Search results for: diphtheria outbreak

Authors: Ni Luh Bayu PurwaEka Payani, Destin Ristanti

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Every child has the right to be healthy, and it is a parents’ obligation to fulfill their rights. In order to be healthy and prevented from the outbreak of infectious diseases, some vaccines are required. However, there are groups of people, who consider that vaccines consist of religiously forbidden ingredients. The government of Indonesia legally set the rule that all children must be vaccinated. However, merely based on religious beliefs and not supported by scientific evidence, these people ignore the vaccination. As a result, this anti-vaccine movement caused diphtheria outbreak in 2017. Categorized as a vulnerable group, child`s rights must be fulfilled in any forms. This paper tries to analyze the contradiction between religious beliefs and the fulfillment of child`s rights. Furthermore, it tries to identify the anti-vaccine movement as a form of human rights violation, especially regarding child's rights. This has been done by examining the event of the outbreak of diphtheria in 20 provinces of Indonesia. Furthermore, interview and literature reviews have been done to support the analysis. Through this process, it becomes clear that the anti-vaccine movements driven by religious beliefs did influence the outbreak of diphtheria. Hence, the anti-vaccine movements ignore the long-term effects not only on their own children’s health but also others.

Keywords: anti-vaccine movement, child rights, religious beliefs, right to health

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Authors: Folajimi Oladimeji Shorunke

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Background: As of October 9, 2023, diphtheria has been noted to be re-emerging in four African countries: Algeria, Guinea, Niger, and Nigeria. 14,587 cases with a case fatality rate of 4.1% have been reported across these regions, with Nigeria alone responsible for over 90% of the cases. In Taraba State Nigeria, the index case of Diphtheria was reported on epidemic week 34, August 24, 2023 with 75 confirmed cases found 3 months after the index case and a case fatality of 1.3%. it described the distribution, trend and common symptoms found during the Outbreak. Methods: The Taraba State Diphtheria Outbreak line list on the Surveillance Outbreak Response Management & Analysis System (SORMAS) for all its 16 local government areas (LGAs) was analyzed using descriptive statistics (graphs, chats and maps) for the period between 24th August to 25th November 2023. Primary data was collected through the use of case investigation forms and variables like Age, gender, date of disease onset, LGA of residence, and symptoms exhibited were collected. Naso-pharyngeal and oro-pharyngeal samples were also collected for Laboratory confirmation. The most common diphtheria symptoms during the outbreak were also highlighted. Results: A total of 75 Diphtheria cases were diagnosed in 10 of the 16 LGAs in Taraba State between 24th August to 25th November 2023, 72% of the cases were female, with the age range 0-9 years having the highest proportion of 34 (45.3%), the number of positive diagnosis reduces with age among cases. The Northern part of the State had the highest proportion of cases, 68 (90.7%), with Ardo-Kola LGA having the highest 28 (29%). The remaining 9.2% of cases is shared among the middle belt and southern part of the State. The Epi-curve took the characteristic shape of a propagated infection with peaks at the 37th, 39th and 45th epidemic weeks. The most common symptoms found in cases were fever 71 (94.7%), pharyngitis 65( 86.7%), tonsillitis 60 (80%), and laryngitis 53 (71%). Conclusions: The number of confirmed cases of Diphtheria in Taraba State, Nigeria between 24th August to 25th November 2023 is 75. The condition is higher among females than male and mostly affected children between ages 0-9 with the northern part of the state most affected. The most common symptoms exhibited by cases include fever, pharyngitis, tonsillitis and laryngitis.

Keywords: diphtheria outbreak, taraba nigeria, descriptive epidemiology, trend

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Authors: Ravipa Rojasavachai, Li Yang

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Working from home has become a global phenomenon after the coronavirus outbreak, and most employees have a choice to choose between working from home or the office. In this paper, we examine the demographics and socio-economics factors influencing individuals’ decision to choose working from home rather than the office before and after the coronavirus outbreak based on Australian household data. We find that all factors impact the working from home choice before the coronavirus outbreak, but the number of children turns to an uninfluenced factor on individuals’ choices after the outbreak. We also find that female employees have a higher probability of choosing to work from home after the coronavirus outbreak. This is because they have less concern for their career opportunities and higher wage premium of working from home due to the changing in cultural norms and advanced working from home technologies in companies after the coronavirus outbreak.

Keywords: work from home, telework, remote working, COVID-19, pandemic, wage

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Authors: Myoungsoon You, Heejung Son

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During a pandemic, hospital workers should protect not only their vulnerable patients but also themselves from the consequences of rapidly spreading infection. However, the evidence on the psychological impact of an outbreak on hospital workers is limited. In this study, we aim to assess hospital workers’ psychological well-being and function at the workplace after an outbreak, by focusing on ‘psychological resilience’. Specifically, the effects of risk appraisal, emotional experience, and coping ability on resilience indicated by the likelihood of post-traumatic syndrome disorder and willingness to work were investigated. Such role and position of each factor were analyzed using a path model, and the result was compared between the healthcare worker and non-healthcare worker groups. In the investigation, 280 hospital workers who experienced the 2015 Middle East Respiratory Syndrome outbreak in South Korea have participated. The result presented, in both groups, the role of the appraisal of risk and coping ability appeared consistent with a previous research, that was, the former interrupted resilience while the latter facilitated it. In addition, the role of emotional experience was highlighted as, in both groups, emotional disruption not only directly associated with low resilience but mediated the effect of perceived risk on resilience. The differences between the groups were also identified, which were, the role of emotional experience and coping ability was more prominent in the non-HCW group in explaining resilience. From the results, implications on how to support hospital personnel during an outbreak in a way to facilitate their resilience after the outbreak were drawn.

Keywords: hospital workers, emotions, infectious disease outbreak, psychological resilience

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Authors: Uduak Umoh, Imo Eyoh, Emmauel Nyoho

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This paper compares fuzzy-machine learning algorithms such as Support Vector Machine (SVM), and K-Nearest Neighbor (KNN) for the predicting cases of fire outbreak. The paper uses the fire outbreak dataset with three features (Temperature, Smoke, and Flame). The data is pre-processed using Interval Type-2 Fuzzy Logic (IT2FL) algorithm. Min-Max Normalization and Principal Component Analysis (PCA) are used to predict feature labels in the dataset, normalize the dataset, and select relevant features respectively. The output of the pre-processing is a dataset with two principal components (PC1 and PC2). The pre-processed dataset is then used in the training of the aforementioned machine learning models. K-fold (with K=10) cross-validation method is used to evaluate the performance of the models using the matrices – ROC (Receiver Operating Curve), Specificity, and Sensitivity. The model is also tested with 20% of the dataset. The validation result shows KNN is the better model for fire outbreak detection with an ROC value of 0.99878, followed by SVM with an ROC value of 0.99753.

Keywords: Machine Learning Algorithms , Interval Type-2 Fuzzy Logic, Fire Outbreak, Support Vector Machine, K-Nearest Neighbour, Principal Component Analysis

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Authors: Rieski Prihastuti, Meliana Depo, Trisno A. Wibowo, Misinem

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On October 19, 2017, Yogyakarta Islamic Hospital reported 38 garment employees with nausea, vomiting, headache, abdominal pain, and diarrhea after they had lunch on October 18, 2017, to Sleman District Health Office. Objectives of this study were to ensure the outbreak and identify source and route of transmission. Case-control study was conducted to analyze food items that caused the outbreak. A case was defined as a person who got symptoms such as abdominal pain, diarrhea, nausea with/without vomiting, fever, and headache after they had lunch on October 18, 2017. Samples included leftover lunch box, vomit, tap water and drinking water had been sent to the laboratory. Data were analyzed descriptively as frequency table and analyzed by using chi-square in bivariate analysis. All of 196 garment employee was included in this study. The common symptoms of this outbreak were abdominal pain (84.4%), diarrhea (72.8%), nausea (61.6%), headache (52.8%), vomiting (12.8%), and fever (6.4%) with median incubation period 13 hours (range 1-34 hours). Highest attack rate and odds ratio was found in grilled chicken (Attack Rate 58,49%) with Odds Ratio 11,023 (Confidence Interval 95% 1.383 - 87.859; p value 0,005). Almost all samples showed mold, except drinking water. Based on its sign and symptoms, also incubation period, diarrheal Bacillus cereus and Clostridium perfringens were suspected to be the causative agent of the outbreak. Limitation of this study was improper sample handling and no sample of food handler and stools in the food caterer. Outbreak investigation training needed to be given to the hospital worker, and monitoring should be done to the food caterer to prevent another outbreak.

Keywords: disease outbreak, foodborne disease, food poisoning, outbreak

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Authors: Duanghathai Saipinta, Tanittian Panyamongkol, Witaya Suriyasathaporn

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Animal management aims to provide a suitable environment for animals allowing maximal productivity in those animals. Prevention of disease is an important part of animal management. Foot-and-mouth disease (FMD) is a highly contagious viral disease in cattle and is an economically important animal disease worldwide. Monitoring the FMD virus in farms is useful management for the prevention of the FMD outbreak. A recent publication indicated collection samples from nasal swabs can be used for monitoring FMD in symptomatic cows. Therefore, the objectives of this study were to determine the FMD virus in asymptomatic dairy cattle using nasal swab samples during the absence of an FMD outbreak. The study was conducted from December 2020 to June 2021 using 185 asymptomatic signs of FMD dairy cattle in Chiang Mai Province, Thailand. By random cow selection, nasal mucosal swabs were used to collect samples from the selected cows and then were to evaluate the presence of FMD viruses using the real-time rt-PCR assay. In total, 4.9% of dairy cattle detected FMD virus, including 2 dairy farms in Mae-on (8 samples; 9.6%) and 1 farm in the Chai-Prakan district (1 sample; 1.2%). Interestingly, both farms in Mae-on were the outbreak of the FMD after this detection for 6 months. This indicated that the FMD virus presented in asymptomatic cattle might relate to the subsequent outbreak of FMD. The outbreak demonstrates the presence of the virus in the environment. In conclusion, monitoring of FMD can be performed by nasal swab collection. Further investigation is needed to show whether the FMD virus presented in asymptomatic FMD cattle could be the cause of the subsequent FMD outbreak or not.

Keywords: cattle, foot-and-mouth disease, nasal swab, real-time rt-PCR assay

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Authors: Chengbin Wang, Li Lu, Luodan Suo, Qinghai Wang, Fan Yang, Xu Wang, Mona Marin

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Background: Two-dose varicella vaccination has been recommended in Beijing since November 2012. We investigated a varicella outbreak in a highly vaccinated elementary school population to examine transmission patterns and risk factors for vaccine failure. Methods: A varicella case was defined as an acute generalized maculopapulovesicular rash without other apparent cause in a student attending the school from March 28 to May 17, 2015. Breakthrough varicella was defined as varicella >42 days after last vaccine dose. Vaccination information was collected from immunization records. Information on prior disease and clinical presentation was collected via survey of students’ parents. Results: Of the 1056 school students, 1028 (97.3%) reported no varicella history, of whom 364 (35.4%) had received 1-dose and 650 (63.2%) had received 2-dose varicella vaccine, for 98.6% school-wide vaccination coverage with ≥ 1 dose before the outbreak. A total of 20 cases were identified for an overall attack rate of 1.9%. The index case was in a 2-dose vaccinated student who was not isolated. The majority of cases were breakthrough (19/20, 95%) with attack rates of 7.1% (1/14), 1.6% (6/364) and 2.0% (13/650) among unvaccinated, 1-dose, and 2-dose students, respectively. Most cases had < 50 lesions (18/20, 90%). No difference was found between 1-dose and 2-dose breakthrough cases in disease severity or sociodemographic factors. Conclusion: Moderate 2-dose varicella vaccine coverage was insufficient to prevent a varicella outbreak. Two-dose breakthrough varicella is still contagious. High 2-dose varicella vaccine coverage and timely isolation of ill persons might be needed for varicella outbreak control in the 2-dose era.

Keywords: varicella, outbreak, breakthrough varicella, vaccination

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Authors: Dativa Maria Aliddeki, Fred Monje, Godfrey Nsereko, Benon Kwesiga, Daniel Kadobera, Alex Riolexus Ario

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Background: Cholera is a severe gastrointestinal disease caused by Vibrio cholera. It has caused several pandemics. On 26 February 2018, a suspected cholera outbreak, with one death, occurred in School X in Hoima Municipality, western Uganda. We investigated to identify the scope and mode of transmission of the outbreak, and recommend evidence-based control measures. Methods: We defined a suspected case as onset of diarrhea, vomiting, or abdominal pain in a student or staff of School X or their family members during 14 February–10 March. A confirmed case was a suspected case with V. cholerae cultured from stool. We reviewed medical records at Hoima Hospital and searched for cases at School X. We conducted descriptive epidemiologic analysis and hypothesis-generating interviews of 15 case-patients. In a retrospective cohort study, we compared attack rates between exposed and unexposed persons. Results: We identified 15 cases among 75 students and staff of School X and their family members (attack rate=20%), with onset from 25-28 February. One patient died (case-fatality rate=6.6%). The epidemic curve indicated a point-source exposure. On 24 February, a student brought fried fish from her home in a fishing village, where a cholera outbreak was ongoing. Of the 21 persons who ate the fish, 57% developed cholera, compared with 5.6% of 54 persons who did not eat (RR=10; 95% CI=3.2-33). None of 4 persons who recooked the fish before eating, compared with 71% of 17 who did not recook it, developed cholera (RR=0.0, 95%CIFisher exact=0.0-0.95). Of 12 stool specimens cultured, 6 yielded V. cholerae. Conclusion: This cholera outbreak was caused by eating fried fish, which might have been contaminated with V. cholerae in a village with an ongoing outbreak. Lack of thorough cooking of the fish might have facilitated the outbreak. We recommended thoroughly cooking fish before consumption.

Keywords: cholera, disease outbreak, foodborne, global health security, Uganda

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Authors: Irfan Ahmad Afip

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This main research objective is to accurately identify the possibility for a Leptospirosis outbreak severity of a certain area based on its input features into a multivariate regression model. The research question is the possibility of an outbreak in a specific area being influenced by this feature, such as social demographics and hydrometeorological extremes. If the occurrence of an outbreak is being subjected to these features, then the epidemic severity for an area will be different depending on its environmental setting because the features will influence the possibility and severity of an outbreak. Specifically, this research objective was three-fold, namely: (a) to identify the relevant multivariate features and visualize the patterns data, (b) to develop a multivariate regression model based from the selected features and determine the possibility for Leptospirosis outbreak in an area, and (c) to compare the predictive ability of multivariate regression model and machine learning algorithms. Several secondary data features were collected locations in the state of Negeri Sembilan, Malaysia, based on the possibility it would be relevant to determine the outbreak severity in the area. The relevant features then will become an input in a multivariate regression model; a linear regression model is a simple and quick solution for creating prognostic capabilities. A multivariate regression model has proven more precise prognostic capabilities than univariate models. The expected outcome from this research is to establish a correlation between the features of social demographic and hydrometeorological with Leptospirosis bacteria; it will also become a contributor for understanding the underlying relationship between the pathogen and the ecosystem. The relationship established can be beneficial for the health department or urban planner to inspect and prepare for future outcomes in event detection and system health monitoring.

Keywords: geographical information system, hydrometeorological, leptospirosis, multivariate regression

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Authors: Rafat Alwazna

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Translation teaching is a particular activity that includes translators and interpreters training either inside or outside institutionalised settings, such as universities. It can also serve as a means of teaching other fields, such as foreign languages. Translation teaching began in the twentieth century. Teachers of translation hold the responsibilities of educating students, developing their translation competence and training them to be professional translators. The activity of translation teaching involves various tasks, including curriculum design, course delivery, material writing as well as application and implementation. The present paper addresses translation teaching during COVID-19 outbreak, seeking to find out the challenges encountered by translation teachers in online translation teaching and the discoveries/solutions arrived at to resolve them. The paper makes use of a comprehensive questionnaire, containing closed-ended and open-ended questions to elicit both quantitative as well as qualitative data from about sixty translation teachers who have been teaching translation at BA and MA levels during COVID-19 outbreak. The data shows that about 40% of the participants evaluate their online translation teaching experience during COVID-19 outbreak as enjoyable and exhilarating. On the contrary, no participant has evaluated his/her online translation teaching experience as being not good, nor has any participant evaluated his/her online translation teaching experience as being terrible. The data also presents that about 23.33% of the participants evaluate their online translation teaching experience as very good, and the same percentage applies to those who evaluate their online translation teaching experience as good to some extent. Moreover, the data indicates that around 13.33% of the participants evaluate their online translation teaching experience as good. The data also demonstrates that the majority of the participants have encountered obstacles in online translation teaching and have concurrently proposed solutions to resolve them.

Keywords: online translation teaching, electronic learning platform, COVID-19 outbreak, challenges, solutions

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Authors: Visa I. Tyakaray, M. Abdulaziz, O. Badmus, N. Karaye, M. Dalhat, A. Shehu, I. Bello, T. Hussaini, S. Akar, G. Effah, P. Nguku

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Introduction: Nigeria has recorded outbreaks of meningitis in the past, being in the meningitis belt. A multi-state outbreak of Cerebrospinal Meningitis (CSM) from Neisseria meningitides occurred in 2017 involving 24 states, and Kano State reported its first two confirmed CSM cases on 22nd March, 2017. We conducted the outbreak investigation to characterize the outbreak, determine its associated risk factors and institute appropriate control measures. Method: We conducted an unmatched Case-control study with ratio 1:2. A case was defined as any person with sudden onset of fever (>38.5˚C rectal or 38.0˚C axillary) and one of the following: neck stiffness, altered consciousness or bulging fontanelle in toddlers while a control was defined as any person who resides around the case such as family members, caregivers, neighbors, and healthcare personnel. We reviewed and validated line list and conducted active case search in health facilities and neighboring communities. Descriptive, bivariate, stratified and multivariate analysis were performed. Laboratory confirmation was by Latex agglutination and/or Culture. Results: We recruited 48 cases with median age of 11 years (1 month – 65 years), attack rate was 2.4/100,000 population with case fatality rate of 8%; 34 of 44 local government areas were affected.On stratification, age was found to be a confounder. Independent factors associated with the outbreak were age (Adjusted Odds Ratio, AOR =6.58; 95% Confidence Interval (CI) =2.85-15.180, history of Vaccination (AOR=0.37; 95% CI=0.13-0.99) and history of travel (AOR=10.16; (1.99-51.85). Laboratory results showed 22 positive cases for Neisseria meningitides types C and A/Y. Conclusion: Major risk factors associated with this outbreak were age (>14years), not being vaccinated and history of travel. We sensitized communities and strengthened case management. We recommended immediate reactive vaccination and enhanced surveillance in bordering communities.

Keywords: cerebrospinal, factors, Kano-Nigeria, meningitis, risk

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Authors: Myoungsoon You, Heejung Son

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Background: In the current study, we investigated the effects of emotions induced by an infectious disease outbreak on the various protective behaviors taken during the crisis and on the perception after the crisis. The investigation was based on two psychological theories of appraisal tendency and action tendency. Methods: A total of 900 participants in South Korea who experienced the 2015 Middle East Respiratory Syndrome outbreak were sampled by a professional survey agency. To assess the influence of the emotions fear and anger, a regression approach was used. The effect of emotions on various protective behaviors and perceptions was observed using a hierarchical regression method. Results: Fear and anger induced by the infectious disease outbreak were both associated with increased protective behaviors during the crisis. However, the differences between the emotions were observed. While protective behaviors with avoidance tendency (adherence to recommendations, self-mitigation), were raised by both fear and anger, protective behaviors with approach tendency (information-seeking) were increased by anger, but not fear. Regarding the effect of emotion on the risk perception after the crisis, only fear was associated with a higher level of risk perception. Conclusions: This study confirmed the role of emotions in crisis protective behaviors and post-crisis perceptions regarding an infectious disease outbreak. These findings could enhance understanding of the public’s protective behaviors during infectious disease outbreaks and afterward risk perception corresponding to emotions. The results also suggested strategies for communicating with the public that takes into account emotions that are prominently induced by crises associated with disease outbreaks.

Keywords: crisis communication, emotion, infectious disease outbreak, protective behavior, risk perception

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Authors: Luna Degife, Desalegn Belay, Yoseph Worku, Tigist Tesfaye, Assefa Tufa, Abyot Bekele, Zegeye Hailemariam, Abay Hagos

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Half of the world’s population is at risk of Dengue Fever (DF), a highly under-recognized and underreported mosquito-borne viral disease with high prevalence in the tropical and subtropical regions. Globally, an estimated 50 to 200 million cases and 20, 000 DF deaths occur annually as per the world health organization report. In Ethiopia, the first outbreak occurred in 2013 in Diredawa administration city. Afterward, three outbreaks have been reported from the eastern part of the country. We received a report of the fifth DF outbreak for Ethiopia and the second for Diredawa city on October 4, 2015. We conducted the investigation to confirm the outbreak, identify the risk factors for the repeatedly occurrence of the disease and implement control measures. We conducted un- matched case-control study and defined a suspected DF case as any person with fever of 2-7 days and 2 or more of the following: a headache, arthralgia, myalgia, rash, or bleeding from any part of the body. Controls were residents of Diredawa city without DF symptoms. We interviewed 70 Cases and 140 controls from all health facilities in Diredawa city from October 7 to 15; 2015. Epi Info version 7.1.5.0 was used to analyze the data and multivariable logistic regression was conducted to assess risk factors for DF. Sixty-nine blood samples were collected for Laboratory confirmation.The mean age for cases was 23.7±9.5 standard deviation (SD) and for controls 31.2±13 SD. Close contact with DF patient (Adjusted odds ratio (AOR)=5.36, 95% confidence interval(CI): 2.75-10.44), nonuse of long-lasting insecticidal nets (AOR=2.74, 95% CI: 1.06-7.08) and availability of stagnant water in the village (AOR=3.61, 95% CI:1.31-9.93) were independent risk factors associated with higher rates of the disease. Forty-two samples were tested positive. Endemicity of DF is becoming a concern for Diredawa city after the first outbreak. Therefore, effective vector control activities need to be part of long-term preventive measures.

Keywords: dengue fever, Diredawa, outbreak, risk factors, second

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Authors: Mini P. Singh, Manasi Majumdar, Kapil Goyal, Pvm Lakshmi, Deepak Bhatia, Radha Kanta Ratho

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India is endemic for Hepatitis E virus and frequent water borne outbreaks are reported. The conventional diagnosis rests on the detection of serum anti-HEV IgM antibodies which may take 7-10 days to develop. Early diagnosis in such a situation is desirable for the initiation of prompt control measures. The present study compared three diagnostic methods in 60 samples collected during two suspected HEV outbreaks in the vicinity of Chandigarh, India. The anti-HEV IgM, HEV antigen and HEV-RNA could be detected in serum samples of 52 (86.66%), 16 (26.66%) and 18 (30%) patients respectively. The suitability of saliva samples for antibody detection was also evaluated in 21 paired serum- saliva samples. A total of 15 serum samples showed the presence of anti HEV IgM antibodies, out of which 10 (10/15; 66.6%) were also positive for these antibodies in saliva samples (χ2 = 7.636, p < 0.0057), thus showing a concordance of 76.91%. The positivity of reverse transcriptase PCR and HEV antigen detection was 100% within one week of illness which declined to 5-10% thereafter. The outbreak was attributed to HEV Genotype 1, Subtype 1a and the clinical and environmental strains clustered together. HEV antigen and RNA were found to be an early diagnostic marker with 96.66% concordance. The results indicate that the saliva samples can be used as an alternative to serum samples in an outbreak situation.

Keywords: HEV-antigen, outbreak, phylogenetic analysis, saliva

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Authors: Marina G. Galitskaya, Svetlana G. Makarova, Andrey P. Fisenko.

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Children on medication-induced immunosuppression are at high risk of developing severe course infectious diseases. Therefore, preventive vaccination is especially important for these children. However, due to the immunosuppressive effects of treatment for the underlying disease, the effectiveness of vaccination may decrease below the protective level. In a multidisciplinary children's medical center, post-vaccination immunity was studied in 79 children aged 4-17 years. The children were divided into 2 groups: Group 1 (38 children) with kidney pathology (Nephrotic Syndrome) and Group 2 (41 children) with inflammatory bowel diseases (Ulcerative Colitis, Crohn's Disease). Both groups of children were vaccinated according to the national vaccination calendar and received immunosuppressive therapy (prednisolone, methotrexate, cyclosporine, and other drugs) for at least 1 year. Using the enzyme-linked immunosorbent assay method, specific IgG antibodies to vaccine-preventable infections were determined: measles, rubella, mumps, diphtheria, pertussis, tetanus, and hepatitis B. The study showed the percentage of children with positive IgG values for vaccine-preventable infections. The highest percentage of children had protective antibody levels to measles (84.2% in children with nephrotic syndrome and 92.6% in those with inflammatory bowel disease) and rubella (71% and 80.4%, respectively). The lowest percentage of children with protective antibodies was for hepatitis B (5.2% and 29.2% respectively). Antibodies to mumps, diphtheria, pertussis, and tetanus were found not in all children (from 39,4% to 82,9%). The remaining percentage of children did not have detectable IgG antibodies to vaccine-preventable infections. Not all children, despite the previous vaccination, preserved antibodies to vaccine-controlled infections and remained unprotected by specific IgG antibodies. The issue of a booster vaccine dose should be considered in children without contraindications to vaccination. Children receiving long-term immunosuppressive therapy require an individual vaccination approach, including a specific definition of the performed vaccination.

Keywords: immunosuppressive therapy, inflammatory bowel diseases, nephrotic syndrome, post-vaccination immunity, specific antibodies, vaccine-preventable infections.

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Authors: Shittu Bisi Agnes

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Ebola virus Diseases outbreak in Nigeria caused a lot of concerns considering the mode of transmission and no known cure discovered. Therefore a lot of safety measures were taken which eventually led to the eradication of the virus in Nigeria. This therefore attempted to determine the various safety measures, how socio-economic characteristic of the people affected adherence to safety measures. And provide reasonable recommendations for total eradication of the virus, future outbreak and general environmental safety Data were collected with the aid of well structured questionnaires and administered 180 randomly selected of the state and oral interview was also utilize. Data collected were analysed using both descriptive tools and inferential statistics vis-a-vis regression analysis. Finding showed that 70.5% was strongly adhere to almost all the measures, 15.2% was fairly advent, 3% was poorly observing the selected measures while 1.3% was in different. 65% of the respondents was strongly aware of the advent of ebola virus diseases, 20% was fairly in awareness, 8.5% was poorly in awareness while 6.55% was in aware of any disease outbreak. Safety measures put forwards were; hand washing, use of hand sanitize-rs, no shaking of hands non-consumption of wildlife games(Bush Meat) and general health and environmental safety measures. It was recommended that policy instrument to increase peoples income will accelerate eradication of diseases as this will enable households to pay for monetary safety measures, health and environmental education, in form of talk shop, workshop, lectures could be organised at the political ward levels, schools, market women, religious bodies functional unions and mass media.

Keywords: ebola diseases, pay, safety, outbreak

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Authors: Geumchan Hwang

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Professional sport leagues in Europe and North America are shut down due to novel coronavirus disease (COVID-19) outbreak. Football leagues in Europe (e.g., La Liga, English Premier League, Bundesliga, Serie A, and Ligue 1) and big four professional sport leagues in North America (e.g., National Football League, Major League Baseball, National Basketball Association, and National Hockey League) are indefinitely suspended or delayed. COVID-19 outbreak has a growing negative impact on economics of sport leagues. For example, loss of revenue in Europe’s top five leagues due to the COVID-19 pandemic was estimated at € 4 billion and loss of revenue in the NBA was estimated at $650 million as of March 2020. In the unprecedented difficult situation, sport teams and leagues try to communicate with sport fans through diverse media platforms. In sport, however, very few studies have been done regarding how sport organizations effectively communicate with sport fans during pandemics, such as COVID-19 outbreak. Understanding sport organizations’ crisis communication is important to develop effective crisis management strategies for sport organizations. Therefore, the purpose of the study is to examine how sport organizations communicate with sport fans via online platforms in COVID-19 outbreak and how sport fans evaluate their communication strategies. 9 official sport league sites (i.e., five major football leagues in Europe and four major sport leagues in North America) and COVID-19 news articles published between January and June in 2020 will be analyzed in terms of coronavirus information, teams and players’ live update, fan interaction, fan support, and community engagement. In addition, comments posted on social media sites (i.e., Facebook and Twitter) of major sport leagues will be also analyzed to examine how sport fans perceive online messages provided by sport leagues as an effective communication strategy. To measure the effectiveness of crisis communication performance, five components (i.e., prompt, compassionate, honest, informative, and interactive) of crisis communication will be collected from leagues’ official websites information and social media posts. Upon completing data collection, content analysis method will be used to evaluate effectiveness of crisis communication among 9 professional sport leagues. The results of the study will provide athletic directors, administrators, and public relations managers in sport organizations with practical information regarding how athlete celebrities and sport organizations should interact with their fans in pandemic situations. In particular, this study will contribute to developing specific crisis management plan for sport organizations. For instance, football teams and leagues in Europe will be able to create standard manuals to minimize damages caused by disease outbreak, such as COVID-19 outbreak.

Keywords: COVID-19, communication, sport leagues, fans

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Authors: Lukman Abiodun Nafiu

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This study examines the impact evaluation of vaccination against eight-child-killer diseases on under-five children mortality at Mbale District. It was driven by three specific objectives which are to determine the proportion of under-five children mortality due to the eight-child-killer diseases to the total under-five children mortality; establish the cause-effect relationship between the eight-child-killer diseases and under-five children mortality; as well as establish the dependence of under-five children mortality in the location at Mbale District. A community based cross-sectional and longitudinal (panel) study design involving both quantitative and qualitative (focus group discussion and in-depth interview) approaches was employed over a period of 36 months. Multi-stage cluster design involving Health Sub-District (HSD), Forms of Ownership (FOO) and Health Facilities Centres (HFC) as the first, second and third stages respectively was used. Data was collected regarding the eight-child-killer diseases namely: measles, pneumonia, pertussis (whooping cough), diphtheria, poliomyelitis (polio), tetanus, haemophilus influenza, rotavirus gastroenteritis and mortality regarding immunized and non-immunized children aged 0-59 months. We monitored the children over a period of 24 months. The study used a sample of 384 children out of all the registered children for each year at Mbale Referral Hospital and other Primary Health Care Centres (HCIV, HCIII and HCII) at Mbale District between 2015 and 2019. These children were followed from birth to their current state (living or dead). The data collected in this study was analysed using cross tabulation and the chi-square test. The study concluded that majority of mothers at Mbale district took their children for immunization and thus reducing the occurrence of under-five children mortality. Overall, 2.3%, 4.6%, 3.1%, 5.4%, 1.5%, 3.8%, 0.0% and 0.0% of under-five children had polio, tetanus, diphtheria, measles, pertussis, pneumonia, haemophilus influenzae and rotavirus gastroenteritis respectively across all the sub counties at Mbale district during the period considered. Also, different locations (sub counties) do not have significant influence on the occurrence of these eight-child-killer diseases among the under-five children at Mbale district. Therefore, the study recommended that government and agencies should continue to work together to implement measures of vaccination programs and increasing access to basic health care with a continuous improvement on the social interventions to progress child survival.

Keywords: Diseases, Mortality, Children, Vaccination

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Authors: Godfrey Nsereko, Daniel Kadobera, Denis Okethwangu, Joyce Nguna, Alex Riolexus Ario

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Background: Malaria is a leading cause of morbidity and mortality in Uganda. In April 2018, malaria cases surged in Nwoya District, northern Uganda, exceeding the action thresholds. We investigated to assess the outbreak’s magnitude, identify transmission risk factors, and recommend evidence-based control measures. Methods: We defined a malaria case as onset of fever in a resident of Nwoya District with a positive Rapid Diagnostic Test or microscopy for malaria P. falciparum from 1 February to 22 May 2018. We reviewed medical records in all health facilities of affected sub-counties to find cases. In a case-control study, we compared exposure risk factors between 107 case-persons and 107 asymptomatic controls matched by age and village. We conducted entomological assessment on vector-density and behavior. Results: We identified 3,879 case-persons (attack rate [AR]=6.5%) and 2 deaths (case-fatality rate=5.2/10,000). Females (AR=8.1%) were more affected than males (AR=4.7%). Of all age groups, the 5-18 year age group (AR=8.4%) was most affected. Heavy rain started on 4 March; a propagated outbreak began during the week of 2 April. In the case-control study, 55% (59/107) of case-patients and 18% (19/107) of controls had stagnant water around households for several days following rainfall (ORM-H=5.6, 95%CI=3.0-11); 25% (27/107) of case-patients and 51% (55/107) of controls wore long-sleeve cloths during evening hours (ORM-H=0.30, 95%CI=0.20-0.60); 29% (31/107) of case-patients and 15% (16/107) of controls did not sleep under a long-lasting insecticide-treated net (LLIN) (ORM-H=2.3, 95%CI=1.1-4.9); 37% (40/107) of case-patients and 52% (56/107) of controls had ≥1 LLIN per 2 household members (ORM-H=0.54, 95%CI=0.30-0.97). Entomological assessment indicated active breeding sites; Anopheles gambiae sensu lato species were the predominant vector. Conclusion: Increased vector breeding sites after heavy rainfall, together with inadequate malaria preventive measures caused this outbreak. We recommended increasing coverage for LLINs and larviciding breeding sites.

Keywords: malaria outbreak, Plasmodium falciparum, global health security, Uganda

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Authors: Yu-Tzu Hsu, Alice Wu, Hsiang-Kuang Tseng

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Introduction: Hepatitis A virus causes acute hepatitis and is usually transmitted by a fecal-oral route of food contamination, which is more prevalent in areas with poor hygienic practices. However, we described a hepatitis A outbreak associated with a fecal-oral route of sexual behavior in men who has sex with men (MSM) in Northern Taiwan. Methods: We retrospectively collected patients with acute HAV infection in MacKay Memorial Hospital, Taipei, Taiwan between July 2015 and November 2016. Demographic data (age, gender, onset time and infection risk), laboratory data (GOT, GPT, bilirubin, HIV status, HBsAg, HCV antibody and syphilis), clinical symptoms and travel history with a foreign tour were analyzed. We compared variables between HIV and non-HIV group. Unless otherwise stated, continuous variables were expressed as mean ± SD, and categorical variables were expressed as number (percentage) for each item. The t test for continuous variables was applied for the comparison between two groups and chi-square for categorical variables were applied for measures of association. Results: We collected 80 cases during the study period. Among them, 54 (67.5%) cases were MSM and 43 (53.8%) cases were HIV positive. The average age was 32.6±7.59 years-old. The average value of initial liver function was 1324 IU/L for AST (GOT), 2100 IU/L for ALT (GPT), and 5.82 mg/dL for bilirubin. We found seven (8.6%) cases were in the status of HBV carrier, five (6.3%) cases were positive for HCV antibody, and 15 (18.6%) cases were co-infected with syphilis. With regards to associated symptoms, 32 (40%) had fever, 46 (57.5%) had nausea, 34 (42.5%) had abdominal discomfort and 46 (57.5%) had general malaise. To compare the non-HIV patients with HIV patients, HIV patients were more likely to be male (p=0.008), MSM (p=0.000), co-infected syphilis (p=0.000) and slowly improving liver function of transaminases (p=0.033, 0.027). Conclusion: The HAV outbreak in Northern Taiwan was mainly occurred in MSM population. Hereafter, our cohort data support a policy in Taiwan to provide one dose of free HAV vaccine shot in this population. Hopefully, the outbreak could be stop by the free vaccine policy and public education.

Keywords: acute hepatitis A, men who has sex with men, human immunodeficiency virus, vaccine

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Authors: Mohammad Mehdizadeh, Sara Miri

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Due to the recent events surrounding the global health crisis and the spread of the coronavirus (COVID-19), the activities of many businesses and start-up companies have been disrupted. It solves many economic problems and can reduce unemployment in countries because governments can take advantage of their potential without direct investment. However, with the help of their innovative ideas and new technologies, these companies can develop and grow the economy. But it is essential to consider that there will be no guarantee of their success in the event of unforeseen events, as the coronavirus outbreak in the last two years has seriously damaged these companies and, like other businesses, challenges and stagnation have started. The startup companies' challenge in the face of coronavirus begins with its impact on customers. Changing customer behavior can affect their products and distribution channels. On the other hand, to prevent countless losses in this crisis, startup companies require creative solutions to address challenges in various areas of human capital, supply chain management, sales and marketing, and so on. Therefore, all business leaders must consider and plan for the current crisis and the future; after overcoming these conditions and returning to regular business routines, it will no longer be an option, and new situations will prevail in a competitive environment. The essential strategies for developing and growing startups during the Coronavirus outbreak can be connecting with the global startup ecosystem, hosting webinars, providing podcasts and free question and answer sessions, mentoring services to growing teams, and consulting pointed out this to firms for digitalization.

Keywords: business, COVID-19, digitalization, startups

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Authors: Helen Nelly Naiga, Jane Frances Zalwango, Saudah N. Kizito, Brian Agaba, Brenda N Simbwa, Maria Goretti Zalwango, Richard Migisha, Benon Kwesiga, Daniel Kadobera, Alex Ario Riolexus, Sarah Paige, Julie R. Harris

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Background: Traditional community beliefs and practices can facilitate the spread of Ebola virus during outbreaks. On September 20, 2022, Uganda declared a Sudan Virus Disease (SVD) outbreak after a case was confirmed in Mubende District. During September–November 2022, the outbreak spread to eight additional districts. We investigated the role of community beliefs and practices in the spread of SUDV in Uganda in 2022. Methods: A qualitative study was conducted in Mubende, Kassanda, and Kyegegwa districts in February 2023. We conducted nine focus group discussions (FGDs) and six key informant interviews (KIIs). FGDs included SVD survivors, household members of SVD patients, traditional healers, religious leaders, and community leaders. Key informants included community, political, and religious leaders, traditional healers, and health workers. We asked about community beliefs and practices to understand if and how they contributed to the spread of SUDV. Interviews were recorded, translated, transcribed, and analyzed thematically. Results: Frequently-reported themes included beliefs that the community deaths, later found to be due to SVD, were the result of witchcraft or poisoning. Key informants reported that SVD patients frequently first consulted traditional healers or spiritual leaders before seeking formal healthcare, and noted that traditional healers treated patients with signs and symptoms of SVD without protective measures. Additional themes included religious leaders conducting laying-on-of-hands prayers for SVD patients and symptomatic contacts, SVD patients and their symptomatic contacts hiding in friends’ homes, and exhumation of SVD patients originally buried in safe and dignified burials, to enable traditional burials. Conclusion: Multiple community beliefs and practices likely promoted SVD outbreak spread during the 2022 outbreak in Uganda. Engaging traditional and spiritual healers early during similar outbreaks through risk communication and community engagement efforts could facilitate outbreak control. Targeted community messaging, including clear biological explanations for clusters of deaths and information on the dangers of exhuming bodies of SVD patients, could similarly facilitate improved control in future outbreaks in Uganda.

Keywords: Ebola, Sudan virus, outbreak, beliefs, traditional

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Authors: Tanapat Chongkamunkong

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The objective of this paper is to present a practical use of Geographic Information System (GIS) to the public health from spatial correlation between multiple factors and dengue fever outbreak. Meteorological factors, demographic factors and environmental factors are compiled using GIS techniques along with the Global Satellite Mapping Remote Sensing (RS) data. We use monthly dengue fever cases, population density, precipitation, Digital Elevation Model (DEM) data. The scope cover study area under climate change of the El Niño–Southern Oscillation (ENSO) indicated by sea surface temperature (SST) and study area in 12 provinces of Thailand as remote sensing (RS) data from January 2007 to December 2014.

Keywords: dengue fever, sea surface temperature, Geographic Information System (GIS), remote sensing

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Authors: Ahmed Ali Samejo, Riffat Sultana

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Pakistan has the sandy Thar Desert in the eastern area, which share border line with India and has exotic fauna and flora, the livelihood of native people rely on livestock and rain fed cultivated fields. The climate of Thar Desert is very harsh and stressful due to frequent drought and very little rainfall, which may occur during monsoon season in the months of July to October and temperature is high, and wind speed also increases in April to June. Schistocerca gregaria is a destructive pest of vegetation from Mauritania to the border line of Pakistan and India. Sometimes they produce swarms which consume all plant where ever they land down and cause the loss in agro-economy of the world. During the recent study, we observed that vegetation was not unique throughout the Thar Desert in the year 2015, because the first spell of rainfall showered over all areas of the Thar Desert in July. However, the second and third spell of rain was confined to village Mahandre jo par and surroundings from August to October. Consequently, vegetation and cultivated crops grew up specially bajra crop (Pennistum glaucum). The climate of Mahandre jo par and surroundings became favorable for S.gregaria, and remaining areas of Thar Desert went hostile. Therefore desert locust attracted to the pleasant area (Mahandre jo par and surroundings) and gradually concentrated, increased reproductive activities, but did not gregarize due to the harvest of bajra crop and the onset of the winter season with an immediate decrease in temperature. An outbreak was near to come into existence, and thereupon conditions become stressful for hoppers to continue further development. Afore mentioned was one reason behind hurdle to the outbreak, another reason might be that migration and concentration of desert locust took place at the end of the season, so climate becomes unfavorable for hoppers, due to dryness of vegetation. Soils also become dry, because rainfall was not showered in end of the season, that’s why eggs that were deposited in late summer were desiccated. This data might be proved fruitful to forecast any outbreak update in future.

Keywords: agro-economy, destructive pest, climate, outbreak, vegetation

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Authors: Osagiede Efosa Kelvin

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The Ebola virus disease (EVD); also Ebola hemorrhagic fever, is a disease of humans and other primates caused by Ebola viruses. Signs and symptoms typically start between two days and three weeks after contracting the virus as a fever, sore throat, muscle pain, and headaches. Then, vomiting, diarrhoea and rash usually follow, along with decreased function of the liver and kidneys. At this time, some people begin to bleed both internally and externally. The first death in Nigeria was reported on 25 July 2014: a Liberian-American with Ebola flew from Liberia to Nigeria and died in Lagos soon after arrival. As part of the effort to contain the disease, possible contacts were monitored –353 in Lagos and 451 in Port Harcourt On 22 September, the World Health Organisation reported a total of 20 cases, including eight deaths. The WHO's representative in Nigeria officially declared Nigeria Ebola-free on 20 October after no new active cases were reported in the follow-up contact. This paper looks at the Ebola Virus in general and the measures taken by Nigeria to combat its spread.

Keywords: Ebola virus, hemorrhagic fever, Nigeria, outbreak

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Authors: Akshata Patel, Reenu Singh

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This paper focuses on current and upcoming fashion trends and global impact on the fashion industry due to the COVID-19 pandemic. The pandemic has had a major impact on the fashion industry worldwide. At the same time, the fashion market also faces challenges in consumer demand. As the supply chain and distribution channels are interconnected, this outbreak has a global impact due to travel restrictions and raw materials shortages. Given that this particular period represents an unprecedented market situation with almost no prior research on how the industry will recover from such a crisis and mold back to its original form, this research aims to propose new possibilities by evaluating the framework of specific segments. Based on the analysis and extensive literature review, the study develops a conceptual model that will illustrate the various connections among the different segments of the fashion industry. The findings provide actionable considerations for fashion industry pupils when implementing appropriate strategies to prevent unfavourable outcomes during times of crisis, such as the COVID-19 outbreak.

Keywords: COVID-19, fashion industry, global impact, new possibilities, pandemic

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Authors: Yasir E. Mohieldeen

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Qatar is one of the most water scarce countries in the World. In 2014, the average per capita rainfall was less than 29 m3/y/ca, while the global average is 6,000 m3/y/ca. However, the per capita water consumption in Qatar is among the highest in the World: more than 500 liters per person per day, whereas the global average is 160 liters per person per day. Since the early 2000s, Qatar has been relying heavily on desalinated water from the Arabian Gulf as the main source of fresh water. In 2009, about 99.9% of the total potable water produced was desalinated. Reliance on desalinated water makes Qatar very vulnerable to water related natural disasters, such as the red-tide phenomenon. Qatar’s strategic water reserve lasts for only 7 days. In case of red-tide outbreak, the country would not be able to desalinate water for days, let alone the months that this disaster would bring about (as it clogs the desalination equipment). The 2008-09 red-tide outbreak, for instance, lasted for more than eight months and forced the closure of desalination plants in the region for weeks. This study aims at identifying favorite conditions for red-tide outbreaks, using satellite data along with in-situ measurements. This identification would allow the prediction of these outbreaks and their hotspots. Prediction and monitoring of outbreaks are crucial to water security in the country, as different measures could be put in place in advance to prevent an outbreak and mitigate its impact if it happened. Red-tide outbreaks are detected using different algorithms for chlorophyll concentration in the Gulf waters. Vegetation indices, such as Normalized Difference Vegetation Index (NDVI) and Enhanced Vegetation Index (EVI) were used along with Surface Algae Bloom Index (SABI) to detect known outbreaks. MODIS (or Moderate Resolution Imaging Spectroradiometer) bands are used to calculate these indices. A red-tide outbreaks atlas in the Arabian Gulf is being produced. Prediction of red-tide outbreaks ahead of their occurrences would give critical information on possible water-shortage in the country. Detecting known outbreaks in the past few decades and related parameters (e.g. water salinity, water surface temperature, nutrition, sandstorms, … etc) enables the identification of favorite conditions of red-tide outbreak that are key to the prediction of these outbreaks.

Keywords: Arabian Gulf, MODIS, red-tide detection, strategic water reserve, water desalination

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Authors: Gal Zagron, Nitza Abramson, Deena R. Zimmerman, Chen Stein-Zamir

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Background: Salmonella enteritidis is a common cause of foodborne outbreaks, primarily associated with poultry eggs. S. enteritidis This is the only Salmonella type that is found inside the eggshell. A rise in Salmonella enteritidis notifications was noted in spring 2017. Aims: The aim of this study is to describe the epidemiological investigation of the outbreak in the Jerusalem district, along with the containment measures taken. Methods: This study is a population-based epidemiological study with a description of environmental control activities. Results: During the months May - July, 2017 848 salmonellosis cases were reported to the Jerusalem district health office compared to 294 cases May - July 2016. Salmonella enteritidis was isolated in 58% of reported cases. Clusters and outbreaks ( > 2 cases) were reported among nursery schools, nursing homes, persons residing in one kibbutz and several cases in different food service establishments in the Jerusalem district. Epidemiological investigations revealed eggs consumption as a common feature among the cases (uncooked or undercooked eggs in most cases). A national investigation among egg suppliers revealed that most cases consumed eggs provided by a single provider with isolation of Salmonella enteritidis at the source as well. Containment measures were taken to control the epidemic including distributing information via electronic and written media to the public, searching for all egg distribution centers, informing local authorities, the poultry council and food stores. The eggs originating from the provider were recalled and extinguished. Written instructions to all food preparation facilities in the district were distributed regarding the proper storage and preparation of eggs. The number of reported cases declined and the outbreak vanished during correlating months of 2018. Conclusions: The investigation of Salmonella enteritidis outbreaks should include epidemiological and laboratory investigations, tracing the source of the eggs and testing the eggs and the source of eggs. Health education activities are essential as to the proper handling of eggs and egg products aiming to minimize susceptibility to Salmonella infection.

Keywords: epidemiological investigation, food-borne disease, food safety, Salmonella enteritidis

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Authors: Ying-Jung Hsieh, Angela S. Huang, Chu-Ming Chiu, Yu-Min Chou, Chin-Hui Yang

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Background and Objectives: Hepatitis A is primarily acquired by the fecal-oral route through person-to-person contact or ingestion of contaminated food or water. During 2010 to 2014, an average of 83 cases of locally-acquired disease was reported to Taiwan’s notifiable disease system. Taiwan Centers for Disease Control (TCDC) identified an outbreak of acute hepatitis A which began in June 2015. Of the 126 cases reported in 2015, 103 (82%) cases were reported during June–December and 95 cases (92%) of them were male. The average age of all male cases was 31 years (median, 29 years; range, 15–76 years). Among the 95 male cases, 49 (52%) were also infected with HIV, and all reported to have had sex with other men. To control this outbreak, TCDC launched a free hepatitis A vaccination program in January 2016 for close contacts of confirmed hepatitis A cases, including family members, sexual partners, and household contacts. Effect of the vaccination program was evaluated. Methods: All cases of hepatitis A reported to the National Notifiable Disease Surveillance System were included. A case of hepatitis A was defined as a locally-acquired disease in a person who had acute clinical symptoms include fever, malaise, loss of appetite, nausea or abdominal discomfort compatible with hepatitis, and tested positive for anti-HAV IgM during June 2015 to June 2016 in Taiwan. The rate of case accumulation was calculated using a simple regression model. Results: During January–June 2016, there were 466 cases of hepatitis A reported; of the 243 (52%) who were also infected with HIV, 232 (95%) had a history of having sex with men. Of the 346 cases that were followed up, 259 (75%) provided information on contacts but only 14 (5%) of them provided the name of their sexual partners. Among the 602 contacts reported, 349 (58%) were family members, 14 (2%) were sexual partners, and 239 (40%) were other household contacts. Among the 602 contacts eligible for free hepatitis A vaccination, 440 (73%) received the vaccine. There were 87 (25%) cases that refused to disclose their close contacts. The average case accumulation rate during January–June 2016 was 21.7 cases per month, which was 6.8 times compared to the average case accumulation rate during June–December 2015 of 3.2 cases per month. Conclusions: Despite vaccination program aimed to provide free hepatitis A vaccine to close contacts of hepatitis A patients, the outbreak continued and even gained momentum in transmission. Refusal by hepatitis A patients to provide names of their close contacts and rejection of contacts to take the hepatitis A vaccine may have contributed to the poor effect of the program. Targeted vaccination efforts of all MSM may be needed to control the outbreak among this population in the short term. In the long term, universal vaccination program is needed to prevent the infection of hepatitis A.

Keywords: hepatitis A, HIV, men who have sex with men, vaccination

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