, from 6.7 to
0.6/1000. Adults aged 15–49 years had the highest malaria incidence among all age groups. The proportion of
Plasmodium falciparum + Mixed among confirmed cases declined from 87.9% (n = 67,489) in 2006 to 16.6% (n =
5,290) in 2019. Clusters of P. falciparum + Mixed and P. vivax + Mixed were detected in forested provinces along all
national borders.
Conclusions
There has been a noted decrease in P. falciparum cases in 2019, suggesting that intensification plan should be
maintained. A decline in P. vivax cases was also noted, although less pronounced. Interventions aimed at
preventing new infections of P. vivax and relapses should be prioritized. All detected malaria cases should be
captured by the national surveillance system to avoid misleading trends.
106
Assessment of Adherence to National Malaria Clinical Management and Testing
Guidelines in Selected Private Clinics of Gambela Town, Gambela Region, Ethiopia,
February 2020
Yamlak Gindola, Ryan Tokarz, Eric Tongren, Desalegn Getahun
Background
The World Health Organization World Malaria Report of 2019 indicates that an estimated 228 million cases of
malaria occurred worldwide in 2018. More than 75% of the total area of Ethiopia is malarious, making malaria
the leading public health problem in Ethiopia. Adherence to clinical guidelines improves the quality of care
received by the patients, thus improving patient outcomes. This study investigated healthcare workers’ adherence
to malaria testing and treatment guidelines in selected private clinics of Gambela town, Ethiopia.
Methods
A mixed study design involving retrospective review of 425 patient files and 20 healthcare worker interviews was
implemented. Data were collected using pre-tested data collection forms. The collected data were then cleaned
and entered into statistical software for analysis, with a level of significance set at < 0.05. A qualitative analysis
was also conducted using healthcare worker interviews to identify the existing barriers to guideline adherence.
Results
Among the 430 cases of suspect malaria, only 65% were tested (by microscopy or RDT) for malaria. Of those
tested, 78.4% tested positive and 25.5% tested negative for malaria. The most common co-morbidity in the
patients treated for malaria was anemia (29.9%) followed by gastroenteritis (9.9%). Patients with co-morbidities
were more likely to receive appropriate treatment (p = 0.03) compared with those with none. All healthcare
workers interviewed were aware of the existence of the malaria treatment guidelines. However, many were not
aware of the contents of the guidelines and only 40% had been trained on the guidelines. Overall, 85% of the
workers claimed to adhere to guidelines, with 15% claiming non-adherence.
Conclusions
The gap between knowledge of the malaria treatment guidelines and their application by healthcare workers
remains wide. The level of knowledge of these guidelines was also low. Continuous training, follow-up,
supportive supervision, and improved adherence to the malaria guidelines are therefore recommended.
107
System Evaluation of Malaria Surveillance, N’dorola Health District, Burkina Faso, May
2020
Brahima Traore, Seydou Ouattara, Sawadogo Bernard, Yelbeogo Dénis, Achille Zabre
Background
The national health situation is characterized by high morbidity and mortality with a high incidence of malaria.
Nationally, malaria was the leading cause of consultation (45.7%), hospitalization (45.6%) and death (25.2%). At
regional and health district levels, we have an increase in incidence. The main findings observed are, among
others, the increase in incidence and the large discrepancy between surveillance data and routine data.
Methods
This was a cross-sectional descriptive study. The target population consisted of health facilities, health workers
from the DS and cases of malaria. Systematic random sampling made it possible to choose 8 health workers and
the reasoned choice of 26 health workers. The interview and the document review were the techniques used with
a questionnaire and a content analysis grid as tools. Data analysis was performed using Epi info software version
7.2.3.1
Results
In view of the attributes that we assessed, we can state that the malaria surveillance system is performing well in
the ND of N’dorola. Indeed, 61.54% of agents found the system to be useful. The steps/ procedures were
found to be simple and easy to use. Regarding acceptability, the completeness of TLOH and RMA reports is
100% for all health facilities, as for promptness, some health facilities were not prompt during the year 2018.
Also, the confirmation of all malaria cases by RDT was taken into account by the surveillance system in 2018 and
many other aspects.
Conclusions
The evaluation resulted in a satisfactory performance of the malaria surveillance system in the health district of
N’dorola in 2018.
108
Malaria Outbreak in Bani Sa'ad District, Almahweet Governorate, Yemen, 2020
Samar Nasher, Esmail Al Dabis, Labiba Anam
Background
In Yemen malaria still a serious public health concern. On September 29, 2020, electronic Integrated Diseases
Early Warning System reported an increasing of malaria cases in Bani Sa'ad district, Almahwit governorate. On
September 30 2020, a team from field epidemiology training program was sent to confirm the outbreak,
determine risk factors and recommend control measures.
Methods
Descriptive study followed by case-control study (1:2 ratio) was conducted. Case was any person had fever with
positive RDTs. Control was a person with no fever, negative RDTs and lived in the same area. Data were
collected on individual, environmental and behavioral risk factors. OR, 95% CI were calculated. P value < 0.05
was considered as significant cut point. 24 blood samples were collected for lab confirmation.
Results
Twenty-four cases met case definition. Males were58%. Age group of 9– < 18 years old was 33%. High density
of adult anopheles was found inside houses (27.8/ one room). There were significant associations between
malaria and presence of opened water tanks (OR 5.6, CI: 1.9–16.3) and no use of ITNs (OR 7.6, CI: 2.3–25.8).
Conclusions
Malaria outbreak was laboratory confirmed. The identified risk factors have been proven to contribute in malaria
infection. Implementation of control and prevention measures to alter related factors as removing vector's
breeding sites, making regular spray campaigns and distributing mosquito nets were recommended.
109
Incidence of Adverse Events Following Yellow Fever Mass Immunization Campaign —
Katsina State, Nigeria, 2019
Amadu Lawal, Suleiman Kabir, Shamsu Yahaya, Nafisa Sani, Alhaji Aliyu, Muktar Tukur, Sufiyan Muawiyya
Babale, AbdulHakeem Olorukooba, Ahmad Umar Ayuba, Lawal Biliaminu, Muhammad Shakir Balogun, Patrick
Nguku
Background
Yellow Fever (YF) outbreak has remained a public health problem despite the availability of effective vaccine. On
August 20, 2019, the Katsina State Primary Health Care Agency reported an outbreak of YF. By October 11,
2019, 16 confirmed and 80 suspected cases had died. In response to the outbreak, a massive immunization
campaign was conducted from September 25–October 10, 2019, in addition to early reactive vaccination. YF
vaccination carries a risk of inducing Adverse Event Following Immunization (AEFI). We, therefore, conducted
AEFI surveillance to detect, confirm, report, and respond to it in a timely manner.
Methods
We conducted a prospective study among individuals aged 9 months–44 years who were vaccinated with the YF
vaccine. All health workers who participated were trained before the campaign to identify, confirm and respond
to AEFI cases, complete case report forms, and send daily reports to the State Emergency Operation Center
electronically. All serious AEFI cases detected were fully investigated. The time interval for detecting AEFI was
from vaccination to 42 days after vaccination. Data collected were analyzed to describe the incidence and
distribution of AEFI cases.
Results
A total of 6,857,826 doses of the YF vaccine were administered to all persons aged 9 months to 44 years. The
administrative vaccination coverage recorded was 86.6%. The overall incidence of AEFI was 29.6/1,000,000
doses with no death. The incidences of non-serious and serious AEFI were 28.0/1,000,000 doses and
1.6/1,000,000 doses respectively. Males accounted for 2,915,863 (45.7%) of persons immunized, with 99 (48.8%)
of them constituting non-serious cases and 5 (45.5%) serious cases of AEFI. Anaphylactic shock constituted
72% of the serious AEFI.
Conclusions
The incidence of AEFI recorded was lower than what was reported in other African settings, indicating that YF
vaccine is still safe. We recommend enhanced AEFI surveillance during both routine and supplemental
immunization activities.
110
A Cross-Sectional Survey of COVID-19 Vaccine Acceptance among Adults in Taiwan,
2021
I-Ping Lin, Chia-ping Su, Chin-Hui Yang
Background
An efficient immunization program is key to containing the COVID-19 pandemic. To increase vaccine coverage,
it is important to understand factors influencing willingness to vaccinate in general population and target groups.
Methods
We performed a population-based, random telephone survey to assess the knowledge, attitude and behavior of
adults aged ≥ 18 years toward COVID-19 vaccine during January–February 2021. We collected participants’
demographic information, including age, gender, and occupation. To understand the acceptance in priority
groups, we included ≥ 500 healthcare workers and 250 first-line public health practitioners. We measured the
willingness by asking if they would accept a COVID-19 vaccine when the emergency use authorization is issued
and factors that can increase their willingness to vaccinate. We assessed the associations between
sociodemographic characteristics, perceived effectiveness and safety with acceptance of COVID-19 vaccine by
chi-square test.
Results
Of the 1,522 participants surveyed, 1,005 (66%) reported willingness and 424 (28%) reported unwillingness to
vaccinate; 93 (6%) were unsure or unknown. The acceptance of a COVID-19 vaccine among health care worker
and first-line public health practitioners were 65% and 75 %, respectively. Compared to other age groups,
participants aged 36–45 years were less likely to receive a COVID-19 vaccine (78% vs 65%, p < 0.01). Only 32%
of the participants intended to vaccinate as soon as possible 59 % of the participants will delay the vaccination
for least one month. Participants who believed vaccine is effectiveness were more likely to receive COVID-19
vaccine (83% vs 59%, P < 0.01). In addition, the willingness to vaccinate was increased in 30% of the
participants when the effectiveness and safety of COVID-19 vaccine has been confirmed.
Conclusions
The acceptance of a COVID-19 vaccine varied by age, occupation, perceived effectiveness and safety of the
vaccine. Continued promotion and education about vaccine in different target groups are needed to increase the
acceptance of COVID-19 vaccine.
111
Oral Presentation Session 17: Vaccine Safety Late Breaker
Analysis of Death Cases and Adverse Events Following Immunization (AEFI) with
Influenza Vaccines in the 2020–2021 Season in the Republic of Korea — Focused on
Social Panic and the Reported Rate of Adverse Events
Hee Kyoung Kim, Seonkui Lee
Background
The number of reported cases of serious adverse events following influenza immunization increased rapidly in
the 2020–2021 season that the cold-chain issue related to vaccine safety occurred. The purpose of this study is to
compare the differences of adverse events reported following influenza immunization between the 2019–2020
and 2020–2021 seasons and analyze media coverage and severe adverse events reported in the 2020–2021 season.
Methods
We investigated adverse events reported within 4 weeks after influenza immunization from September 8, 2020 to
February 28, 2021. We conducted case-case study to analyze adverse events reported in the 2019–2020 season
(control group) and 2020–2021 season (experimental group) by age and International Classification of Diseases
(ICD-10). We retrieved the weekly number of press articles in 2020 that contained the following keywords:
“influenza” AND “vaccination” OR “immunization” OR “death”.
Results
The number of reported adverse events per 100,000 population vaccinated were 14.8 cases in 2020–2021 season
and 1.07 in 2019–2020 season respectively. It showed that the reported cases of AEFI in 2020–2021 were 14
times higher than those in 2019–2020. The most reported rate of adverse events by age was 3.39 (per 100,000
population vaccinated) in 70s in the 2020–2021 season and 0.23 under 10 and 60s in the 2019–2020 season
respectively. The reported rate (1.1) of severe adverse events in 2020–2021 was increased 110 times than those
(0.01) in 2019–2020.
Conclusions
There was a difference in the reported rate of adverse events following influenza immunization by age and
ICD-10 in the 2019-2020 and 2020–2021 seasons. These differences show the necessity and importance of
transparent risk communication and prompt investigation for adverse events following influenza immunization.
112
Epidemic Dengue Observed during COVID-19 Pandemic in Singapore, 2020
Pui Li Teoh, Ai Jia Soong, Qi Gao, Aruni Seneviratna, Irving Charles Boudville, Matthias Paul Han Sim Toh,
Steven Peng Lim Ooi
Background
Dengue is the most prevalent urban mosquito-borne viral disease with high public health burden in Singapore
which experiences periodic dengue outbreaks despite maintaining the overall Aedes house index under 1%. In
2020, during the COVID-19 pandemic, a resurgence of epidemic dengue was observed, with the highest ever
annual incidence reported in Singapore.
Methods
To understand the situation, we examined the changing epidemiology of dengue, with data on demographics
(2014–18), dengue serotypes, severity (2014–20) and environment extracted from government websites.
Results
2020 saw 35,315 cases, which was a three-fold increase compared to the average number over previous years.
From 2014–20, less than 1% of all cases were notified as severe dengue (p-for-trend = 0.358) with a case fatality
ratio of less than 0.2% (p-for-trend = 0.125). Cases were predominantly aged 25–44 years (47.1%) and male
(62.5%), however the rates among those aged ≥ 65 years increased significantly (p-for-trend = 0.03). The incidence
rate among foreigners was higher compared to residents from 2014 to 2016, but decreased thereafter. The
number of clusters fell from 1,418 (2014) to 245 (2018), but rose to 3128 (2020). The predominant serotype was
DEN-1 (79.4%) in 2014 but switched to DEN-2 from 2015 onwards (> 45%). DEN-3 and DEN-4 cases
increased dramatically from 2014 (2.5%, 0.2%) to 2020 (24%, 27.2%).
Conclusions
Despite the spike of dengue in 2020, the number of severe dengue cases remained low. All four dengue virus
serotypes were in circulation locally, but the predominant strain was found to have switched from DEN-1 to
DEN-2. Multifactorial contributions to the observed resurgence in 2020 included changing dengue virus
serotypes, low herd immunity in at-risk populations, favorable conditions for mosquito breeding brought on by
warmer weather and increased rainfall, and reduced vector control activities by pest control operators during
pandemic lockdown.
113
Emergence of Circulating Vaccine-Derived Poliovirus Type 2 — Marogong, Lanao Del
Sur, Philippines, September 2019
Nolie Rimando, Jessica Cagadas, Ma. Nemia Sucaldito, Vikki Carr de los Reyes, Alethea De Guzman
Background
After nineteen years of being free from wild polio virus, the Philippines reported a confirmed vaccine derived
poliovirus type 2 (VDPV2) case on September 19, 2019. The case was a three-year-old girl from Marogong,
Lanao del Sur. We conducted an investigation to look for evidence of circulation of the virus in the community.
Methods
We profiled the case, conducted a healthy children stool survey among children aged < 15 years and reviewed the
vaccination status of children aged six weeks–59 months. An active search for acute flaccid paralysis (AFP) cases
in health facilities and community was done. We also reviewed routine OPV and IPV vaccination coverage from
2014 to 2018 and interviewed local health authorities on sanitation and their water supply. We conducted an
environmental survey and collected water samples from a nearby river.
Results
The case was born in Manila and received one dose of OPV before migrating to Marogong, Lanao del Sur. She
was reported as an AFP case and stool samples collected. Her stool samples were positive for VDVP2. No
VDPV2 was detected from close contacts nor healthy children surveyed. No other polio cases were found in the
province. Among the surveyed children, only 8 (23%) were given OPV3 while 3 (8%) received IPV. Both OPV
and IPV coverages for the last 5 years were < 90%. Households used a communal toilet and had a piped water
supply. Solid waste was buried or burned. Open defecation was being practiced. River water samples were
negative for poliovirus.
Conclusions
The VDPV detected from the case was classified as cVDPV2 since it was genetically-linked to VDPV2s from
environmental samples in Manila and Davao. Low polio vaccination coverage and poor environmental sanitation
facilitated circulation of VDPVs. Response measures included supplemental immunization activities using
mOPV2, enhanced AFP surveillance and environmental surveillance.
114
Serosurvey of SARS-CoV-2 Infection in Garment Workers of a Selected District in
Bangladesh, 2020
Shahta Zarab Salehin, Mallick Masum Billah, Md Mahabub ul Anwar, Manjur Hossain Khan, Mahbubur Rahman,
Nawsher Alam, ASM Alamgir, M.Salim Uzzaman, Tahmina Shirin, Meerjady Sabrina Flora
Background
COVID-19 pandemic hit Bangladesh in March 2020 and the government declared general holidays from 26
March 2020 to contain the disease. However, considering the economic constraints, the ready-made garments
industry, which contributes 11.2% of the National Gross Domestic Product, was opened from 26 April 2020. In
such a situation, it was important to conduct a seroepidemiological survey to understand the extent of SARS
CoV-2 infection and factors associated with it among the garment workers.
Methods
We conducted a cross-sectional seroepidemiolocal survey among randomly selected garment workers from five
garments of Gazipur district during October 1–15, 2020. We collected 5 ml of blood from them for conducting
the antibody test using Abbott Alinity™ SARS-CoV-2 IgG antibody kit (sensitivity 90.6% and Specificity 100%).
We also interviewed them with a semi-structured questionnaire and analyzed the data calculating odds ratio and
95% CI.
Results
We enrolled 550 workers, among which 545 (99%) participated in the study. The mean age of the participants
was 30.3 (SD = 8.7) years, and 51.1% (283) were female. Among the participants 16% (88) were tested positive
for SARS-CoV-2 antibodies, of which 76.1% (67) were asymptomatic. Male had a higher possibility of being
COVID-19 positive than female (OR: 2.7; 95% CI 1.6–4.4). Results also found that 40 + years of age (OR: 1.9;
95% CI 1.0–3.4), comorbid condition (OR: 6.8; 95% CI 4.0–11.5), past contact history (OR: 3.5; 95% CI 2.1–
4.4), smoking (OR: 1.7; 95% CI 1.1–2.5) had higher odds of getting COVID-19 disease. The study also revealed
that not using mask properly (OR: 2.0; 95% CI 1.2–3.0), not maintaining social distancing (OR: 1.9; 95% CI 1.2–
3.4) had a higher chance of getting COVID-19 disease.
Conclusions
This study revealed evidence of SARS-CoV-2 transmission in garment workers. Findings suggested that
maintaining healthy behaviors, mask use and social distancing, both inside and outside of the factory premises
might help to reduce the transmission of SARS-CoV-2.
115
Oral Presentation Session 18: More on Vaccine Preventable Diseases Late Breaker
Seroprevalence of COVID-19 among Healthcare Workers in Primary Healthcare Centers
in Al-Sader City, Baghdad, Iraq, 2020
Raheem Hussein Zayer, Faris Lami, Nadhir H Salim
Background
SARS-CoV-2 infection produces a detectable immune response in most cases reported to date. A serological test
can capture previously asymptomatic infections and help to assess the immune status of a subject. Iraqi
healthcare workers are highly vulnerable to COVID-19 infection mainly because of the shortage of personal
protective equipment (PPE). Al-Sader city is an overcrowded neighborhood in Baghdad which makes the
healthcare workers serving there even more vulnerable to COVID-19. The objective of this study was to
determine the seroprevalence of COVID-19 infection among healthcare workers working in Primary Healthcare
Centers (PHC) in Al-Sader City, Baghdad, Iraq, 2020.
Methods
A cross-sectional study was conducted in nine PHCs selected by a cluster random sampling technique during
November and December 2020. We developed a questionnaire to gather demographic variables, history and
determinants of contracting COVID-19 infection, and training and use of the PPEs. All healthcare workers had
COVID-19 rapid antibody test (IgM-IgG Rapid test).
Results
A total of 470 participants were enrolled in the study. We found that 125 (26.6%) participants had positive rapid
tests, 104 (83.2%) of them had positive IgG, 5 (4%) had positive IgM, and 16 (12.8%) had positive IgG and IgM.
Also, 101(21.5%) had a history of COVID-9 infection )75.2% were diagnosed by real-time polymerase reaction
chain (RT-PCR)). There was a significant association between positive rapid test and history of COVID-19
infection (P<0.001), and positive PCR test (P<0.001). The sensitivity and specificity of the rapid test as
compared to PCR testing were 56.6% and 79.2%, respectively. Rapid test results and history of COVID-19
infection were significantly associated with smoking, comorbidity, training, and use of personal protective
equipment, and households’ infection (P<0.05).
Conclusions
COVID-19 infection was common among the healthcare workers working in the Primary Healthcare Centers.
Strong measures are needed to strengthen infection prevention and control activities including further training
and enhanced use of personal protective equipment. Also, healthcare workers should be the priority group to
have the COVID-19 vaccine.
116
A Case Report of a Child with Immunodeficiency-Related Vaccine-Derived Poliovirus
Type 2, Laguna, Philippines, September 2019
Ludina Insigne, Nolie Rimando, Ma. Ivy Rozeth Saavedra-Iturralde, Denisse Lou Adriano, Jezza Jonah Aclan,
Agnes Benegas-Segarra, Herdie Hizon, Alethea De Guzman, Vikki Carr de los Reyes, Ferchito Avelino
Background
On September 22, 2019, a vaccine-derived poliovirus type 2 (VDPV2) case detected through acute flaccid
paralysis (AFP) surveillance in a private hospital was reported to the Epidemiology Bureau. We conducted a case
investigation and assessed the risk of transmission.
Methods
We used the World Health Organization Detailed Epidemiologic Case Investigation form and the Jeffrey Modell
Foundation 10 Warning Signs of Primary Immunodeficiency Disease (PID) in assessing the patient. Blood was
collected for immunity deficiency (ID) testing. Another set of stool samples were collected for poliovirus
isolation. An environmental surveillance site was identified in the area where the case resides.
Results
The case was a five-year-old, boy from Laguna, who previously received three doses of oral polio vaccine. Since
2015, he had several hospital admissions for various infections and was diagnosed with Hirschsprung’s disease
and thalassemia. He was also malnourished. On August 25, 2019, he had sudden onset of fever, diarrhea and
paralysis of both lower extremities. He was reported as an AFP case. Two stools were submitted which tested
positive for VDPV2. The case had three of the 10 warning signs of PID. Stools collected 23 days after paralysis
onset remained positive for VDPV2. Immunoglobulin panel showed decreased immunoglobulin levels. Three
other AFP cases were identified in the municipality during enhanced AFP surveillance. All were negative for
poliovirus. A river and creek were identified as environmental surveillance sites. Samples were positive for
non-polio enterovirus.
Conclusions
This is the first case of immunodeficiency-related VDPV in the Philippines. Anti-viral therapy will be given since
that follow up stool samples remain positive for poliovirus. There is no evidence of ongoing transmission in the
municipality. However, survey among healthy children in Brgy. Lingga will be done every two months. To date
no VDPV has been detected, so no evidence of circulation.
117
Recent Surge of Genital Chlamydia Disease among Young Male and Female in Japan
Tomohiko Ukai, Takuya Yamagishi, Kazuhiko Kanou, Takuri Takahashi, Yuzo Arima, Tomimasa Sunagawa,
Motoi Suzuki
Background
Chlamydia trachomatis is a sexually transmitted infection, which has various clinical presentations including
asymptomatic carriers and severe complications, such as pelvic inflammatory disease, ectopic pregnancy, and
infertility. In Japan, genital chlamydia disease (GC) is one of the targeted sexually transmitted diseases under
surveillance by law, with minimal information about GC collected through sentinel sites. In recent years, the
number of GC cases have been increasing in both genders. To better understand the background of this trend,
we describe the basic characteristics of GC cases reported by the national sentinel surveillance.
Methods
We used sentinel surveillance data about GC in the National Epidemiological Surveillance for Infectious Diseases
(NESID) system, which approximately 1000 sentinel medical institutions of obstetrics & gynecology, urology and
sexually transmitted disease clinics report to monthly. Basically, symptomatic patients who were diagnosed at
these clinics/hospitals and with laboratory confirmation were reported. We extracted data from 2001 to 2020,
which included gender and age-specific number of newly diagnosed cases of GC.
Results
In Japan, the number of GC cases reported continuously decreased from 2002 to 2015 by 40–54%, followed by a
sharp increase until 2020. Men, in particular, increased by 23% in 2020, compared with 2015. People in their 20’s
and 30’s showed increasing trend in the 2010s among both genders, while the age group 15–19 continuously
showed decreasing trend throughout. The increase of cases in their 20’s was particularly significant in the last
three years, which showed more than 40% increase in men and 14–15% increase in women, respectively.
Conclusions
In Japan, the number of GC cases increased from 2016, particularly those in their 20’s and 30’s. Enhanced
control measures, including providing frequent testing opportunities and sexual education among young people,
need to be implemented. Unlike other diseases, influence of COVID-19 outbreak was not evident in sentinel
reporting of GC.
118
Prevalence and Predictors of Renal Dysfunction among People Living with Human
Immunodeficiency Virus on Antiretroviral Therapy in the Southern Highland of
Tanzania: A Hospital-Based Cross-Sectional Study
Mololo Noah, Loveness Urio, Mtebe Majigo
Background
Human Immunodeficiency Virus (HIV) infection and antiretroviral therapy (ART) poses a significant risk of
developing renal dysfunction in people living with HIV (PLHIV). Renal dysfunction contributes to the morbidity
and mortality of PLHIV. There is limited information on renal dysfunction among PLHIV in the Southern
Highland, the highest HIV prevalent area in Tanzania. We conducted a study to estimate the magnitude and
predictors of renal dysfunction among PLHIV on ART.
Methods
A cross-sectional study was conducted at Njombe Town Council Hospital from December 2019 to April 2020,
recruiting 396 participants. Serum was obtained to measure creatinine level then calculated glomerular filtration
rate (GFR) using CKD-EPI and the Bedside Schwartz equations. The participants' information were collected
using a structured questionnaire. Data analysis was performed using STATA version 15; a modified Poisson
regression model was used to estimate prevalence ratios (PR). The level of significance was specified at 0.05
Results
The overall prevalence of renal dysfunction defined as GFR less than 90 mL/min/1.73 m2 was 20.7%, which
increased by 4% as the age increases. The prevalence of renal dysfunction was higher in PLHIV on ART for
more than six months to 24 months compared to their counterparts. Likewise, obese individuals had a 2.5 times
higher prevalence of renal dysfunction than normal individuals.
Conclusions
There is a relatively high prevalence of renal dysfunction among PLHIV on ART, predicted by age, duration on
ART, and nutrition status.
119
A Case-Control Study on the Melioidosis Outbreak in Isabela Province and Santiago
City, Philippines, 2019
Karla May Manahan, Ludina Insigne, Alethea De Guzman, Agnes Benegas-Segarra, Ma. Nemia Sucaldito, Vikki
Carr de los Reyes
Background
Melioidosis is caused by Burkholderia pseudomallei, a bacteria found in soil and water. There were increasing
melioidosis cases in Isabela Province in August 2019. Farming is the most common livelihood. This study aims to
determine the existence of an outbreak, identify source and mode of transmission, determine risk factors, and
recommend control and preventive measures.
Methods
A 1:4 case-control study was done. We collected demographic data and factors associated with melioidosis. We
used the following definitions. A suspect case was a previously well resident of Isabela Province who developed
any of the following from May 1 to August 9, 2019: a) Acute pulmonary infection with high fever b) Acute or
chronic localized infection c) A disseminated infection with fever and weight loss. A confirmed case was a
suspect case positive for Burkholderia pseudomallei through culture of blood or swabs from abscesses.
Results
Twenty cases were identified. Eight died (CFR: 40%). Age ranged from 9 to 74 years (median = 53). Seven (35%)
were disseminated infection, six (30%) with pulmonary infection, and three (15%) had localized infection. Fifteen
(79%) were positive for Burkholderia pseudomallei. Risk factors were having chronic disease (OR = 101.5, 95% CI =
6.21–4713.69), drinking water from a communal stand post (OR = 78, 95% CI = 4.57–3711.39), bathing from a
communal stand post (OR = 18, 95% CI = 1.59–865.84), having diabetes (OR = 14.5, 95% CI = 0.89–786.19),
frequent alcohol drinker (OR = 23, 95% CI = 1.63–1179.62), and gardening in a moist soil (OR = 6.13, 95% CI
= 0.73–53.12. Drinking water from a water refilling station was a protective factor (OR = 0.03, 95% CI = 0.00–
0.40).
Conclusions
There was an outbreak of melioidosis in Isabela Province. Direct contact with water from a level 1 system,
contact with moist and paddy soil, and having co-morbidity were associated with melioidosis. Drinking water
from water refilling station protects individual from melioidosis. We recommended boiling contaminated water
before drinking, avoid contaminated water if with open wound, and wear gloves when gardening.
120
Antibiotic Prescription Pattern in Primary Health Care Centers - Bauchi State Nigeria,
2019: Experience from Nigeria State Health Investment Project (NSHIP)
Garba Mustapha Umar, Adamu Mohammed, Ibrahim Sani, Adamu Ibrahim
Background
Antibiotic resistance is an emerging global public health issue and antibiotics are prescribed and used daily in
health care settings. Overprescription of antibiotics leads to increased treatment cost, waste of resources,
increased risk for adverse drug reaction and global threat of antimicrobial resistance (AMR). We determine the
trend of antibiotic prescription pattern in primary health care centers (PHCs) of Bauchi State supported by
performance-based financing (PBF) intervention.
Methods
Bauchi State has 20 Local Government Areas (LGA) and is situated in northeastern Nigeria with one main PHC
per ward totaling 323 PHCs in the State. The State piloted PBF in the second quarter of 2017 in Dass LGA and
scaled up to Bauchi and Katagum LGAs in the second quarter of 2018. Certified PBF supervisors assessed the
quality of services rendered on quarterly basis using standard quality checklist. The national allowable proportion
of consultations to be treated with antibiotics without clear evidence must be less than 30% of the last 100
patients treated. The health facilities (HF) quality score and their quarterly subsidy earnings are affected beyond
this cut off. We analyzed the quarterly assessment data for antibiotic prescription pattern for all the 53 supported
PHCs, 2017–2019 and calculated proportions using Microsoft excel.
Results
Of the 53 PBF intervention PHCs in three LGAs of the state, only 22 (41.5%) PHCs were prescribing
antibiotics appropriately at baseline. The proportion improved from 46.2% to 98.1% for quarter 1 and 7 of the
intervention respectively. The proportion of HFs with appropriate prescription pattern by LGAs were 33.3%,
44.4% and 45.0% at baseline, 60.0%, 83.3% and 80.0% at one year of intervention, 100%, 94.4% and 95.0% at
two years of intervention for the Dass, Katagum and Bauchi LGAs respectively.
Conclusions
Rational antibiotic prescription has greatly improved in the PHCs in Bauchi State supported by PBF intervention.
121
Proximity in Work-Setting Leading to Transmission of COVID-19 in a Medical Research
Institute- Chennai, Tamil Nadu, 2020
Nuzrath Jahan, Mohankumar Raju, Jeyashree Kathiresan, Prabu Rajkumar, CP Girish Kumar, Tarun Bhatnagar,
Manickam Ponnaiah
Background
There is very little information on Corona Virus Disease-2019(COVID-19) transmission specific to the different
clusters reported across India. From June to September 2020, a cluster of 45 COVID-19 cases was notified to the
Institutional COVID-19 Response Committee, of a Medical Research Institute in Chennai, India. We
epidemiologically investigated the cluster to effect control measures.
Methods
We defined a person with a positive RT-PCR(Reverse Transcriptase-Poly Cyclomerase Reaction) for SARS-CoV-2
as a confirmed COVID-19 case-patient. Testing was done in the institute’s COVID-19 lab. We conducted
contact-tracing and testing inside and outside the institute. We collected information through telephone
interviews and abstraction of laboratory records. We described the cluster using Epi-curve, attack rate, and spot
maps. We hypothesized that working in proximity increased the risk of contracting COVID-19. We defined cases
as COVID-19 positive staff-members of the institute and compared each of them to three un-matched controls
recruited among COVID-19 negative staff-members. We computed Crude-Odds Ratio(OR) with 95% confidence
interval(CI) by comparing attack rates among cases and controls.
Results
Cases were reported starting from 8 July 2020, peaked on 9 July, with 3 more peaks till September 4, 2020. The
attack rate was highest among the malaria research staff (AR = 10/14) and billing staff (AR = 6/9). We identified
5 sub-clusters corresponding to the peaks in the epi-curve. We identified clustering of cases by time (date of
reporting) and location in the bills section, dining hall, and the Malaria research lab of the institute. Males (OR:
2.0; 95% CI = 0.7–5.4), and diabetics (OR: 3.4; 95%CI = 0.8–14.8) were more likely to be COVID-19 positive.
Mask compliance (19%) and maintaining physical distance (19%) were poor outside institute than at institute
(82%, 59%respectively) or during commute to institute (86%, 86%respectively).
Conclusions
We suggest improving physical distance and ventilation in certain sections of the institute. Strict adherence to
infection control practices both outside and inside the institute might prove effective in controlling transmission.
122
Characteristics and Risk Factors Associated with COVID-19 Infection Severity among
Health Care Workers — Iraq, 2020
Inam Hameed
Background
Coronavirus disease 2019 (COVID-19) pandemic is a global health emergency that continues to spread around
the world. The front line for this crisis is health care workers (HCWs) who are exposed to hazards of infection
through pathogen exposure. Limited data present for risk factors that make the COVID-19 infection become
worse among HCWs. This study aims to identify the risk factors associated with the severity of COVID-19
infection among HCWs in Iraq.
Methods
An epidemiological survey was conducted among HCWs with positive respiratory samples for SARS-CoV-2 by
real-time polymerase chain reaction (RT-PCR), and/or positive IgG, IgM test from 6 July to 31 October 2020.
The questionnaire included demographics, clinical features, and information related to risk factors. Categorical
variables were analyzed by Pearson’s χ2 test by four levels of severity that ranked as asymptomatic, mild,
moderate, severe, and critical. Generalized linear model was used to identify the independent predictors of
severity. A P-value of less than 0.05 was considered statistically significant.
Results
Among 6331 HCWs enrolled, 52 % (3298/6331) were paramedical staff and 71% (4237/6331) were moderate
and 14 % (836/6331) were severe and critical. Many comorbidities have a significant association with severity as
asthma (OR = 2.619, CI: 2.080–3.297), renal disease (OR = 2.143, CI: 1.413–3.253), hypertension (OR = 1.410,
CI: 1.165–1.707), diabetes mellitus (OR = 1.531, CI: 1.198–1.956), age (OR = 1.013, CI: 1.007–1.019) and BMI
(OR = 1.012, CI: 1.001–1.023).
Conclusions
This survey concludes that comorbidities like hypertension, diabetes, asthma, renal disease, and overweight are
independent variables to predict the severity of COVID-19 infection among HCWs, which may be helpful for
early clinical surveillance of disease severity among HCWs. Good management of chronic diseases which make
the infection worse were recommended. Furthermore , a case-control study will be of value to identify the risk
factors of getting COVID-19 infection among HCWs.
123
COVID-19 Cluster in a Coastal Fishing Community: A Case Control Study ― Poonthura,
Kerala, India 2020
Lipsy Paul, Binoy Babu, Sushma Choudhary, Anoop Velayudhan, Meenakshy V, Tanzin Dikid
Background
Coronavirus disease (COVID -19) is an ongoing pandemic with high transmissibility. A cluster of COVID 19
cases was reported in a fishermen community by the Integrated Disease Surveillance Programme Unit,
Poonthura, Kerala, in July 2020. We described the cluster’s epidemiology, identified risk factors for illness and
provided recommendations to prevent transmission.
Methods
A case was defined as a resident of Poonthura confirmed with SARS-CoV-2 infection, through Reverse
Transcriptase Polymerase Chain Reaction or rapid antigen test, between June 17–July 25, 2020. We conducted
hypothesis-generating interviews and performed a 1:2 unmatched case-control study. Cases (both symptomatic
and asymptomatic) and controls (those COVID-19 negative) were selected randomly from those tested for any
reason between June 17–July 25, 2020, at the Community Health Center, Poonthura. Phone interviews were
conducted using a standardized questionnaire. Data was analyzed using Epi info version 7.2.3.1.
Results
We identified 620 cases with median age of 34 years (4 months–91 years). Fifty percent were females and 37% of
cases were in the age group 21-40 years. Among 2226 tested, 620 (28%) were positive. The overall attack rate was
1.9%. Of the 16 cases interviewed for hypothesis generation, 11 (69%) had fishing exposure, either personally or
by a family member. This case-control study showed that 31% (15/49) of cases had exposure to the fish market
compared to 10% (9/49) of controls (OR 3.9, 95% CI 1.4–10.7), and 37% of (18/49) cases had a family member
in the fishing business compared to 16% (15/49) of controls (OR 2.8,95% CI 1.2–6.7).
Conclusions
This cluster of COVID-19 cases was associated with visiting the fish market or having family members involved
in fishing, suggesting unrecognized transmission in these settings. We recommended reinforcement of
surveillance and contact tracing and testing among persons exposed to these settings, with quarantine and
isolation as appropriate.
124
Description of Cases of a COVID-19 Outbreak in a Care Home for Young People Living
with Human Immunodeficiency Virus in Mexico City, 2020
Evelyn Guadalupe Pineda Lopez, José Luis Alomía Zegarra, Celia Mercedes Alpuche Aranda, Irma López
Martínez, Ana Lucía De la Garza Barroso, Lucía Hernández Rivas, Rodrigo Aparicio-Antonio, Nilza Aslim Rojas
Arroyo, María del Rocío Muñoz Hernández, Noris Marlene del Socorro Pavia Ruz
Background
COVID-19 is a disease that has significantly impacted Mexico. As of January 1, 2021, there were 1,437,185 cases
and 126,507 cumulative deaths (CFR 8.8%). There is little evidence of the presentation of COVID-19 in people
living under certain physical and environmental conditions, such as pediatric patients, people living with Human
Immunodeficiency Virus (HIV)2-5 or those living in confinement.
Methods
A series of cases describing COVID-19 outbreak in a care home in Mexico City for young people living with
HIV (23 beneficiaries) were enrolled. A database was created with the epidemiological study of suspected case of
SARS-CoV-2, applied surveys, serological results emitted from a first test by private laboratory and second by the
Epidemiological Diagnostic and Reference Institute (InDRE).
Results
A total of 72% (n=16) were women with median age of 15 years. All of them with perinatal transmission and
antiretroviral treatment; 56% (n=14) presented one or more comorbidities. The median CD4+ count was 794
cell/ml [353–1,394] and the viral load was < 40 copies. Sixty percent (n=12) met operational definition of
suspected viral respiratory infection (VRI), of these 10% (n=2) corresponded with severe acute respiratory
infection (SARI) according to Epidemiological Surveillance System for Viral Respiratory Diseases (SISVER).
None were hospitalized. In 76% (n=19) tests showed evidence of antibodies against SARS-CoV-2. No
differences in treatments, social dynamics or comparative behavior were identified in negative patients. In the
bivariate analysis, no statistical significances were found.
Conclusions
In these patients COVID-19 had a satisfactory evolution. Due that the main limitation found was sample size,
especially of those without evidence of SARS-CoV-2 infection, it is recommended to conduct further analytical
studies with individuals who share the same characteristics. The study of COVID-19 outbreaks in confined
spaces such as care homes could be an opportunity to learn more about the dynamics of COVID-19 disease.
125
Evaluation of Point of Entry Surveillance for COVID-19 — Mumbai International
Airport, India, July 2020
Khyati Aroskar, Rajesh Sahu, Sushma Choudhary, Achhelal Pasi, Pragati Gaikwad, Binoy Babu, Tanzin Dikid,
Sudhir Kumar Jain, Sujeet Kumar Singh
Background
India started Point of Entry (PoE) surveillance at Mumbai International Airport from January 18, 2020, by
screening passengers returning from COVID-19 affected countries using infrared thermometers. We evaluated
PoE surveillance with Centers for Disease Control and Prevention evaluation framework to make
recommendations for system strengthening.
Methods
We conducted cross-sectional evaluation in July 2020 for surveillance data collected during March 1–22, 2020. We
conducted key informant interviews, reviewed passenger self-reporting forms (SRFs) (randomly selected) and
relevant records from Airport Health Organization Mumbai and Integrated Disease Surveillance Program (IDSP)
Maharashtra.
Results
Of the 165,885 passengers screened, three COVID-19 suspects were detected and all tested negative by RT-PCR.
Line-list of passengers kept under quarantine; passenger SRFs were sent to State officials, and not available in the
paper-based PoE system, 392/400 SRFs were completely filled: 49/49 had newly added variables filled. There
were eight written complaints: 6/8 regarding inconvenience of filling SRF; 3/8 related to no inflight
announcements made about filling SRFs and standing in long queues for their submission. Screened passenger
reports were sent daily to IDSP. Among screening staff, 128/150 (85.3%) were deployed from other agencies.
The staff to passenger screening ratio was 1:300. IDSP reported 59 COVID-19 confirmed self-reported cases
against zero detected at PoE during screening in the reference period. Of the 15 key informants, 2/2 reported
the system was easy to use and 11/11 informed pooling of resources for surveillance establishment.
Conclusions
PoE surveillance was simple, timely, flexible, and useful since it created awareness among passengers, provided
information to follow up by IDSP. It missed cases at PoE and had poor stability. We recommend dedicated
manpower, logistics for PoE surveillance and data integration with IDSP.
126
Knowledge, Attitudes and Practices of Populations in 5 Regions of Burkina Faso on
COVID-19, October 2020
Ouedraogo Jean-Baptiste, Sawadogo Bernard, Yelbeogo Dénis
Background
In 2020, the whole world was confronted with the COVID-19 pandemic. Burkina Faso registered its first case on
March 9, 2020. Accordingly, the Ministry of Health developed and implemented a communication plan for the
population. However, it is clear that there is an increase in cases despite the actions taken. In order to improve the
quality of the response to combat the pandemic, we conducted a survey on knowledge, attitudes and practices in
five regions of Burkina.
Methods
We carried out a cross-sectional study from September 20 to October 10, 2020. The data were collected through
a semi-structured interview. We collected the socio-demographic and qualitative variables on knowledge, attitudes
and practice. The data was recorded on Epi-info. We calculated proportions.
Results
Out of 497 people questioned, all had heard of the disease, 88.13% of which had been heard from the radio.
Those saying the disease is very dangerous were 91%. Those who identified regular hand washing with soap and
water to protect against disease was 87.32%. On the other hand, 38.83% of respondents replied stating that they
greet each other by shaking hands. One quarter (25%) of respondents perceive COVID-19 as a political affair, or
a disease only concerning Western populations and the rich.
Conclusions
The population has fairly good knowledge of COVID-19 as well as the methods of prevention. However, certain
preventive measures are not respected. Some people do not believe the disease exists. It is therefore necessary to
increase awareness campaigns on the respect of barrier measures with the use of several communication
channels.
127
Post-Recovery Symptoms and Rehabilitation Needs among COVID-19 Survivors — A
Cross-Sectional Study from Puducherry, India, 2020
Ravivarman Lakshmanasamy, Manikandanesan Sakthivel, Ramesh Jayaraman, Mohan Kumar Sivaperuman
Background
Persistent and new-onset symptoms among individuals recovered from COVID-19 have been reported in many
countries, including India. The morbidity attached with the COVID-19 recovered individuals is significant. We
did this study to estimate the prevalence of symptoms, factors associated and rehabilitation needs among
survivors of COVID-19 three months after their recovery in Puducherry district, India.
Methods
We defined “post-COVID syndrome” as any signs and symptoms that develop during or following COVID-19
infection and continue for more than 12 weeks. We conducted a cross-sectional study in December 2020 among
all the individuals recovered from COVID-19 in Puducherry between April and August 2020. Trained medical
officers interviewed the participants using a semi-structured questionnaire prepared by adopting COVID-19
Yorkshire Rehabilitation Screening (C19-YRS) tool to the local context. We estimated the proportion with
symptoms and self-reported severity among those who had symptoms. We did multivariate binomial regression to
determine the factors associated with “Post-COVID syndrome” using the adjusted prevalence ratio (aPR).
Results
We interviewed 972 individuals recovered from COVID-19, of which 58% were males, and 23% had
comorbidity. The mean (SD) age and follow-up period after COVID-19 infection were 40 (18) years and 116 (20)
days, respectively. Of 972 individuals, 97 (10%) had post-COVID symptoms, the commonest symptoms being
cough (2.7%), fatigue (2.1%) and breathlessness (1.4%). Hospital admission (aPR-1.8), treatment with oxygen
(aPR-2.4), diabetes mellitus (aPR-1.3), and sore throat (aPR-2.6), breathlessness (aPR-1.6) and body pain
(aPR-2.0) during COVID-19 illness were significantly associated (p-value < 0.05) with post-COVID symptoms.
Conclusions
Symptomatic people, who required oxygen supplementation during hospital admissions, should be given due care
and follow up. We recommended setting up post-COVID clinic to address the rehabilitation needs of the
COVID-19 survivors.
128
Role of Event-Based Surveillance (EBS) in Early Detection of COVID-19 — Egypt,
2020–February 2021
Mohamad Fawzy, Fatma Osman, Hanaa Abuelseoud
Background
Egypt launched Event-based Surveillance (EBS) as a main component of Early Warning And Rapid Response
System (EWAR) since Nov 2015. Egypt adopted the one health approach for implementation of EBS.
COVID-19 pandemic spread rapidly around the globe since late Dec 2019. EBS detected the first COVID-19
case that reported from Egypt in 14 February 2020. Egyptian EBS is based on detection of any public health
threat including human, animal and environmental signals. This report aims to highlight the importance of EBS
in early detection of COVID-19 and any public health threat.
Methods
A descriptive analysis was conducted using EBS data from all sources (media, community-based surveillance
(CBS), national hotline, health facilities and EIOS). Signals were reported through EBS online platform with two
reporting levels (national, subnational). Database imported in 1 March, 2021 to excel and analyzed by Microsoft
Excel 2013. Data analyzed by residence governorate, filtered signals, verification, report source and signal
classification.
Results
Out of 8342 reported signal, hotline was the main reporting source (n = 3948, 47.9%), followed by media (n =
3076, 37.5%) and CBS (n = 1131, 13.7%). Health facilities and EIOS were the lowest reporting sources, (n = 59,
0.7%) and (n = 29, 0.4%) respectively. Signals could be classified into human (72.5%), animal (1.7%) and
environmental (13.2%). Out of the total signals, 83.5% were sent for verification. Verification resulted in 73.5%
true events. Fifty-two percent of the total reported signals (n = 4313) were COVID-19 signals, 93.5% were true
events. Seventy-three percent of true events (4322) were COVID-19 signals and early detected by EBS.
Conclusions
EBS proved the capability of early detection of COVID-19 cases. Hotline was the main source of reporting
during the pandemic. Public health workers were loaded with multiple tasks because of the pandemic so hotline
data wasn't all recorded. Assign a dedicated team to hotline is highly recommended.
129
The First Month COVID-19 Cases in Indonesia: Epidemiology and Outcome
Defi Amalia, Eka Muhiriyah, Triya Novita Dinihari, Endang Burni Prasetyowati, Santi Martini
Background
COVID-19 is an ongoing worldwide pandemic which needs global public health concern and collaborative effort
to prevent the rapid spread. In Indonesia, the first COVID-19 confirmed case was reported on 2 March 2020.
One month after the first case was reported, COVID-19 cases gradually increased and spread widely in 31
provinces in Indonesia. This study aims to identify epidemiological characteristics and outcome of the first
month COVID-19 cases in Indonesia.
Methods
The study included the first month patients with laboratory-confirmed SARS-CoV-2 from 2–31 March 2020. The
demographic, clinical, and epidemiological data from outbreak investigation report of Ministry of Health
Indonesia were analyzed descriptively.
Results
A total of 1528 COVID-19 positive cases were dominated by male. The median age was 48 years (range, 0–88).
698 (45.68%) cases were symptomatic and the most common initial symptoms were cough, history of fever, and
difficulty of breath. There were 80 imported cases and Java Island provinces contributed to 84% of the national
cases. Eighty-one cases (recovery rate 5.3%) had been discharged in stable condition and 136 cases died
(mortality rate 8.9%). Mortality was highest among the elderly. The relative risk of death among cases with at
least one and two or more comorbidities were 2.30 (95% CI: 1.43–3.69) and 4.47 (95% CI: 2.79–7.17), compared
with cases without comorbidity.
Conclusions
Our finding showed that in the first month COVID-19 cases in Indonesia, the mortality rate was higher than the
recovery rate. Early diagnosis and prompt treatment for the elderly and people with comorbidity should be
prioritized to reduce the mortality rate among these groups. Active case finding, increased testing capacity,
intensive contact investigation, and restriction on population movement is needed to suppress the COVID-19
spread.
130
Prevalence of Depression, Anxiety, and Stress and Associated Factors among Individuals
Working at Military COVID-19 Quarantine Facilities in Northern Vietnam
Dan Phan Tan, Kien Nguyen Xuan, Thuy Nguyen Phuong, Hung Pham Ngoc, Khanh Nguyen Cong, Pho Dinh
Cong
Background
In Vietnam, over 175 military facilities have been used to quarantine approximately 170,000 returned Vietnamese
nationals. It is a unique and effective measure to prevent COVID-19 transmission. However, staff working at
these facilities may be psychologically distressed. We aimed to assess the prevalence of depression, anxiety, stress
and associated factors among staff at quarantine facilities.
Methods
We conducted a cross-sectional study using the Depression Anxiety Stress Scale on 550 personnel at 14 military
quarantine camps, from July to September 2020, in Northern Vietnam. The cut-off points of Depression,
Anxiety, Stress were 8, 10, and 15 respectively. The association between DAS and related factors was determined
using multivariate logistic regression analysis.
Results
Amongst 550 subjects, 94.4% was male, mean age 32.1 ± 9.6, and 12% was healthcare workers. Around 6.2% of
subjects suffering at least a chronic condition, and 1.1% having a family history of psychological problems.
Prevalence of depression, anxiety, and stress were 2.7%, 6.6%, and 3.5% respectively; most of them were mild
and moderate. Factors associated with depression included having a family history of psychological conditions
(OR: 93.6; 95% CI: 3.0–292.1), family members being discriminated against (OR: 7.8; 95% CI: 1.38–44.8), and
being quarantined (OR: 0.1, 95% CI: 0.01–0.66). Anxiety was associated with having a chronic disease (OR: 4.2;
95% CI: 1.36–13.1), having direct contact with quarantined people (OR: 2.3; 95% CI: 1.03–5.24), having a
SARS-CoV-2 test (OR: 0.22; 95% CI: 0.09–0.54), and having PPE training prior to deployment (OR: 0.32; 95%
CI: 0.12–0.85). Stress was associated with a family history of a psychological condition (OR: 49.6; 95% CI: 4.9–
498.8), direct contact with quarantined people (OR: 4.46; 95% CI: 1.20–16.6), being discriminated against (OR:
5.03; 95% CI: 1.20–21.2), and being quarantined (OR: 0.19; 95% CI: 0.05–0.73).
Conclusions
A low prevalence of DAS and several associated factors were found amongst serving personnel. Our results
could help to identify opportunities for improving mental health for staff at military quarantine facilities.
131
Coronavirus Disease 2019 (COVID-19) Clusters in Community, Linked by Occupational
Setting, Bangkok, Thailand, April 2020
Pitiphon Promduangsi, Peeriya Watakulsin, Thanawadee Chantian, Patchanee Plernprom, Chonthicha Bonpuek
Background
In April 2020, Thailand Department of Disease Control was notified a confirmed COVID-19 case in a train
repair factory in Bangkok. We investigated to verify the diagnosis and identify cases associated with index case
and describe possible behavioral factors contributing to transmission in the workplace.
Methods
A descriptive study, including active case finding and contact tracing in both workplace and household settings,
was conducted. Cases and close contacts were interviewed. A laboratory-confirmed case was defined as any
persons who worked in fixing diesel building or being close contact with case between 1st March and 7th May
2020 with a laboratory positive for SAR-CoV-2 by real-time reverse transcription polymerase chain reaction. We
interviewed confirmed cases and high-risk contacts about inappropriate behaviors in the aspect of prevention
and control disease such as social distancing and mask-wearing. Walk-through survey was done to identify
possible environmental risks of transmission.
Results
A total of 8 laboratory-confirmed cases were identified (overall attack rate = 3.6%). Of eight cases, three cases
worked together in the same building and the other five cases were from two workers’ families. The attack rates
among the workplace and two households were 2.7%, 30%, and 16.7% respectively. The potential source case
was from index’s household which transmitted to workplace and then the other household. Potential behavioral
factors included talking within 1 meter (77.4%), staying together in poorly ventilated rooms (51.6%), talking
without mask-wearing (32.3%), physically closed working (45.2%), and dining together (29.0%). Additionally,
sharing glass, sharing cigarettes and crowded room were found.
Conclusions
The outbreak was associated with a household-workplace-household transmission. Prompt identification and
isolation of potentially infectious worker should be emphasized to halt household-workplace transmission.
Ventilation rates in break room and good hygiene and infection control practice of workers should be improved.
Hazards in workplace which could lead to transmit the disease should be removed.
132
Evaluation, Challenges and Cost Analysis of the Thailand Global HEARTS Package on
Healthy Lifestyle and Blood Pressure Control among Hypertensive Patients, Angthong
Province, 2019–2020
Charuttaporn Jitpeera, Phanthanee Thitichai, Mondha Kengganpanich, Deliana Kostova, Chuleeporn

Jiraphongsa
Background
Hypertension is the most important factor for cardiovascular disease (CVDs). The HEARTS technical package is
a set of interventions to strengthen CVD management in primary care. In March 2019–March 2020, Thailand
applied a version of the HEARTS technical package in a quasi-experimental setting with two main interventions:
Motivation Interviewing (MI) by Village Health Volunteers (VHVs) and Home Blood Pressure Measurement
(HMBP).
Methods
Context-Input-Process-Product (CIPP) Model was used to evaluate the program. In-depth interviews were
conducted among stakeholders, researchers, VHVs and patients with purposive sampling. The comparison of
mean difference between month 0 and month 12 with independent T-test among the experimental site (Nong
Mae Kai community) and the control site (Muang Tia community) in each outcome (blood pressure,
knowledge-attitude-practice (KAP) and Thai CVD Risk score) were done with statistical significance set at
p-value < 0.05. A program cost analysis was conducted using the HEARTS Costing Tool.
Results
The baseline characteristics of patients and VHVs between experimental site and control site were not
significantly different. After the one-year implementation, there was no difference in all expected outcomes
between Nong Mae Kai and Muang Tia. However, evaluation limitations occurred due to unevaluated
MI-training and program changes related to questionnaire, self-monitoring record form, supervision and
reporting. Additionally, Muang Tia Health Promoting Hospital has skilled and experienced staff on MI and caring
hypertension patients. The total cost of the program after one year implementation was 5,620 USD (152
USD/person). Over half (56%) of the cost was attributed to essential medicines and technologies with most of
this component attributed to purchasing equipment for patients and 26% of the program cost was training
VHVs.
Conclusions
Post-training evaluation for VHVs should be done to ensure quality of the intervention. Revising KAP
questionnaire and self-monitoring record form are also recommended to enable accurate evaluation.
133
Identifying the Scope of Task Shifting for Delivering Community-Based Hypertension
Control Program in the Bhopal District
Ashish Krishna, Anupam Khungar Pathni, Bhawna Sharma, Saurabh Purohit, Suyesh Shrivastava, Tapas Chakma,
Mohankumar Raju, Sharan Murali, Andrew Moran
Background
Task-shifting is one of the plausible solutions for decentralization of non-communicable diseases (NCD)
services. Task shifting aims at training the non-physician healthcare workers (NPHWs) to perform less technical
tasks, which are traditionally performed by the physicians. This study aims to identify the barriers and facilitators
for providing services to hypertensive patients through the auxiliary nurse midwives (ANMs) who are the
NPHWs at the subcenters.
Methods
We conducted 24 in-depth interviews (IDI), and six focus group discussions with ANMs selected from the 34
subcenters of the Bhopal district during November-December 2018. The interview guide was developed to
explore the knowledge of ANMs on managing hypertensive patients, infrastructure availability, type of services
delivered and the health-seeking behavior of the community. MS Excel was used to conduct thematic analysis on
the verbatims prepared under the two major themes – facilitating and hindering factors.
Results
All the study participants were females aged between 25–45 years. Subthemes identified under the facilitating
factors were knowledge, community outreach, and drug availability at the sub-center level. Hindering factors
included multiple job responsibilities of the staff, non-availability of NCD drugs in the ANMs drug kit, and
cultural barrier. ANMs reported to have adequate knowledge on measuring the blood pressure and to have good
community outreach. Subcenters have been the delivery points for maternal and child health programs and the
same is creating an inhibition among males in assessing the services offered at the subcenters.
Conclusions
Despite certain challenges, task shifting from physicians to ANMs was showing good acceptability, and a viable
option to be implemented. System needs to be further strengthened by appointing adequate manpower, drugs
and by educating the males to avoid the stigma and start utilizing the subcenter services.
134
Magnitude, Trend and Pattern of Hypertension among Adults Aged 15 and above —
Dire Dawa, Ethiopia, from 2015 to 2019
Dagmawi Abebe
Background
Background: Hypertension is an important public health problem worldwide and is the most widely recognized
modifiable risk factor for cardiovascular disease, cerebrovascular disease and end-stage renal disease. A
meta-analysis study in Ethiopia found that an estimated prevalence of hypertension among adult was 19.6% in
Addis Ababa. A community-based study conducted in 2017 showed the prevalence of hypertension was 24.43%
in Dire Dawa. Little is known about the picture of hypertension situation from secondary data. This study
assessed the secondary data to determine the magnitude, trend and pattern of hypertension of the past five years.
Methods
Descriptive cross-sectional study was used. The study was conducted from November 25 to December 30, 2020.
Data was obtained from HMIS and DHIS2 report from 2015 to 2019. Data completeness was checked by
reviewing all data elements to identify missing value and consistency was also checked through comparing the
reported values between health facilities report and regional health bureau database. Data was entered in to a
computer and analyzed using Microsoft Excel 2013 and data cleaning was done to fix incorrect, and duplicated
data. The data was analyzed by time, place and personal characteristics. The magnitude and trend was described
using ratio, rate, percentage and proportion. Tables and graphs were used for summary.
Results
Result: A total of 30,623 hypertensive cases were reported between 2015 and 2019. The prevalence of
hypertension among adult ≥ 15 year was 3.7%. Out of 30,623 reported cases, 97.5% were urban dwellers.
Hypertension prevalence among females is higher (359 per 10,000) than males (285 per 10,000). The trend of
prevalence increased from 2.2% in 2015 to 3.7% in 2019. Death to case ratio is 17 per 10,000.
Conclusions
Conclusion: The overall prevalence of hypertension presented in this report is very low with higher burden in
urban setting. I recommended efficient screening and promoting healthy lifestyle.
135
Poster Session: Vectorborne Diseases
Chikungunya in a Village: An Outbreak Investigation — Udupi, Karnataka, India,
February 2020
Prashant Bhat, Mohankumar Raju, Ravikumar K, Sudheerchandra Sooda, Premananda K, Jagadish H S,

Prabhdeep Kaur
Background
Nethajinagar, a village with 10,000 square meters and 392 residents, reported 33 fever cases with joint pain in
January 2020. On initial investigation Chikungunya (CHIKV) outbreak was confirmed. We investigated this
outbreak.
Methods
We followed the classical 10 outbreak investigation steps. After confirming the outbreak, cases were defined as
residents of Nethajinagar with fever and joint pain from 01 December, 2019 to 31 March, 2020. Four cases were
confirmed by CHIKV-IgM. Door-to-door case search along with larva survey were carried out concurrently.
Time-place-person analysis was done. A spot-map of vector breeding and CHIKV suspects was plotted. The
emerging hot spot of cases and vector breeding were analyzed by spatiotemporal method. Environmental study
was performed to guide further public health actions.
Results
Of 392 residents, 109 (attack rate: 27.8%) were cases. While index case was reported on 17th December 2019,
surge in cases was observed in last week of January 2020. Spot map showed 12 houses in the middle of second
lane had maximum vector breeding (Breteau index: 67%) and 48 houses in and around (two houses on all sides)
this high breading zone had maximum cases (hotspot, 80 cases; AR: 39%). There is not much difference in attack
rates among age groups and genders (25%–29%). Average house, container and Breteau indices were 14%, 5%
and 19% respectively. On spatiotemporal analysis, of 206 residents in the hotspot, 80 developed illness, compared
to 29 among 186 in non-hotspot area (Mantel Haenszel Chi-square test 26.24, p < 0.05, OR: 3.4 [95% CI: 2.1–
5.6]). The village received water twice daily through community taps. Instead of being emptied, the water
containers were topped-up every time. Thirty houses had overhead tank, six of which didn’t have lids.
Conclusions
CHIKV outbreaks can be quick and explosive. A robust and sensitive routine surveillance system is warranted to
contain spread of infection at the early stages.
136
Dengue Fever Outbreak Investigation in Al-Hurriya Village, Taiz Governorate, Yemen,
2020
Sumia Alturki, Abdulkareem Nassar, Nabeel Hajip, Fakhreia Alobaidi, Abdulwahed Al Serouri
Background
Dengue Fever (DF) is an increasing health problem in Yemen where recurrent outbreaks are reported recently
with destruction of water and sanitation infrastructure by the protracted conflict. In September 2020, Taiz
governorate surveillance officer reported an increase in DF cases in Al-Hurriya village and team from Field
Epidemiology Training Program was deployed to investigate. The aims were to confirm and describe DF
outbreak, identify possible risk factors, and recommend control measures.
Methods
Active house-to-house search was performed using a modified WHO case definition. Forty-one cases that found
positive by anti-dengue non-structural protein 1 (NS1) test were matched for age and gender with controls (1:1)
who have no symptoms and negative by anti-dengue NS1. Data were collected on individual, environmental and
behavioral risk factors. Sixteen houses with 209 water containers were examined for mosquito larvae. Odds
Ratios (OR) and 95% confidence interval (CI) were calculated.
Results
Seventy-three percent of cases were males and 51% were 15–29 years old. Attack rate was 3.9/1,000 population.
All cases suffered from fever, headache and fatigue, while hemorrhagic manifestations were reported in 10%.
House, water container and Breteau indexes were 88%, 82% and 1068%, respectively. While poor environment
around house (OR = 8.4, CI: 3.1–22.8), and not using bed nets (OR = 3.1, CI = 1.2–7.9) were found to be risk
factors, having piped water was found to be protective (OR = 0.3, CI = 0.1–0.9).
Conclusions
DF outbreak was confirmed in Al-Hurriya village where water containers were found to be the main source. Poor
environment around house and not using bed nets were the main risk factors. Improving environment around
house and encouraging using of bed nets together with supplying houses with piped water were recommended.
Improving dengue surveillance and rapid response with increasing community awareness regarding transmission
and prevention were recommended.
137
Investigation of High lethality Associated with Severe Malaria in Children under 5 years
at Dori Regional Hospital Center — Sahel Region, Burkina Faso
Berenger Kabore, Noaga Sawadogo, Souleymane Porgho, Yelbeogo Dénis, Sawadogo Bernard, Sidwaya Hamed
Ouédraogo, Pegdwende Hamadou Seogo
Background
Malaria is a public health problem in Sahel region of Burkina-Faso. In 2018 it was the major reason of death of
the region causing 38.6% of deaths. An alert was given during surveillance week number 34 of year 2020 with the
notification of high lethality of 3.7% linked to malaria in children under 5 years by the regional hospital center
(CHR) of Dori. Investigation was conducted to determine the main reasons of the outbreak.
Methods
A case-control study was carried out from September 10 to 15, 2020 in the pediatric department of the Dori
CHR, with 150 samples, including exhaustive sampling of 50 cases and random selection of 100 controls. We
have chosen two controls for one case. The data collection tools consisted of a questionnaire and an interview
guide. We calculated means, proportions, odds ratios, and performed statistical tests using Chi-square test
Results
Fifty deaths due to severe malaria were recorded out of 316 children under 5 hospitalized with severe malaria
during period as a lethality of 15.82%. Not taking seasonal malaria chemoprevention (OR = 6.14 [2.92–12.93] p
= 0.0000004), non-availability of labile blood products at Dori's CHR (OR = 3.22 [4.02–43.47] p = 0.0000048)
and the treatment of malaria cases in non-compliance with guidelines (OR = 2.77 [1.12–6.86] p = 0.015) were
associated with occurrence of death.
Conclusions
The high case fatality associated with Dori's CHR is partly linked to insufficient coverage of seasonal malaria
chemoprevention, rupture of labile blood products and insufficient management of malaria cases according to
national guidelines. Strong actions would be necessary for adequate care of children with severe malaria and the
application of preventive measures.
138
Malaria Outbreak Investigation in Nono Benja Woreda, Jimma-Zone, Ethiopia, 2020
Berhanu Abebe, Chaltu Fikru, Gemechu Adnew, Bekele Dasse
Background
Globally malaria remains one of the highest burden diseases particularly in developing countries. Malaria is a
major public health problem in Ethiopia and reported as one of the three leading causes of morbidity and
mortality. In September 2020, Nono Benja woreda health office was notified of a suspected malaria outbreak.
The aim of this study was verification, investigation and control of outbreak.
Methods
Descriptive cross-sectional study and unmatched case control study with 1:1 ratio cases and controls, with sample
size of 136, (68 cases and 68 controls). An interviewer-administered questionnaire was used to collect data. Data
was entered to Epi-data version 3.1 and export to SPSS version 25.0 for analysis. Bivariate analysis was used to
choose candidate variables with a cutoff of 25% p-value and multivariable analysis was done to fit final model.
AORs with 95% CIs were estimated and 5% p-value significance were reported and interpreted.
Results
A total of 687 cases were detected and overall attack rate was 1%, but no death. The mean age of affected
population (cases) was 21.71 years. Identified risk factors were, not having insecticide treated nets (AOR = 3.060,
95% CI = 1.047–8.93), living in house not sprayed by indoor insecticide residual spray, (AOR = 4.46, 95% CI =
1.250–15.927), presence of stagnant water in living area (AOR = 4.055, 95% CI = 1.343–12.241), not getting
health education on malaria in last one year (AOR = 3.709, 95% CI = 1.207–11), poor knowledge of malaria
prevention (AOR = 5.457, 95% CI = 1.647–18.083. Educational level of grade 9–12 reduces risk of having
malaria by 93% compared to higher than grade 12 (AOR = 0.070, 95% CI = 0.006–0.806).
Conclusions
Poor knowledge of malaria prevention, presence of stagnant water, not having ITNS, no indoor insecticide
residual spray, not getting health education on malaria were significantly associated with this malaria outbreak.
Therefore, Woreda health office should supply ITNS, spray insecticide-chemical and provide health education on
malaria.
139
Situational Analysis of Dengue in Perlis, Malaysia, 2015–2019
Che Muzaini Che Muda, Hasrina Hassan, Siti Halimah Syed Shaikh, Azmi Ahmad, Sirajuddin Hashim
Background
Dengue is transmitted by female mosquito of mainly Aedes aegypti and Aedes albopictus with four distinct serotypes
of dengue virus; DENV-1,2,3 and 4. The incidence of dengue has increased in Malaysia and similarly in Perlis.
This study was conducted to describe the epidemiology of dengue disease in Perlis between 2015 and 2019.
Methods
A cross-sectional study was conducted. The socio-demography, clinical presentations, prevention and control
activities, entomological data, case progression status and weather information from 2015 to 2019 were retrieved
from surveillance data. Linear regression and logistic regression were used in analysis.
Results
The highest dengue incidence rate (IR) was 148.5 per 100,000 populations in 2018. There were 1276 dengue cases
with mean (SD) age of 31.15 (17.95) years. Majority were Malay with male to female ratio of 1:1. A total of
164,177 premises being inspected, 180,947 premises were fogged with 1,689 fines and 781 cleaning orders given
as a response to dengue cases (p-value of 0.021 to < 0.001). As the amount of rainfall increases, the dengue cases
significantly reduced (p-value=0.032). Cases with interval from onset to first control activities of five days or more
had 1.45 times the odds of an outbreak than if the duration was shorter (95% CI: 1.003,2.101; p-value = 0.048).
Diagnostic delay contributed 41.1% while patient delay in seeking medical treatment contributed 19.8%.
Conclusions
Significant preventive and control activities towards the dengue cases were recorded for past 5 years. However,
cases were still not effectively reduced. The quality and amount of activities need to be monitored closely
particularly after heavy rains. Early case detection and control intervention program will prevent outbreaks, thus
continued training for medical practitioner and health education programs for community are ongoing.
140
Clinical Manifestations, Laboratory Characteristics and Treatment of Toxocariasis
Patients Treated with Albendazole: A Cross-Sectional Study in Northern Vietnam
Nguyen Thu Huong
Background
Human toxocariasis is caused by nematode Toxocara canis and T. cati. In Vietnam, there are few studies on Toxocara
infection status as well as clinical, subclinical, and treatment characteristics of Toxocariasis focusing on
epidemiological features.
Methods
A cross-sectional study was performed on Toxocara patients between 2018 and 2019 in two hospitals. A total of
103 Toxocariasis participants over 16 years-old, were examined to diagnose with at least two clinical symptoms
and positive for anti-IgG Toxocara ELISA. Toxocara patients were treated with albendazole 800mg/day for 14 days.
The data on clinical manifestations were obtained from personal health records. Clinical performance data
collected from personal health profiles were analyzed and evaluated for pre-and post-treatment efficacy of
albendazole.
Results
The median age of patients was 43.6 years. The most common symptom groups were the skin and mucosa
(88.3%), followed by neurological symptoms (44%). The number of infected larvae days before admission
accounted for the highest proportion from 1 to 12 months with 36.9%. There are 76.7% of patients with risk
factors of contact with pet dogs and cats. The majority (85.4%) of patients had eosinophil counts in the normal
range (< 8%). the major results of the OD value of ELISA were in the group (≥ 0.3– < 1.5) accounted for
75.7%. Presence of skin and mucosa lesions in toxocariasis patients is significantly related to higher IgE values (p
< 0.05). After one month treatment with albendazole, 48.1% of patients had symptom resolutions. It was
statistically significant between contact with dogs/cats and the treatment outcomes on clinical symptoms (p <
0.05)
Conclusions
This study confirmed again that toxocariasis in humans is a common cause of poor health conditions affecting
occupational health in the clinical symptoms of adults. Further research is needed to identify pathogens in cats
and dogs in communities involving patients, to recommend preventive measures to limit transmission
141
Evaluation of the Human Immunodeficiency Virus Epidemiological Surveillance System
at Outpatient Treatment Center — Mauritania, 2020
Mohamedou Hmeied Maham, Abdarrahmane Mohamedoune, Mohamedou Mohamed Ahmed, Otshudjandjeka

Joseph, Marianne Laurent, Fadima Diallo, Yanogo Pauline, Nicolas Meda
Background
HIV/AIDS continues to be a public health problem and a major global concern. West and Central Africa had 4.9
million cases in 2019, including 240,000 new cases and about 140,000 deaths related to HIV/AIDS. In
Mauritania, in 2019, according to WHO estimates, the prevalence of HIV/AIDS is estimated at 0.2%. We
evaluated the HIV/AIDS surveillance system in the Nouakchott region to describe its organization and
functioning, determine its usefulness, and assess its attributes according to the updated guidelines of the Center
for Disease Control and Prevention for the evaluation of public health surveillance systems.
Methods
This descriptive cross-sectional study was conducted from May to December 2020 and involved data from
January 2019 to December 2019. The study population consisted of actors directly involved in surveillance at all
levels of the country's surveillance system. Data were collected through document review and semi-structured
interviews. Data analysis was done using Epi Info 7.2.2.6 and Excel. Proportions and rates were calculated.
Attribute Appreciation Score was low (< 50%); Medium (≥ 50% < 75%); Good (≥ 75% ≤ 100%).
Results
The monitoring system is complex but useful, achieving its objectives. It is well structured, accepted, responsive,
flexible, and of good data quality. Nevertheless, it is weakly representative and moderately stable. The sensitivity
(95.80%) and the positive predictive value (96.24%) are high in 2019.
Conclusions
The monitoring system was found to be useful and met its objectives. Representativeness and funding need to be
improved. We recommend to the national AIDS program to establish other HIV/AIDS testing centers and
outpatient treatment centers at the district and regional levels, avoid breakdowns in laboratory reagents and
consumables, train health care providers on HIV/AIDS, motivate those involved in the fight against HIV/AIDS,
regularly supervise the outpatient treatment centers.
142
Resilience Social Factor Index to Earthquake at West Halmahera District, North Maluku
Province, Indonesia, 2019
Febriyanti Abd Radjak, Atik Choirul Hidajah, Santi Martini
Background
West Halmahera is one of the districts in North Maluku Province, which frequently experienced earthquakes with
large magnitudes recorded from 1907–2017. Resilience needs to be owned by people in this region to be able to
avoid and minimize risk of becoming a victim. The aims to measure resilience social factor index owned by
community to earthquake disasters.
Methods
Descriptive study conducted in August–September 2019 using the concept of Community Resilience Index. The
indicators assessed in compiling index are level of education, age groups < 15 and ≥ 60 years, health insurance
ownership, vulnerable groups (physical disabilities, mental disabilities, infants, pregnant women and elderly) and
social capital. The cut point of each indicator was adopted from the study of Ainuddin and Routray, 2012. The
index are divided by criteria of very high (0.81–1.00), high (0.61–0.80), moderate (0.41– 0.60), low (0.21–0.40)
and very low (0.00–0.20). Data was taken from 33 villages in 7 sub-districts in West Halmahera District.
Results
The most frequent education level was elementary school (18.59%) and least was college graduates (5.35%). Age
groups < 15 years (25.60%) and ≥ 60 years (8.81%). Percentage of participants with ownership of public health
insurance was 73.83%. The percentage of vulnerable groups was 14.54%, with the most common condition
being elderly (11.51%) and the least common physically disabled (0.30%). Social capital was a community
organization that allows keeping coordinating with related parties after an earthquake has a percentage of
56.41%. The value of resilience social factor index obtained was 0.93.
Conclusions
Resilience social factor index of community earthquakes in West Halmahera District was stated on higher
criterion because high health insurance ownership, high social capital as well as the frequent intensity of
earthquakes causing community to be more alert. However, lack of tertiary education reflects need in increase
knowledge about earthquakes so it can increase preparedness and evacuation during an earthquake.
143
Seroprevalence of Hepatitis B Virus among Antenatal Clinic Attendees — Gamawa
Local Government Area, Bauchi State, Nigeria, 2018
Garba Mustapha Umar, Ibrahim Abdulrasul, Muhammad Shakir Balogun, Chukwuma David Umeokonkwo,
Aisha Indo Mamman
Background
Hepatitis B virus disease is a potentially life-threatening liver infection and a major global health problem. It
causes chronic infection and puts people at high risk of death from cirrhosis and liver cancer. WHO estimated
257 million people are living with hepatitis B virus (HBV) infection and in 2015 alone HBV resulted in 887,000
deaths globally. We determined the prevalence and associated factors of hepatitis B virus infection among
Antenatal Care (ANC) attendees in Gamawa Local Government Area, Bauchi State.
Methods
We conducted a descriptive cross-sectional, health facility-based study between March and April 2018. We used
systematic random sampling technique to recruit 210 pregnant women aged 15–49 years. With a structured
questionnaire, we interviewed the respondents and collected blood sample to test for hepatitis B surface antigen
(HBsAg). We calculated frequencies, means, proportions, and tested for associations using Epi Info 7.2 and
Microsoft Excel.
Results
The mean age of respondents was 24.5 ± 6.0 years; 112 (53%) of whom were younger than 25 years. All were
married, 183 (87%) had no formal education and up to 190 (90%) were employed. Overall, 14 (6.7%) tested
positive for HBsAg. Women aged ≥ 35 years had the highest prevalence (10%). None with tertiary education
tested positive and women married before 18 years had 13 (6.2%) prevalence.
Conclusions
The prevalence of HBsAg among pregnant women in Gamawa LGA was 6.7% which is quite lower than the
national prevalence reported. We recommended improved surveillance of HBV infection and screening of
women attending ANC.
144
Selected Abstracts for Presentation
Stress, Anxiety, Depression and Related Factors of Healthcare Workers Directly
Contacted COVID-19 Patients in Hospitals — Southern, Vietnam
Le Thi Ngoc Anh
Background
Healthcare workers (HCWs) at COVID-19 treatment hospitals may be psychologically distressed due to increased
risk of infection, work pressure, and stigma. We aimed to determine the rate of depression, anxiety, stress, and
related factors among HCWs who directly contact COVID-19 patients in hospitals.
Methods
A cross-sectional study, using Depression, Anxiety, and Stress (DAS) Scales (DASS-21), was conducted on 494
HCWs at 14 hospitals, from July to September 2020, in Southern, Vietnam. The cut-off score of DAS were 9, 7,
and 14 respectively. We used multivariable logistic regression analysis (MLRA) to identify factors related to DAS
with a significance level at α<0.05.
Results
Out of 494 participants, 239 (48.4%) were female, 85% aged ≤ 40 years old, 55.3% were married and 56.1%
obtained university and graduate. Prevalence of DAS were 18%, 11.5% and 7.7%, respectively. The MLRA
results showed that HWs > 40 years old had depression lower than ≤ 30 years old (OR = 0.3, 95% CI (0.1 –0.8)).
Those with university and graduate had a higher rate of depression (OR = 2.0, 95% CI (1.1–3.5)) and stress (OR
= 3.5, 95% CI (1.4–9.2)) than lower education. HCWs worked for more than 8 hours/day were more stressful
than ≤ 8 hours/day (OR = 2.4, 95% CI (1.1–5.3)). HCWs weren’t trained on infection control prevention before
care and treatment for COVID-19 patients had greater rate of depression (OR = 4.8, 95% CI 1.6–14.8), anxiety
(OR = 4.1, 95% CI 1.4–12.7) and stress (OR = 7.8, 95% CI 2.2–27.5). People whose families were shunned and
stigmatized had higher rate depression (OR = 3.2, 95% CI 1.8–5.8) and anxiety (OR = 3.2, 95% CI 1.7–6.1).
Additionally, HCWs acquired symptoms after exposure to COVID-19 patients (as fatigue, sore throat, diaphysis,
arthralgia, loss of appetite, insomnia) also increased the rate of DAS.
Conclusions
A high prevalence of DAS and some related factors were found amongst HCWs in COVID-19 hospitals. Health
authorities should consider some intervention measures for these groups before treating and serving COVID-19
patients.
145
Selected Abstracts for Presentation
Incidence of COVID-19 in Quarantined Health Care Workers: A Single-Centre
Retrospective Analysis of Hospital-Based Contact Tracing during Australia’s Second
Wave
Chris Bailie, Vivian Leung, Liz Orr, Sheena Sullivan, Martyn Kirk, Cate Kelly, Caroline Marshall
Background
Hospital-based contact tracing aims to prevent the spread of COVID-19 within healthcare facilities. In large
outbreaks, this can be resource intensive, and planners may have to consider workforce impacts of quarantining
staff. To inform strategies for defining, quarantining, and testing health care worker (HCW) contacts, we aimed to
determine the rate and timing of COVID-19 among quarantined HCWs, and to examine factors associated with
infection.
Methods
We extracted data on HCW quarantined through hospital-based contact tracing from the contact tracing database
of a large public healthcare facility in Melbourne, Australia, for the period June-September 2020. Close contacts
were quarantined for 14 days following exposure and tested routinely on day 11. We used multivariate logistic
regression to examine factors associated with diagnosis in quarantine. We fit gamma, lognormal, and Weibull
distributions to symptom onset data for quarantined HCWs.
Results
COVID-19 was diagnosed in 11% (52/483) of instances in which HCW were quarantined due to close contact,
accounting for 19% of all 270 HCW cases. In 361 instances with a clear index case, higher odds of infection were
associated with contact with an infectious patient compared to an infectious HCW (OR: 4.69, 95% CI: 1.98–
12.14). Contact external to the workplace was associated with higher odds of infection compared to workplace
contact only (OR: 7.70, 95% CI: 2.63–23.05). We estimated 16–46%, 65–92% and 88–100% of symptomatic
cases would develop symptoms by 3, 7, and 11 days since last close contact, respectively.
Conclusions
In our setting, hospital-based contact tracing detected and effectively contained a significant proportion of HCW
cases, without resulting in furlough of an excessive number of non-infected staff. Contact between HCWs
outside of the workplace must be recognized and responded to. Case detection strategies relying solely on routine
testing of quarantined HCWs before 11 days since last exposure may be insensitive.
146

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Itt is well-recoognized thatt every coun ntry needs efffective field

I would like tto thank thee Taiwan FE

I would also like to thankk the Taiwan

Itt is my honoor to deliver this welcom

Itt is with greaat pleasure that

Shih-Ch hung Che n, DDS

I regret that, instead of sitting

Jui-Yuan n Hsueh,, MD, LLM M

I want to usee this occasio

Jih-Haww Chou, D DDS, MPH H

Dr. Jui-Yuan Hsueh, Chair

Dr. Jih-Haw Chou, Vice Chair

Dr. Carl Reddy, Committee Member

Dr. Maria Consorcia Lim-Quizon, Committee Member

Dr. Feng-Yee Chang, Chair

Dr. Angela Hilmers, Committee Member

Dr. Maria Concepcion Roces, Committee Member

Dr. Shan-Chwen Chang, Committee Member

Dr. Song-En Huang, Committee Member

Dr. Philip Yi-Chun Lo, Chair

Ms. Ju-Hsiu Teng, Vice Chair

Dr. Wan-Chin Chen, Executive Secretary

Ms. Yumin Chou, Committee Member

Ms. Kai-Ling Tsao, Committee Member

Mr. Jui-Wei Hsieh, Committee Member

Mr. Shih-Hao Liu, Committee Member

Dr. Song-En Huang, Committee Member

Valan Adimai Siromany Wan-Ting Huang Michela Sabbatucci

Workshop 1: I am scared of (adverse events following) immunizations — vaccine

Organizer: Taiwan FETP

Organizer: FETP, Bangladesh

Organizer: ENDING PANDEMICS

Organizer: Field Epidemiology in Action

Datee & Time: 133:30–14:30, GMT+8, Friday,

The first stop is the North Gate.

The third stop is Taipei Con

Best Poster Presentation, 1st Place

Ma. Ivy Rozethh Saavedra--Iturralde

Foggging focus: T This activityy is carried out

A phhoto was takken during a surveillance data analyysis activity, in

 Facebook Vote Winner

11:45 – 13:15, Tuesday, November 2

13:30 – 15:00, Tuesday, November 2

Oral Presentation Session 2: Non-Communicable Diseases

Oral Presentation Session 3: Outbreak Investigation and Response

Oral Presentation Session 4: Surveillance

10:00 – 11:30, Wednesday, November 3

11:45 – 13:15, Wednesday, November 3

13:30 – 15:00, Wednesday, November 3

Oral Presentation Session 6: Animal Health and Zoonotic Diseases

Oral Presentation Session 7: Vaccine Preventable Diseases

10:00 – 11:30, Thursday, November 4

11:45 – 13:15, Thursday, November 4

Oral Presentation Session 10: Severe Illnesses and Deaths

Oral Presentation Session 11: Foodborne Diseases

13:30 – 15:00, Thursday, November 4

Oral Presentation Session 14: Environmental Health

Oral Presentation Session 15: Healthcare-Associated Infections

Oral Presentation Session 16: Malaria

11:45 – 13:15, Friday, November 5

Oral Presentation Session 18: More on Vaccine Preventable Diseases

Oral Presentation Session 19: Other Infectious Diseases

20088, BS, Biologgy & BA, Ennvironmentaal Studies, U

Preseent positionn – Surveillan