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Epidemiology of bluetongue and related orbiviruses in the Sultanate of Oman.

Sentinel herds at 34 farms were used to study the epidemiology of bluetongue and related orbiviruses in Oman. The results indicate that bluetongue virus (BTV) is widespread and is enzootic in Northern Oman. At least three BTV serotypes (3, 4 and 22) were present at the time of the study. Antibodies to epizootic haemorrhagic disease of deer virus (EHDV) type 2 and EHDV-318 were also detected but were less prevalent. Entomological investigations identified the presence of 16 species of Culicoides. The peak seasonal incidence of the BTV vector C. imicola and the EHDV vectors C. schultzei (group) midges at Rumais in Northern Oman correlated closely with the spring rains in that area. However, both species of midge were also present in lower numbers throughout the year. four species of Oman midge, C. arabiensis, C. ibriensis, C. neoschultzei and C. buettikeri are new to science.

Animals

Some virus diseases of domestic animals in the Sultanate of Oman.

Little is known of the occurrence of animal virus diseases in the Sultanate of Oman. This paper reports the results of a countrywide survey carried out in 1978 to establish the prevalence of some important viral pathogens of domestic animals with the dual purpose of providing baselines for future investigations and guidelines for those entrusted with disease control. Foot-and-mouth disease virus type O, previously identified in Oman in 1976, was isolated from clinically affected animals. In addition, virus types A and Asia 1 were isolated from unaffected animals. Serological studies indicated that infection with all 3 types had been widespread. The presence of infectious bovine rhinotracheitis was confirmed by virus isolations and sheep and goat pox, long recognised in Oman, was confirmed by the demonstration of pox particles in dried lesion material. In serological studies antibodies were found to the viruses of peste des petits ruminants, bovine herpes mammillitis, bovine virus diarrhoea, parainfluenza 3 and African horse sickness. There were no significant antibody levels to rinderpest in unvaccinated animals and no antibody to equine infectious anaemia or vesicular stomatitis viruses.

Animals

Microbiological and serological studies on caprine pneumonias in Oman.

Eight of 10 typical cases of contagious caprine pleuro-pneumonia in Oman yielded strain F38-like mycoplasmas from the lungs in high titre, but no other mycoplasmas: both negative animals had been treated with tylosin shortly before death. Among 21 other lungs examined three of six cases of acute pneumonia yielded Mycoplasma ovipneumoniae; one also yielded M capricolum. M ovipneumoniae was also isolated from all eight cases of chronic pneumonia sampled from an abattoir, and from the lungs of three animals which died without overt signs of pneumonia. A single isolate of M arginini and three of unidentified mycoplasmas were also obtained from goats with and without pneumonia. Various bacterial species were isolated, none of which predominated. Antibodies to M mycoides subspecies capri (M m capri) and strain F38 were detected in sera from eight different sources. Assuming titres of 1 in 40 or more as positive in the indirect haemagglutination test used, 29 per cent of 422 serum samples had antibodies to M m capri alone, 2.6 per cent to strain F38 alone and 3.6 per cent to both organisms. These results confirm the presence of F38-like mycoplasmas in Oman, and indicate also widespread infection with M m capri. The role of the latter in caprine pneumonias in Oman requires elucidation.

Animals

Poliomyelitis in Oman: acute flaccid paralysis surveillance leading to early detection and rapid response to a type 3 outbreak.

Countries are increasingly requesting guidance on carrying out acute flaccid paralysis (AFP) surveillance, aimed at detecting and confirming all cases of acute paralytic poliomyelitis. The experience of Oman provides many lessons in this respect. AFP surveillance in Oman was established systematically. First, an epidemiologist was assigned to coordinate surveillance, and a laboratory for performing polio-virus isolation was identified. Next, operational guidelines for AFP surveillance were developed and widely promoted among health staff. The quality of the system has been monitored for more than 3 years with selected performance indicators. From January 1990 to April 1993, 49 AFP cases were reported, corresponding to an average annual rate of 2.1 AFP cases per 100,000 children aged less than 15 years. A total of 98% of the AFP cases were investigated within 48 hours of being reported; two stool samples were obtained from 94% of the cases. Following complete investigation, nearly a third of the reported AFP cases were classified as being clinically compatible with Guillain-Barré syndrome. Four AFP cases, all reported in 1991, were confirmed to be due to wild type 3 poliovirus. Because AFP surveillance detected these cases rapidly, Oman was able to carry out outbreak control measures promptly and more than 350,000 extra doses of oral poliovirus vaccine were delivered to children under 6 years of age.

Adolescent

Copper deficiency and posterior paralysis (Shalal) in small ruminants in the Sultanate of Oman.

A posterior ataxia or paralysis in goats and sheep is a syndrome known as Shalal within the Sultanate of Oman. An investigation was carried out into the etiology of the syndrome. Samples of blood and tissues were obtained from normal and Shalal-affected goats and sheep. Samples of feed were collected from the affected areas of the Sultanate. Chemical analyses of samples showed that affected animals suffered from severe copper deficiency in spite of sufficient copper contents in feed. However, concentrations of sulphur and iron in the feed were high. It was concluded that the Shalal syndrome in Oman is the condition generally known as swayback or enzootic ataxia caused by conditioned copper deficiency. The deficiency is probably due to copper-sulphur and copper-iron interactions in the rumen, enhanced by feeding of fresh roughage containing rumen degradable proteins.

Animal Feed

A comparison of the complement fixation and immunofluorescent antibody tests in a survey of the prevalence of Babesia equi and Babesia caballi in horses in the Sultanate of Oman.

The incidence of antibodies to Babesia equi and B. caballi in horses in the Royal Stables of His Majesty the Sultan of Oman was assessed by complement fixation (CF) and immunofluorescent antibody (IFA) tests. Two series of samples taken with a 2-year interval, mainly from animals reared in Oman, indicated a stable but high prevalence of antibodies. On the 2 occasions 94.6 and 97.7% respectively were positive to B. equi by IFA and 76.8 and 75.0% were positive by CF. For B. caballi the corresponding percentage figures were lower--67.9 and 40.9 by IFA and 30.4 and 40.9 by CF. A group of animals tested within 4 months of importation gave 60.4% positive reactions by IFA and 62.5% by CF to B. equi; 6.3% positive to B. caballi by IFA and 8.3% by CF. These figures are consistent with the probable relative prevalence of the parasites. The discrepancy between the results obtained by the 2 serological tests was probably due to the greater sensitivity of the IFA test and the faster decay of the antibodies detectable by the CF test.

Animals

Isolation and identification of arboviruses from the Sultanate of Oman.

Sentinel herds and a vector surveillance system were used to identify the presence of arboviruses in Oman. Two strains of bluetongue virus (BTV) serotype 4 and two strains of Akabane virus, were isolated and identified. Both BTV isolates and one Akabane virus isolate came from goats while the second Akabane isolate came from Culicoides imicola. This is the first isolation of an Akabane virus from Culicoides in Arabia. Vector competence studies with the Oman viruses in laboratory reared C. variipennis showed that after oral infection both viruses replicated in Culicoides and were maintained at high titre for at least 10 days post infection.

Animals

Bluetongue in the Sultanate of Oman, a preliminary epidemiological study.

A group specific agar-gel immunodiffusion test was used to demonstrate that there is a frequent and widespread distribution of bluetongue virus throughout the Sultanate of Oman. The Culicoides midges C. imicola and C. schultzei, both capable of transmitting bluetongue group viruses, were recorded throughout the year. Although these studies did not establish that bluetongue is enzootic in Oman, type-specific neutralizing antibody results supported previous evidence for the existence of a Saudi Arabian bluetongue ecosystem. Variations in antibody evidence of virus activity within a restricted locality suggested a hot-spot theory concerning the perpetuation of the virus.

Animals

Paralytic poliomyelitis in Oman: association between regional differences in attack rate and variations in antibody responses to oral poliovirus vaccine.

Variation in attack rates of paralytic disease by region during the 1988-1989 epidemic of type 1 poliomyelitis in Oman provided the stimulus to test the hypothesis that these observations were due to regional differences in the response of infants to trivalent oral poliovirus vaccine (OPV). Seroprevalence studies of 394 children born during the outbreak were conducted in six different regions of Oman and in two socioeconomic status (SES) groups in the capital city of Muscat; a seroconversion study was also carried out in 105 infants born after the outbreak. Seroprevalence rates by region after receipt of at least three doses of OPV ranged from 90% to 100% (median 94%) to poliovirus type 1, and from 86% to 100% (median 97%) to type 2, and from 47% to 79% (median 72%) to type 3, with the lowest rates observed in regions with the highest incidence of type 1 paralytic disease. In Muscat, seroprevalence rates were also significantly lower in low versus high SES groups (type 1: 84% versus 98%, respectively [P = 0.006]; type 3: 59% versus 86%, respectively [P = 0.001]). In the seroconversion study conducted after the outbreak, 89%, 100% and 50% of infants had detectable antibodies to types 1, 2, and 3, respectively, after four doses of OPV. Low responses to type 3 were also associated with the occurrence of sporadic cases of type 3 poliomyelitis in 1991, in spite of high rates of coverage with at least four doses of OPV (> 96%) throughout the country.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies, Viral

Diabetes mellitus in the sultanate of Oman.

In February 1990 a World Health Organization consultancy was undertaken to assess the current impact of diabetes mellitus in Oman. Routine national health statistics suggested that diabetes was the principal diagnosis in approximately 1% of all hospital discharges in 1988. The number of 'new cases' of diabetes treated at hospitals during the same year was 4.8 per 1000 Omani population, representing almost 6000 diabetic patients. In 1989, at the Royal Hospital, Muscat, diabetes was recorded as the principal diagnosis for 2.6% of all discharges, and 6% of those in subjects aged 45 years and over. It is known that the frequency of diabetes is generally underestimated by routine health statistics. Limited ad hoc investigation during the consultancy suggested that approximately 9% of all adult hospital admissions and 12% of adult hospital bed occupancy were associated with diabetes. Thus, diabetes should be considered a priority in a national health strategy for Oman. It is recommended that emphasis be placed upon epidemiological research, education, and the provision of appropriate technology.

Age Factors

The pattern of malignant lymphoma in Oman.

The pattern of malignant lymphoma (ML) in the Middle East has not been well documented and constitutes a lacuna in the epidemiology of this disease. This preliminary report describes a retrospective study of 46 native Omanis who, at the Sultan Qaboos University Hospital and the Royal Hospital, Sultanate of Oman, were diagnosed in 1990 as having ML. Of the 46 patients with ML, 16 (35%) were found to have Hodgkin's disease (HD) and 30 (65%) had non-Hodgkin's lymphomas (NHL). Among the HD, mixed cellularity (MC) appeared in 9 cases (56%). Among the NHL, 25 (83%) showed a diffuse pattern and 5 (17%) were follicular. Twenty-one (70%) of the NHL were of high-grade type, of which 5 (17%) were Burkitt-like lymphomas. Immunological study of the NHL biopsies revealed 24 (80%) of the B cell type, 2 (7%) of the T-cell type, 1 (3%) of the null cell type and 3 (10%) could not be classified because of scanty material or unsatisfactory fixation. We present in this study the pattern of ML in Oman, which was found to be different from those reported from the West, Far East and Saudi Arabia, with some resemblance to the pattern from tropical Africa.

Adolescent

Prehistoric "fish-eaters" along the eastern Arabian coasts: dental variation, morphology, and oral health in the Ra's al-Hamra community (Qurum, sultanate of Oman, 5th-4th millennia BC).

The Ra's al-Hamra prehistoric fishermen lived in isolation on the Qurum rocky promontorium in Oman during the 5th-4th millennia BC. To date, they represent the most ancient and numerous human fossil group excavated from the Arabian peninsula. Like other contemporaneous archaeologically documented small communities along the desert Arabian coasts, they intensively exploited ocean resources and collected molluscs from nearby mangrove swamps. The present study analyzes aspects of dental anthropology (including crown variation, morphology, dental wear, and oral health), in 600 permanent teeth from 49 individuals of both sexes excavated at the Mesolithic RH5-site by the Italian Archaeological Mission in Oman from 1981 to 1985. In association with a general low degree of morphometric variation, the Ra's al-Hamra dental crowns show low sexual dimorphism and are consistently reduced in size. These features are unexpected in a preagricultural population, especially when these data are compared to other eastern African and near Middle Eastern prehistoric populations. These data are discussed within the general context of human dental structural reduction occurring during the post-Pleistocene and are interpreted according to the "increasing population density effect" model. There are other significant differences that characterize the Ra's al-Hamra dentitions with respect to both eastern and western prehistoric human groups. The frequency of numerous nonmetric crown traits supports the hypothesis that a microdifferentiation phenomenon occurred in this marginal area. The preliminary skeletal analysis and the palaeodemographic profile show that the Omani prehistoric fishermen were affected by genetic isolation and inbreeding as well as strong environmental stress. Because of the grit assimilated with dried fish and the high shellfish consumption, dental wear was extreme in all age groups at Ra's al-Hamra and occasionally was responsible for serious hematogenously spread infections. In spite of the great anthropological importance of ancient Arabian populations, very few studies on skeletal and dental samples have been completed. The present paper offers an odontological data set for future comparative research in the area.

Adult

Capripox in the Yemen Arab Republic and the Sultanate of Oman.

Capripox was shown to be endemic in all the provinces of the Yemen Arab Republic and the Sultanate of Oman. Investigations into outbreaks of capripox indicated that some strains of capripox virus were infecting both sheep and goats and this was confirmed by inoculating experimental sheep and goats with isolates derived from field cases. The husbandry methods prevalent in the Middle East predispose to the rapid spread of capripox and annual vaccination of all sheep and goats must be considered as the only effective method of controlling the disease.

Aging

Outbreak of paralytic poliomyelitis in Oman: evidence for widespread transmission among fully vaccinated children.

From January, 1988, to March, 1989, a widespread outbreak (118 cases) of poliomyelitis type 1 occurred in Oman. Incidence of paralytic disease was highest in children younger than 2 years (87/100,000) despite an immunisation programme that recently had raised coverage with 3 doses of oral poliovirus vaccine (OPV) among 12-month-old children from 67% to 87%. We did a case-control study (70 case-patients, 692 age-matched controls) to estimate the clinical efficacy of OPV, assessed the immunogenicity of OPV and extent of poliovirus spread by serology, retrospectively evaluated the cold chain and vaccine potency, and sought the origin of the outbreak strain by genomic sequencing. 3 doses of OPV reduced the risk of paralysis by 91%; vaccine failures could not be explained by failures in the cold chain nor on suboptimum vaccine potency. Cases and controls had virtually identical type 1 neutralising antibody profiles, suggesting that poliovirus type 1 circulation was widespread. Genomic sequencing indicated that the outbreak strain had been recently imported from South Asia and was distinguishable from isolates indigenous to the Middle East. Accumulation of enough children to sustain the outbreak seems to have been due to previous success of the immunisation programme in reducing spread of endemic strains, suboptimum efficacy of OPV, and delay in completing the primary immunisation series until 7 months of age. Additionally, the estimated attack rate of infection among children aged 9-23 months exceeded 25% in some regions, suggesting that a substantial proportion of fully vaccinated children had been involved in the chain of transmission.

Case-Control Studies

Survey of infection in babies at the Khoula Hospital, Oman.

A 12-month prospective study of infection was carried out in the special care baby unit (SCBU), Khoula Hospital, Muscat, Sultanate of Oman. During this period, 8720 babies were born in the hospital and 1265 were admitted to the SCBU. Altogether, 490 babies were of less than 36 weeks' gestation. A total of 190 babies (160 born in the hospital, 30 born before admission) satisfied the criteria for infection. The most common clinical presentation was pneumonia. There was one outbreak of iatrogenic infection. Infection was confirmed microbiologically in 76 of 190 symptomatic babies. Staphylococcus aureus was the most common pathogen and was isolated from 48 infected babies (25%). Beta-haemolytic streptococci were isolated from superficial sites only in eight babies. Klebsiella spp were the commonest enteric bacteria isolated, but they were rarely associated with infection. Of 46 babies who had bacteraemia, 9 also had meningitis. Nine of the 46 babies died, including 6 of the 9 who had meningitis. The mortality following Gram-negative infection was higher than that following Gram-positive infection. Fourteen per cent of infected babies born in hospital and 27% of those born before admission died. A high proportion of bacteria isolated were resistant to ampicillin and/or gentamicin. Results suggest that alternative antibiotics would be more appropriate for initial treatment. The study shows that in developing countries, unsophisticated research, using basic facilities, can be of value in identifying the problems of infection and in recognizing possible solutions to them.

Bacterial Infections

Height, weight and menarcheal age of adolescent girls in Oman.

A cross-sectional survey was carried out on 683 school girls aged 11.5-18.5 years in Oman, in order to assess their physical growth. Height, weight and age at menarche were measured. Results showed that median height and weight of Omani girls fluctuates between 25th and 5th percentiles and 25th and 10th percentiles of the North American reference standard (NCHS), respectively. The mean age at menarche was 13.3 +/- 0.09 years. In general Omani girls are shorter and lighter than girls of similar age in other Arabian Gulf countries (Bahrain and Kuwait).

Adolescent

Attributable risk of DTP (diphtheria and tetanus toxoids and pertussis vaccine) injection in provoking paralytic poliomyelitis during a large outbreak in Oman.

Although injections administered during the incubation period of wild poliovirus infection have been associated with an increased risk of paralytic poliomyelitis, quantitative estimates of the risk have not been established. During a poliomyelitis outbreak investigation in Oman, vaccination records were reviewed for 70 children aged 5-24 months with poliomyelitis and from 692 matched control children. A significantly higher proportion of cases received a DTP (diphtheria and tetanus toxoids and pertussis vaccine) injection within 30 days before paralysis onset than did controls (42.9% vs. 28.3%; odds ratio, 2.4; 95% confidence interval, 1.3-4.2). The proportion of poliomyelitis cases that may have been provoked by DTP injections was 35% for children 5-11 months old. This study confirms that injections are an important cause of provocative poliomyelitis. Although the benefits of DTP vaccination should outweigh the risk of subsequent paralysis, these data stress the importance of avoiding unnecessary injections during outbreaks of wild poliovirus infection.

Age Factors

The prevalence of rheumatoid arthritis in the Sultanate of Oman.

One thousand nine hundred and twenty-five Omani adults aged 16 and over were studied in a house-to-house survey in representative areas of Oman. Seven cases (five female) are described who satisfied the 1987 ARA criteria for rheumatoid arthritis (RA), indicating a prevalence of 3.6 per thousand adults. Adjusted for the population structure, the prevalence was 8.4 per thousand adults. Complementary data are also presented on cases of RA ascertained by special screening clinics in rural health centres and by hospital rheumatology clinics. In all parts of the study, cases of RA were less often seropositive than in European populations which may account for the lower prevalence of erosive disease.

Adult