ABSTRACT BOOK
SEVENTH ARAB CONFERENCE FOR ANTIMICROBIAL AGENTS

NOVEMBER 6-8, 11- 2009
BEIRUT, LEBANON
Scientific Sessions: Commodore Hotel, Beirut (Nov. 6-7, 2009)
& Lebanese American University (LAU), Byblos, Nov. 8, 2009

 

 

 

 

O-1 Overview of H1N1 Pandemic
Mamunur Malik, M.D.
Medical Officer, IHR, CSR
WHO/EMRO
Cairo, Egypt
E-mail: Malikm@emro.who.int

The rapid global spread of influenza caused by a novel influenza virus, pandemic (H1N1) 2009, first uncovered in April, prompted WHO to declare an influenza pandemic on 11 June 2009. This is the first declaration of an influenza pandemic in 41 years. The declaration also meant that the world is facing a health crisis of global proportions in which all people and countries are equally at risk. So far, the severity of this current pandemic remains mild compared to the past influenza pandemics of 1918, 1957 and 1968.

The current influenza virus has spread at unprecedented speed across international borders. Globally, over 350 000 confirmed cases of pandemic (H1N1) 2009 were reported to WHO by 191 Member States up to 03 October since the outbreak first unfolded in April 2009. During the same period, at least 4400 deaths were also recorded from the affected countries. The death rate reported among the laboratory-confirmed cases globally is just over 1%. In the Eastern Mediterranean Region, 21 out of 22 countries are now affected. Kuwait and the United Arab Emirates reported the first confirmed cases in the Region on 25 May 2009. Since then and up to 03 October 2009, 12 861 confirmed cases of pandemic (H1N1) 2009 including 80 deaths were reported in the Region. The number of human cases of pandemic (H1N1) 2009 is still increasing in the Region even in countries that have already been affected for some time. The death rate reported among the laboratory-confirmed cases in the Region is 0.6%.

To date, the vast majority of cases in all countries have occurred among adolescents and young adults. Males and females are similarly affected in most countries. About 50% to 80% of
severe cases had underlying health or medical conditions. Severe cases and deaths have occurred in young and previously healthy adults. The majority of deaths (over 71%) have been reported among patients aged 25 to 64 years and the cause of the majority of deaths was severe viral pneumonia. Data available from the affected countries showed that between 50% and 80% of hospitalized patients had one or more co-existing medical condition. Although, just over 1% of all laboratory-confirmed cases reported to WHO resulted in death, the case-fatality rate attributable to pandemic (H1N1) 2009 virus infection has been estimated to be between 0.1% and 0.4% based on surveillance data from some of the first affected countries as well as from mathematical modeling. To date, the overall impact of pandemic (H1N1) 2009 on health services is considered to be low, although some sub-national health services have experienced a moderate impact, i.e. health care demands have put stress on the health care system above the usual levels

A number of lessons have been learnt so far on pandemic (H1N1) 2009. Applying the lessons learned to date from this ongoing influenza pandemic can help in driving the future response strategies on the basis of scientific evidence and knowledge gained so far on the virus. Monitoring of outbreaks from different parts of the world has also provided some information to draw tentative conclusions about how the influenza pandemic might evolve in the coming months. A number of countries have considered two options in their planning: one for a mild pandemic where health and other services will be able to manage the demand for services; and the other where additional preparations will be needed to ensure that health and other services are able to cope with the increased influx of patients.

The co-circulation of both seasonal influenza virus as well as the pandemic (H1N1) 2009 virus during the coming winter season may trigger a stronger wave of pandemic in countries of the Region. It is impossible to predict when this new wave will sweep the Region, but it seems likely that countries could be hit considerably earlier than is typical for seasonal influenza. Different patterns of morbidity and mortality may emerge as the virus spreads to affect the low-income countries in the Region. In the event the new wave comes to the Region, many more cases may occur at once. A large number of cases occurring at once, even if only a small proportion of these cases result in severe illness, may be enough to stress the health system. Large numbers of severely ill patients requiring intensive care will likely stress the health system and possibly disrupt the provision of care for other diseases.

The Member States of Eastern Mediterranean Region face a number of challenges to face this pandemic. Currently, there is great variation, amongst the countries in the Region, in terms of surveillance as well as health systems capacity to respond effectively to this pandemic. Many countries in the EMR are in complex emergency situations with large number of its people internally displaced. The ongoing pandemic from influenza A(H1N1) imposes extra concerns and challenges to public health officials for hosting mass gatherings which are common features in the Eastern Mediterranean Region. Ensuring equitable access of both low and middle income countries of the Region to antivirals and pandemic vaccines would be a critical issue. Moreover, the co-circulation of pandemic (H1N1) 2009 with influenza A (H5N1) and also with seasonal influenza (H1N1) strains raises the fear of re-assortment resulting in more virulent strain of pandemic influenza or strain that is resistant to commonly used anti-viral like the oseltamivir.

The current pandemic is spreading faster than any other influenza pandemic in the past. As transmission may resurge in the countries of the Region during the coming winter in the form of a new seasonal wave, it would be prudent for countries to scale up their current level of public health response to reduce mortality and morbidity, limit the burden of pandemic on the health care system and minimize the social and economic impact of pandemic. The issues that would strategically be of immense important would be to (i) gear up the surveillance for influenza; (ii) standardize treatment practices for clinical management of pandemic (H1N1) 2009 influenza virus; (iii) roll out a plan for vaccine deployment; (iv) prioritize community mitigation interventions in accordance with the stage of the epidemic; (v) improve risk communication; (vi) strengthen infection control practices in and out of health-care facilities; (vii) practice transparency in sharing information as and when it happens; (viii) demonstrate leadership of the health sector to fight a global health threat;, and (ix) develop a surge plan for the health systems in order to ensure continuity of health care services.

 

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O-2 Communicable Diseases Surveillance in Lebanon
Nada Ghosn, M.D.
Ministry of Health, ESUMOH, Beirut, Lebanon
E-mail: esumoh@cyberia.com.lb

The Lebanese law on communicable diseases CD has defined the legislative infrastructure for communicable diseases surveillance. Physicians report to health authorities specific target events.
Since 1957 till now, different new components were added to surveillance of communicable diseases: zero-reporting, sentinel surveillance, laboratory-based surveillance, school-absenteeism monitoring, hospital deaths surveillance…
Each system provides information and a picture from different angle of CD epidemiology situation in Lebanon.

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O-3 Potential Effects of Bacterial Endotoxin Released by Antibiotics from Gram Negative Bacteria: Effects of Some Antibiotics on the Biological Properties of Endotoxins
Alexander M. Abdelnoor, Ph.D.
Department of Microbiology and Immunology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
E-mail: aanoor@aub.edu.lb

Bacterial endotoxins constitute the outer layer of Gram negative bacteria. When released from the bacterial cell they act as a potent inflammatory agent. The activity of released endotoxin depends on its 3 dimensional conformation. In the early days of antibacterial therapy to treat Gram negative infections, It had been suggested that antimicrobial agents may promote the release of endotoxin and contribute to transient exacerbation of clinical symptoms. A number of antibacterial agents have been reported to release endotoxin from the bacterial cell. The amount released depends on the class/subclass of antibacterial agent, its concentration and the time interval post-administration of antibacterial agent.
There are also reports indicating that some antibacterial agents decrease the activity of, or decrease the host response to, released endotoxin, We studied the effect of endotoxin treated-antibacterial agent, using a number of antibacterial agents on the production of γ-interferon, TNF-α and nitric oxide induced by endotoxin. In all cases there was a reduction in the levels of these mediators.
Most reports including ours dealing with the release of endotoxin from Gram negative bacteria and the effect of antibacterial agents on the biological properties of endotoxin used in vitro studies and/or animal models. Few studies in humans are suggestive of a role of endotoxin release following anti-bacterial therapy resulting in exacerbation of symptoms.

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O-4 Antibiotics for Staphylococcus aureus: The Old and The New
Jacques Mokhbat, M. Sfeir and G. Nakad
Department of Medicine, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
E-mail: Jacques.mokhbat@gmail.com

Methicillin resistant Staphylococcus aureus (MRSA) has become one of the most common causes of health care associated infections, particularly in device associated infections. Its management is a continuous subject of debate especially that classically used drugs (namely the glycopeptides) are associated with toxicity, need for parenteral access and poor outcomes. In the last few years, cases of community acquired MRSA (CA-MRSA) have further complicated the management of community acquired infections. Recently, local studies demonstrated low prevalence of CA-MRSA but a high prevalence among the health care workers (Sfeir et al, 2009), thus contributing to heightened risks of MRSA acquisition in hospitals. A review of the currently available drugs and novel protocols for the management of MRSA is also presented.

 

 

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