Communicable Disease Surveillance Research Articles

Assessment of Competencies of Districts’ Surveillance Officers in Iraq

Background: Assessment of communicable diseases surveillance officers is one of the important aspects of the detection of obstacles that prevent the development of surveillance system, which would certainly affect their control programs. Objectives: To assess the Competencies of communicable diseases' surveillance officers in all Iraqi provinces Subjects and Methods: A cross sectional study from the15th March to 30th September 2019 in which all the communicable diseases' surveillance officers (136) that are employed by Ministry of Health all over Iraq were included. A structured questionnaire developed by the researcher and filled by them. The questionnaire form gathered demographic data, service characteristics and status of competencies including basic epidemiology, biostatistics, surveillance, outbreak investigation, rapid response to health incidence and developing scientific reports. Results: The response rate was 85.3%, about half of surveillance officers was responsible for less than 10 Primary Health Care Centre. More than half of them (55.3%) were responsible for 1-2 hospitals. Their age ranged between 21 and 62 years and the males constituted more than three quarters (78.4%) of the study sample, Diploma was the highest educational certificate. 15.6% of the sample did not attend any training activity. Cholera has been the most frequently reported incident (53.8%). Conclusions: The surveillance system in Iraq at district level was operated mainly by low qualified and under-trained health personnel. There is inequity in distribution of workload and training sessions between surveillance officers in health offices, therefore redistribution is recommended. Supporting continuous training programs with increase incentives.

Nonspecific Effects of the Bacillus Calmette-Guérin Vaccine in Portuguese Children Under 5 Years of Age: Protocol for a Population-Based Historical Birth Cohort Study.

The Bacillus Calmette-Guérin vaccine (BCG) against tuberculosis (TB) shows beneficial nonspecific effects, which are likely related to innate immune training. Until 2016, a single BCG dose was administered to all newborns in Portugal. In July 2016, a clinical guideline established that only children under 6 years belonging to high-risk groups should receive BCG. This might have prevented nonvaccinated children from developing trained immunological responses as effectively as BCG-vaccinated children. This study aims to investigate if there is variation in TB-related and all-cause mortality, and severe, moderate, or mild morbidity in children under 5 years of age, and whether such variation might be explained by the BCG vaccination policy change in 2016. This population-based historical birth cohort study includes children under 5 years of age born in Portugal between July 1, 2010, and June 30, 2021. Newborns with low birth weight, premature status, or known or suspected HIV infection are excluded. The follow-up period is until the completion of 5 years of age or the end of follow-up (June 30, 2021). The study will use secondary data from the National Health Service user registry, death certificate database, vaccination registry, communicable diseases surveillance system, TB surveillance system, diagnosis-related group information system for hospital admissions and emergency department visits, and primary health care information system. The data will be linked. Primary outcomes include person-time incidence rates of death (all causes and TB), TB diagnosis, and all causes and some specific causes of severe, moderate, or mild morbidity, and the incidence rate ratio of nonvaccinated to BCG-vaccinated children. We will compare the probability of surviving the first and fifth years of life or of not having severe, moderate, or mild morbidity during the follow-up period according to exposure (BCG vaccinated or nonvaccinated, number of doses, and time from birth until the first dose), using the log-rank test for assessing differences in survival rates between exposed and nonexposed children and hazard ratios for quantifying the differences. Moreover, we will perform a proportional hazards regression analysis. Ethics approval has been obtained. In March 2022, database owners were contacted to present the project and discuss the request for data. A unique identifier will be used. In July 2023, a process of redefinition of the variables per database was initiated. Data were received in October and November 2023. In November 2023, further work was conducted. By April 2024, we expect to start analyzing the full data set. The results will contribute to the accumulating body of knowledge and might have relevance to guide global BCG vaccination policy. Data linkage can contribute to a swifter mechanism to use available health data to conduct population-based studies and inform policy decision-making. ClinicalTrials.gov NCT05471167; https://clinicaltrials.gov/study/NCT05471167. DERR1-10.2196/55332.

AN ASSESSMENT OF COMMUNICABLE DISEASE SURVEILLANCE IN KAILAHUN DISTRICT

Disease surveillance is critical for recognizing and anticipating infectious disease epidemics. It collects health-related data from a community in order to detect and monitor disease epidemics in their early stages. Disease monitoring necessitates a large network of sentinel sites to follow infections throughout the community. The study focuses on communicable illness surveillance in the Kailahun district. It looks into the surveillance reporting system for communicable diseases, the flow of surveillance information, the various components of individuals involved in surveillance activities, the challenges faced by the surveillance system in the Kailahun district, and the involvement of community members in surveillance activities, as well as ways to improve communicable disease surveillance in the Kailahun district. This study employs a quantitative cross-sectional design for research. It consequently employs the cross-sectional study design. I picked a cross-sectional design for this study based on the data needed to address the research questions. As a result, I structured the study questions so that qualitative data would be collected to provide descriptive information, while quantitative data would be analyzed in tables and charts. Infectious disease surveillance is widely acknowledged as the foundation of public health policy and practice. Surveillance statistics are critical for monitoring the populations health state, diagnosing diseases, and taking action to avoid future illness and contain public health problems. The need to strengthen disease surveillance and response systems is now widely recognized around the world.

SARS-CoV-2 Pandemic: A Comparison Between the Epidemiological Situation in Greece and Romania.

Introduction Since the onset of the SARS-CoV-2 pandemic, there seems to be scarce data targeting the comparison of epidemiological data among different countries. In an attempt to reveal and characterize the epidemiological profile in the Balkan peninsula,a cross-sectional study has been conducted, aiming to retrospectively collect all the existing information regarding the SARS-CoV-2 pandemic over a period of three years, starting from March 2020 until March 2023. The comparative analysis of the epidemiological features and the main indicators between Romania and Greece can generate a good overview of the factors that can influence public healthand create an adequate system of measures to limit the COVID-19 pandemic in the area. A retrospective comparative study aiming to detect and associate the main indicators determining the evolution of the SARS-CoV-2 pandemic data with the control measures adopted in Romania and Greece was performed. Methods Publicly available data were obtained from official sources such as the World Health Organization, the European Centre for Disease Control, the Romanian and Greek Ministries of Health,and the Romanian National Centre for Surveillance and Control of Communicable Diseases. The reported number of cases, in total and in conjunction with the age distribution, total number of deaths, and vaccination coverage, from the onset of the pandemic in March 2020 until March 2023, were collected. All officially reported cases of COVID-19 were included in this analysis. Reports with missing or incomplete values regarding the timeframe, age distribution, and vaccination status were excluded. Results During the timeframe of the study, from March 2020 until March 2023, Greece reported a higher number of confirmed SARS-CoV-2 cases as compared to Romania (5,910,103 cases and 3,352,356 cases, respectively).Still, in terms of the overall death toll, Romania recorded a higher mortality rate than Greece during the pandemic (67.773 deathsvs.36.372 deaths). Concerning both cumulative incidence rates and the 14-day case notification rate per 100.000 inhabitants, it is evident that Romania exhibited greater numbers throughout the course of the pandemic. Although it is not clearly stated, the compulsory vaccination ofelderly people that was set as a high priority in Greece may have contributed to the above results. In terms of the 14-day death notification rate per 100.000 inhabitants in 2020 and 2021, Romania showed a higher rate than Greece, while Greece reported a greater rate in 2022 and up until March 2023. Between 2020 and 2023, Greece presented both a higher number of vaccinated individualsand a higher vaccination coverage with two doses (7,034,695 individuals, 70% of the general population), as compared to Romania (6,467,804 individuals, 33.68% of the general population, p<0.0001). Conclusions Despite the similar restrictions and preventive actions adopted by Romania and Greece, some of the epidemiological data between the two countries tends to differ. It must not be ignoredthatevery nation should be considered a unique entity with distinct features, including individuals, customs, and policies, rather than being categorized with other countries based on geographic proximity or regionalization.

Hepatitis A Exposure Response and Outbreak Prevention in a Large Urban Jail - Los Angeles County, California, May-July 2023.

Correctional settings provide a high-risk environment for hepatitis A transmission because of the high proportion of homelessness and injection drug use among persons who are incarcerated. On May 30, 2023, Los Angeles County Department of Public Health informed the Communicable Disease Surveillance and Control (CDSC) unit of the Los Angeles County Jail system that a symptomatic incarcerated person had received a positive test result for acute hepatitis A. Upon learning the next day that the patient was a food handler, CDSC staff members identified 5,830 potential contacts of the index patient, 1,702 of whom had been released from the jail. During June 1-12, a total of 2,766 contacts who did not have a documented history of hepatitis A serology or vaccination that could be confirmed from the electronic health record or state immunization registry were identified. These persons were offered hepatitis A vaccination as postexposure prophylaxis; 1,510 (54.6%) accepted vaccination. Contacts who were food handlers without confirmed evidence of immunity and who declined vaccination were removed from food-handling duties for the duration of their potential incubation period. No additional cases were identified. Identifying contacts promptly and using immunization and serology records to ensure rapid delivery of postexposure prophylactic vaccine can help prevent hepatitis A transmission during exposures among incarcerated populations.

COVID-19 surveillance based on consumer wearable devices.

Consumer wearable devices such as wristbands and smartwatches have potential application value in communicable disease surveillance. We investigated the ability of wearable devices to monitor COVID-19 patients of varying severity. COVID-19 patients with mobile phones supporting wearable device applications were selected from Dalian Sixth People Hospital. Physiological parameters from the wearable devices and electronic questionnaires were collected from the device wearing until 14 days post-discharge. Clinical information during hospitalization was also recorded. Based on imaging data, the patients were categorized into the milder group without pneumonia and the more severe group with pneumonia. We plotted the curves of the physiological parameters of the two groups to compare the differences and changes. Ninety-eight patients were included in the analysis. The mean age was 39.6 ± 10.5 years, including 45 males (45.9%). There were 24 asymptomatic patients, 10 mild patients, 60 moderate patients, and 4 severe patients. Compared with the milder group, the more severe group had higher heart rate-related parameters, while the heart rate variability (HRV) was the opposite. In the more severe group, the heart rate-related parameters showed a downward trend from 0 to 7 days after the fever resolution. Among them, the resting heart rate and sleep heart rate decreased on the 25th day after the onset and were close to the milder group 1 week after discharge. Consumer wearable devices have the potential to monitor respiratory infections. Heart rate-related parameters obtained from these devices can be sensitive indicators of COVID-19 severity and correlate with disease evolution. ClinicalTrials.gov NCT04459637.

Communicable disease surveillance through predictive analysis: A comparative analysis of prediction models

Effective prediction and surveillance of communicable diseases are vital for public health management. This study leveraged machine learning algorithms to predict disease occurrences in the Province of Marinduque, focusing on Hand Foot Mouth Disease, Dengue, Typhoid, Influenza, Chikungunya, Rabies, Measles, Meningitis, Hepatitis, and Acute Bloody Diarrhea using data from 2015 to 2019. The monthly morbidity rate served as the criterion variable. Machine learning models, including Random Forest, Logistic Regression, SVM, and k-Nearest Neighbors, were employed. Material and methods encompassed data collection, preprocessing, feature selection, and model evaluation. Results revealed Random Forest as the most accurate algorithm, with implications for proactive disease management and resource allocation. This research enhances disease prediction methodologies and contributes to public health surveillance.

Evaluation of Communicable Diseases Surveillance System Structure in Mosul City

Background: One of the most important global public health issues and it is a major source of death for many people around the world. Illnesses caused by infection invasion of the body with specific germs such as viruses, bacteria, funguses, and parasites. Aim(s): Evaluatıng communicable diseases surveillance system structure at Mosul City. Methodology: A descriptive study using an evaluation approach is conducted to evaluate the Communicable Diseases Surveillance System Structure in Mosul City from April 20th 2022 to May 21th 2023. A non-probability multistage sample was adopted of the study, as twenty-three (23) health institutions are chosen and interview is conducted with health staff works in the communicable diseases Surveillance System. Developed evaluation tool (Questionnaire) used to collect the data according to WHO framework (Generic Questionnaire) for monitoring and evaluating surveillance and response system for communicable disease. Results: The outcomes indicate that the most of system's organizational structure component are effective, available and sufficient to implement such system for the benefit of consumers from communicable diseases services’ in relation to patient surveillance manual, personnel, resources and supplies and training. However, the study findings showed that Public Health Department, both healthcare sectors and hospitals, in Mosul City, have much better organizational structure of Communicable Diseases Surveillance System than Main and Family Medicine Primary Healthcare Centers. Conclusion: All hospitals, in Mosul City, have presented an experimental evidence that their organizational structure of the Communicable Diseases Surveillance System is well competent to implement it.

Status Report of National Reference Laboratories for Epidemiological Surveillance of Communicable Diseases and Diseases with Epidemic Potential in Côte d'Ivoire after More Than a Decade of Existence

Status Report of National Reference Laboratories for Epidemiological Surveillance of Communicable Diseases and Diseases with Epidemic Potential in Côte d'Ivoire after More Than a Decade of Existence

Development of a Surveilens System as a Means for Collection and Reporting of Infectious Diseases in Puskodono Health Center, Sragen

Surveillance is an important activity in the context of disease data collection. The results of these surveillance activities can also be used as a consideration for making decisions related to disease management, especially infectious diseases. The aim of the research was to develop an information system for surveillance of infectious diseases for data collection and reporting to support management decision making at the Sukodono Health Center, Sragen.This research method is qualitative and quantitative. Prototype model research development. The research population is all parties involved in the development of an Infectious Disease Management Information System at the Sukodono Health Center, Sragen. The subjects of this study were the Head of the Community Health Center, the Head of the Infectious Diseases Program and the four Communicable Diseases Program Holders. the research object is the Communicable Disease Health Center Management Information System. This research method is qualitative and quantitative. Prototype model research development. The subjects of this study were one head of the health center, one head of the infectious disease program and four holders of the infectious disease program. the research object is the Communicable Disease Health Center Management Information System. Data analysis in this study was carried out by means of content analysis for qualitative and descriptive analysis methods for quantitative. The acquisition of the evaluation results from the total average percentage is Accurate at (62.19%), Complete at (83.89%), timeliness (84.44%), and Relevant at (95.20%). Meanwhile, in terms of data accuracy (accuracy) and completeness of content or data availability (content), information system users are very satisfied, as indicated by the results of the total average percentage of both 80.36 and 99.36% indicating that the user is very confident in the completeness and correctness of the examination data that has been inputted into the information system by paramedics. The results of the evaluation of the information system as a whole are 81.43%, meaning that the Information System for Surveillance of Communicable Diseases can be received and used by users of the information system very well

Australian Paediatric Surveillance Unit (APSU) Annual Surveillance Report 2022.

For 30 years the Australian Paediatric Surveillance Unit (APSU) has conducted national surveillance of rare communicable diseases and rare complications of communicable diseases. In this report, we describe the results of thirteen such studies surveyed by the APSU in 2022, including reported case numbers and incidence estimates, demographics, clinical features, management and short-term outcomes. Conditions described are: acute flaccid paralysis (AFP); congenital cytomegalovirus (cCMV); neonatal and infant herpes simplex virus (HSV) infection; perinatal exposure to human immunodeficiency virus (HIV) and paediatric HIV infection; severe complications of influenza; juvenile-onset recurrent respiratory papillomatosis (JoRRP); congenital rubella infection/syndrome; congenital varicella syndrome (CVS) and neonatal varicella infection (NVI); and the new conditions dengue; Q fever; and severe acute hepatitis. In 2022, cases of severe complications of influenza were reported to the APSU for the first time since 2019. This likely reflects the easing of government-mandated restrictions imposed in 2020-2021 to curb the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the re-emergence of a range of infectious diseases. As previously, AFP surveillance by the APSU contributed to Australia achieving a minimum target incidence of one AFP case per 105 children aged less than 15 years. Cases of JoRRP and NVI were reported in 2022. This indicates potential gaps in human papillomavirus (HPV) and varicella vaccination coverage respectively, especially in high-risk groups such as young migrant and refugee women of childbearing age from countries without universal vaccination programs. Paediatric HIV case numbers resulting from mother-to-child-transmission (MTCT) of HIV remain low in Australia due to use of effective intervention strategies. However, there has been an increase in the number of imported cases of HIV in children (mainly perinatally-acquired) from countries with a high HIV prevalence. Without effective vaccines, there has been no decline in the incidence of congenital CMV and neonatal HSV, indicating the importance of early identification and management to reduce morbidity and mortality. The first cases of dengue, Q fever and severe acute hepatitis were received by APSU in 2022, including two cases of acute hepatitis in which aetiology has not been confirmed to date. The APSU has an important ongoing role in monitoring rare childhood infections.

Communicable Disease Surveillance in Lebanon during the Syrian Humanitarian Crisis, 2013-2019.

Lebanon has been one of the most affected countries by the Syrian humanitarian crisis. The national communicable disease surveillance was enhanced to detect outbreaks among Syrians. In this study, we aim to describe the findings of the communicable disease surveillance among Syrians in Lebanon, compare it to residents' data, and describe the implemented surveillance activities between 2013 and 2019. During the study period, data on communicable diseases was mainly collected through the routine national surveillance system and an enhanced syndromic surveillance system. Predefined case definitions and standard operating procedures were in place. Data collection included both case-based and disease-specific reporting forms. Descriptive data and incidence rates were generated. Information was disseminated through weekly reports. Activities were conducted in close collaboration with different partners. The most commonly reported diseases were: viral hepatitis A, cutaneous leishmaniasis, mumps, and measles. Hepatitis A incidence increased in 2013 and 2014 among Syrians as well as residents. For leishmaniasis, the incidence increased only among Syrians in 2013 and decreased after that. An outbreak of mumps was reported among Syrians between 2014 and 2016, with a peak in 2015 concomitant with a national outbreak. Outbreaks of measles were reported among Syrians and residents in 2013, 2018, and 2019. The infrastructure of the well-implemented surveillance system in Lebanon has been utilized to monitor the health status of Syrians in Lebanon, early detect communicable diseases among this population, and guide needed preventive and control measures. This highlights the importance of having a flexible surveillance system that can be adapted to emergencies and the importance of sharing results with involved partners.

De la variole du singe à la Mpox ou la réémergence d’une ancienne zoonose

AbstractMonkeypox is a zoonotic disease caused by the Monkeypox virus (MPXV) of the Orthopoxvirus genus. The first human cases occurred in Africa in the 1970s and remained confined to the African continent for a long time until 2003, when several dozen cases occurred in the United States, following contamination by prairie dogs. Unprecedented transmission events have led to more than 80,000 reported cases worldwide between May 2022 and February 2023, primarily affecting men who have sex with men. The changing epidemiology of Mpox has raised concerns about its ability to become endemic beyond its traditional geographic areas. Confirmatory diagnosis is based on direct detection by molecular biology. Pre- or post-exposure smallpox vaccination was widely deployed in early summer 2022 to limit the spread of the disease. In case of severe forms, the use of antivirals can be considered, only tecovirimat being recommended in this indication. The current epidemic has had the merit of showing that a disease that was previously confined to regions of initial virus circulation can spread very rapidly in Western countries and of the need to reinforce the implementation of tools for the surveillance and control of communicable diseases.

Thinking about development of multi-channel surveillance and multi-dimensional early warning system of emerging respiratory communicable diseases

The world has paid a heavy price for the pandemic of the emerging respiratory communicable disease, so more concern about communicable disease surveillance and early warning has been aroused. This paper briefly reviews the establishment of the surveillance and early warning system of respiratory communicable diseases in China, discusses its future development and introduces the novel surveillance methods and early warning models for the purpose of establishment of a multi-channel surveillance and multi-dimensional early warning system of communicable diseases in the future and the improvement of the prevention and control of emerging respiratory communicable diseases in China.

Prevalence of hepatitis C virus among fatal drug overdoses in Tennessee: an analysis using 2019-2020 Tennessee State Unintentional Drug Overdose Reporting System Data.

Given the nature of the co-occurring epidemics of hepatitis C virus (HCV) and fatal stimulant overdose, we sought to assess the prevalence of HCV among opioid and stimulant-positive overdoses. We conducted a cross-sectional study to examine theprevalence of HCV among fatal drug overdoses in Tennessee using 2019-2020 data from the State Unintentional Drug Overdose Reporting System. We defined history of HCV using surveillance data and autopsy reports. Descriptive statistics were calculated for circumstances of overdose deaths for different categories of opioid and stimulant positivity on toxicology. Between 2019 and 2020, 3570 unintentional or undetermined drug overdose deaths occurred in Tennessee with an available autopsy. History of HCV was found in 24.6% of deaths. When assessing different involvement between stimulants and opioids, the highest prevalence of HCV was found for deaths where methamphetamine and opioids were present in toxicology (35.4%). Scene evidence of injection drug use occurred more frequently among decedents with a history of HCV (P<.0001). This analysis while descriptive highlights the importance of linking datasets to enhance infectious disease and drug overdose surveillance. Partnership between communicable disease and drug overdose surveillance teams should continue toidentify relationships between disease and drug overdose and strengthen the evidence to tailor crucial treatment and prevention activities.

Wastewater Surveillance for Communicable Diseases

&#x0D; This Horizon Scan summarizes the available information regarding wastewater epidemiology, or wastewater surveillance, for the detection of pathogens that cause communicable diseases.&#x0D; Wastewater surveillance can detect the presence of pathogens or chemical substances within the wastewater system and allows for the monitoring of a broad population with a single sample.&#x0D; Wastewater surveillance has been used for decades but has become more common since it was implemented around the world for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19. In Canada, wastewater surveillance is currently used for the detection of SARS-CoV-2, influenza, and respiratory syncytial virus.&#x0D; Studies conducted in Canada and internationally indicate that wastewater surveillance can be used as a reliable method for detecting pathogens at the population level.&#x0D; Future uses of wastewater surveillance may include monitoring of antibiotic use and antibiotic resistance, detection of cancers in the population, or assessing the prevalence of other infections within communities.&#x0D;

Human and animal brucellosis in the Sultanate of Oman: an epidemiological study

Brucellosis is an infectious disease caused by direct contact with infected animals or animal products contaminated with Brucella. Brucella is a Gram-negative aerobic coccobacillus that infects different types of animals and is considered to be an important zoonotic disease. Brucella were isolated from blood samples and identified following biochemical tests and agglutination with A and M monospecific antisera. Furthermore, Brucella antibody titers of the tested sera were obtained by the microtiter agglutination method (MAM). The main Brucella species isolated in Oman was B. melitensis. However, in countries bordering Oman and their neighboring countries, both B. melitensis and B. abortus have been isolated and identified. A total of 412 human patients with suspected cases of brucellosis were admitted to the Department of Communicable Disease Surveillance and Control in the Dhofar Governorate for diagnosis and treatment. During the year 2015, a total of 343 human cases were positively diagnosed with brucellosis in the Dhofar Governorate. During the years 2015 to 2019, a total of 10,492 animals were examined in different Governorates of Oman for brucellosis. The results indicated that 1161 (11%) animals were serologically positive for brucellosis. The results of this study confirmed that Brucella melitensis is the main species responsible for human brucellosis in Oman. It was not surprising that the Dhofar Governorate exhibited a high percentage of infected patients since it is culturally acceptable to drink raw camel milk (unpasteurized), unlike cow milk which is pasteurized.

SARS-CoV-2 variants-associated outbreaks of COVID-19 in a tertiary institution, North-Central Nigeria: Implications for epidemic control.

The COVID-19 global pandemic is being driven by evolving SARS-CoV-2 variants with consequential implications on virus transmissibility, host immunity, and disease severity. Continuous molecular and genomic surveillance of the SARS-CoV-2 variants is therefore necessary for public health interventions toward the management of the pandemic. This study is a retrospective analysis of COVID-19 cases reported in a Nigerian tertiary institution from July to December 2021. In total, 705 suspected COVID-19 cases that comprised 547 students and 158 non-students were investigated by real time PCR (RT-PCR); of which 372 (~52.8%) tested positive for COVID-19. Using a set of selection criteria, 74 (~19.9%) COVID-19 positive samples were selected for next generation sequencing. Data showed that there were two outbreaks of COVID-19 within the university community over the study period, during which more females (56.8%) tested positive than males (47.8%) (p<0.05). Clinical data together with phylogenetic analysis suggested community transmission of SARS-CoV-2 through mostly asymptomatic and/or pre-symptomatic individuals. Confirmed COVID-19 cases were mostly mild, however, SARS-CoV-2 delta (77%) and omicron (4.1%) variants were implicated as major drivers of respective waves of infections during the study period. This study highlights the importance of integrated surveillance of communicable disease during outbreaks.

The lessons of COVID-19 pandemic for communicable diseases surveillance system in Kurdistan Region of Iraq

ObjectivesThis study aimed to determine the opportunities of and barriers to communicable diseases surveillance system (CDSS) during the COVID-19 pandemic and the extent to which the disease integrated into the CDSS in the Kurdistan region of Iraq. Study designA descriptive qualitative approach was applied. MethodsWe conducted seven semi-structured interviews and seven interviewee in a focus group discussion (FGD) with purposefully identified Key Informants (KI) from June to December 2020. All interviews were digitally recorded and transcribed verbatim. We adopted a mixed deductive-inductive approach for thematic data analysis, facilitated by using MAXQDA20 software for data management. ResultsAlthough the CDSS was considered appropriate and flexible, the COVID-19 was interpreted not to be integrated into the system due to political influence. The main concerns regarding core and support activities were the lack of epidemic preparedness, timeliness, and partial cessation of training and supervision during the pandemic. The existence of reasonable surveillance infrastructure, i.e., trained staff, was identified as an opportunity for improvement. The main challenges include staff deficiency, absence of motivation and financial support for present staff, scarce logistics, managerial and administrative issues, and lack of cooperation, particularly among stakeholders and surveillance staff. ConclusionOur findings revealed that the CDSS in the Kurdistan region requires substantial enhancement in epidemic preparedness, strengthening human resources, and logistics. the system can be developed by fostering meaningful intersectoral collaboration. We advocate that the health authorities and policy-makers prioritise the surveillance and effective management of communicable diseases.

Exploring stakeholders’ experiences and perceptions regarding barriers to effective surveillance of communicable diseases in a rural district of Pakistan: a qualitative study

ObjectiveTo explore the experiences and perceptions of health system stakeholders of a rural district of Sindh, Pakistan regarding the barriers to effective surveillance of communicable diseases.DesignThis qualitative descriptive exploratory design...