Papers by Mohamed Elhakim
Health Security, 2024
The COVID-19 pandemic has underscored the importance of the International Health Regulations (IHR... more The COVID-19 pandemic has underscored the importance of the International Health Regulations (IHR) (2005) in addressing global health emergencies. This review aims to improve healthcare system capabilities, future preparedness, and actions in the Eastern Mediterranean Region, particularly in low-resource areas. The IHR, established in 1969, initially focused on 6 diseases but has since expanded to include a wider range of public health threats. These rules establish a globally recognized legal framework that is applicable to all 196 states parties, including all 194 World Health Organization member states. The IHR prioritize the prevention, protection, and control of global disease transmission while minimizing unwarranted disruptions to international travel and commerce. Nonetheless, the response to COVID-19 in the Eastern Mediterranean Region revealed a range of deficiencies despite the regulatory strengths. Some countries encountered challenges in fully complying with their IHR obligations, particularly in terms of preparedness, and occasional geopolitical tensions obstructed international collaboration. The pandemic experience underscores the need for improved trust, resource allocation, and regulatory revisions to address upcoming global health challenges. This case study highlights positive aspects of the pandemic response, including the swift exchange of information and global cooperation, while also recognizing shortcomings, such as delays in reporting and unequal vaccine access. In summary, the COVID-19 pandemic underscores the urgency of subsequent updates to the IHR or comparable accords, such as the IHR amendments and the pandemic treaty, to rectify these deficiencies. Updates should place a greater emphasis on transparency, cultivating trust, enhancing preparedness, and establishing mechanisms that incentivize comprehensive compliance among all participating nations.
Background: The Eastern Mediterranean Region (EMR) faces numerous public health risks caused by b... more Background: The Eastern Mediterranean Region (EMR) faces numerous public health risks caused by biological, chemical, man-made, and natural hazards. This manuscript aimed to assess the multifaceted interventions and strategies used to strengthen the EMR's preparedness capacities to respond properly to current and upcoming health emergencies.
BMJ Global Health, 2022
Since the first case of COVID-19 in Djibouti in March 2020 up to the end of May 2021, the country... more Since the first case of COVID-19 in Djibouti in March 2020 up to the end of May 2021, the country experienced two major epidemic waves of confirmed cases and deaths. The first wave in 2020 progressed more slowly in Djibouti compared with other countries in the Eastern Mediterranean Region. The second wave in 2021 appeared to be more aggressive in terms of the number and severity of cases, as well as the overall fatality rate. This study describes and analyses the epidemiology of these two waves of the COVID-19 pandemic in Djibouti and highlights lessons learnt from the National Plan for Introduction and Deployment of COVID-19 vaccines developed and implemented by the Ministry of Health of Djibouti. From 17 March 2020 up to 31 May 2021, Djibouti officially reported 11 533 confirmed cases of COVID-19 with 154 related deaths (case fatality rate, CFR: 1.3%), with an attack rate of 1.2%. The first epidemic wave began in epidemiological week 16/2020 (12-18 April) and ended in epidemiological week 25/2020 (14-20 June) with 4274 reported cases and 46 deaths (CFR: 1.1%). The second wave began in epidemiological week 11/2021 (14-20 March) and ended in epidemiological week 18/2021 (2-8 May) with 5082 reported cases and 86 deaths (CFR: 1.7%). A vaccination campaign was launched by the President of the Republic in March 2021; approximately 1.6% of the population were vaccinated in only two months' time. Early Preparedness, multisectoral and multicoordinated response, and collaboration with WHO are among the major lessons learnt during the pandemic in Djibouti.
Journal of Infection and Public Health, 2019
Influenza viruses with pandemic potential have been detected in humans in the Eastern Mediterrane... more Influenza viruses with pandemic potential have been detected in humans in the Eastern Mediterranean Region. The Pandemic Influenza Preparedness (PIP) Framework aims to improve the sharing of influenza viruses with pandemic potential and increase access of developing countries to vaccines and other lifesaving products during a pandemic. Under the Framework, countries have been supported to enhance their capacities to detect, prepare for and respond to pandemic influenza. In the Eastern Mediterranean Region, seven countries are priority countries for Laboratory and Surveillance (L&S) support: Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Morocco and Yemen. During 2014-2017, US$ 2.7 million was invested in regional capacity-building and US$ 4.6 million directly in the priority countries. Countries were supported to strengthen influenza diagnostic capacities to improve detection, enhance influenza surveillance systems including sentinel surveillance for severe acute respiratory infection and influenza-like illness, and increase global sharing of surveillance data and influenza viruses. This paper highlights the progress made in improving influenza preparedness and response capacities in the Region from 2014 to 2017, and the challenges faced. By 2017, 18 of the 22 countries of the Region had laboratory-testing capacity, 19 had functioning sentinel influenza surveillance systems and 22 had trained national rapid response teams. The number of countries correctly identifying all influenza viruses in the WHO external quality assurance panel increased from 9 countries scoring 100% in 2014 to 15 countries in 2017, and the number sharing influenza viruses with WHO collaborating centres increased by 75% (from eight to 14 countries); more than half now share influenza data with regional or global surveillance platforms. Seven countries have estimated influenza disease burden and seven have introduced influenza vaccination for high-risk groups. Challenges included: protracted complex emergencies faced by nine countries which hindered implementation of influenza surveillance in areas with the most needs, high staff turnover, achieving timely virus sharing and limited utilization of influenza data where they are available to inform vaccine policies or establish threshold values to measure the start and severity of influenza seasons.
Journal of Infection and Public Health, 2019
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
Journal of Infection and Public Health, 2019
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
Viruses, 2018
Dromedary camels (Camelus dromedarius) are now known to be the vertebrate animal reservoir that i... more Dromedary camels (Camelus dromedarius) are now known to be the vertebrate animal reservoir that intermittently transmits the Middle East respiratory syndrome coronavirus (MERS-CoV) to humans. Yet, details as to the specific mechanism(s) of zoonotic transmission from dromedaries to humans remain unclear. The aim of this study was to describe direct and indirect contact with dromedaries among all cases, and then separately for primary, non-primary, and unclassified cases of laboratory-confirmed MERS-CoV reported to the World Health Organization (WHO) between 1 January 2015 and 13 April 2018. We present any reported dromedary contact: direct, indirect, and type of indirect contact. Of all 1125 laboratory-confirmed MERS-CoV cases reported to WHO during the time period, there were 348 (30.9%) primary cases, 455 (40.4%) non-primary cases, and 322 (28.6%) unclassified cases. Among primary cases, 191 (54.9%) reported contact with dromedaries: 164 (47.1%) reported direct contact, 155 (44.5%)...
Eastern Mediterranean Health Journal, 2013
The Eastern Mediterranean Region of World Health Organization has been an emerging focus for glob... more The Eastern Mediterranean Region of World Health Organization has been an emerging focus for global health after the discovery of a novel coronavirus infection in some countries in the Region. The Region has already witnessed a number of emerging zoonoses with epidemic potential. In view of this new virus, there is now an urgent need for strong public health vigilance and monitoring of the evolution of the virus in the Region. The situation will challenge and test the national health authorities' resilience and ability to respond in a timely manner. This review summarizes the evidence related to the emergence in the Region of new epidemic diseases of predominantly zoonotic origin and the challenges posed by the discovery of the novel coronavirus infection, and outlines recommendations for the countries for early detection, prevention and control of public health threats from this novel coronavirus infection.
Frontiers in public health, 2017
The Eastern Mediterranean Region (EMR) of the World Health Organization (WHO) continues to be a h... more The Eastern Mediterranean Region (EMR) of the World Health Organization (WHO) continues to be a hotspot for emerging and reemerging infectious diseases and the need to prevent, detect, and respond to any infectious diseases that pose a threat to global health security remains a priority. Many risk factors contribute in the emergence and rapid spread of epidemic diseases in the Region including acute and protracted humanitarian emergencies, resulting in fragile health systems, increased population mobility, rapid urbanization, climate change, weak surveillance and limited laboratory diagnostic capacity, and increased human-animal interaction. In EMR, several infectious disease outbreaks were detected, investigated, and rapidly contained over the past 5 years including: yellow fever in Sudan, Middle East respiratory syndrome in Bahrain, Oman, Qatar, Saudi Arabia, United Arab Emirates, and Yemen, cholera in Iraq, avian influenza A (H5N1) infection in Egypt, and dengue fever in Yemen, S...
PLoS ONE, 2020
First cases of COVID-19 were reported from Wuhan, China, in December 2019, and it progressed rapi... more First cases of COVID-19 were reported from Wuhan, China, in December 2019, and it progressed rapidly. On 30 January, WHO declared the new disease as a PHEIC, then as a Pandemic on 11 March. By mid-March, the virus spread widely; Djibouti was not spared and was hit by the pandemic with the first case detected on 17 March. Djibouti worked with WHO and other partners to develop a preparedness and response plan, and implemented a series of intervention measures. MoH together with its civilian and military partners, closely followed WHO recommended strategy based on four pillars: testing, isolating, early case management, and contact tracing. From 17 March to 16 May, Djibouti performed the highest per capita tests in Africa and isolated, treated and traced the contacts of each positive case, which allowed for a rapid control of the epidemic. COVID-19 data included in this study was collected through MoH Djibouti during the period from 17 March to 16 May 2020. A total of 1,401 confirmed cases of COVID-19 were included in the study with 4 related deaths (CFR: 0.3%) and an attack rate of 0.15%. Males represented (68.4%) of the cases, with the age group 31–45 years old (34.2%) as the most affected. Djibouti conducted 17,532 tests, and was considered as a champion for COVID-19 testing in Africa with 18.2 tests per 1000 habitant. All positive cases were isolated, treated and had their contacts traced, which led to early and proactive diagnosis of cases and in turn yielded up to 95–98% asymptomatic cases. Recoveries reached 69% of the infected cases with R0 (0.91). The virus was detected in 4 regions in the country, with the highest percentage in the capital (83%). Djibouti responded to COVID-19 pandemic following an efficient and effective strategy, using a strong collaboration between civilian and military health assets that increased the response capacities of the country. Partnership, coordination, solidarity, proactivity and commitment were the pillars to confront COVID-19 pandemic.
Environmental Health, 2020
Background: Over the past four decades, drought episodes in the Eastern Mediterranean Region (EMR... more Background: Over the past four decades, drought episodes in the Eastern Mediterranean Region (EMR) of the of the World Health Organization (WHO) have gradually become more widespread, prolonged and frequent. We aimed to map hotspot countries and identified key strategic actions for health consequences. Methods: We reviewed scientific literature and WHO EMR documentation on trends and patterns of the drought health consequences from 1990 through 2019. Extensive communication was also carried out with EMR WHO country offices to retrieve information on ongoing initiatives to face health consequences due to drought. An index score was developed to categorize countries according vulnerability factors towards drought. Results: A series of complex health consequences are due to drought in EMR, including malnutrition, vector-borne diseases, and water-borne diseases. The index score indicated how Afghanistan, Yemen and Somalia are "hotspots" due to poor population health status and access to basic sanitation as well as other elements such as food insecurity, displacement and conflicts/political instability. WHO country offices effort is towards enhancing access to water and sanitation and essential healthcare services including immunization and psychological support, strengthening disease surveillance and response, and risk communication. Conclusions: Drought-related health effects in the WHO EMR represent a public health emergency. Strengthening mitigation activities and additional tailored efforts are urgently needed to overcome context-specific gaps and weaknesses, with specific focus on financing, accountability and enhanced data availability.
ELSEVIER - Journal of Infection and Public Health, 2019
Influenza surveillance systems in the Eastern Mediterranean Region have been strengthened in the ... more Influenza surveillance systems in the Eastern Mediterranean Region have been strengthened in the past few years and 16 of the 19 countries in the Region with functional influenza surveillance systems report their influenza data to the EMFLU Network. This study aimed to investigate the epidemiology of circulating influenza viruses, causing SARI, and reported to the EMFLU during July 2016 to June 2018. Data included in this study were collected by 15 countries of the Region from 110 SARI sentinel surveillance sites over two influenza seasons. A total of 40,917 cases of SARI were included in the study. Most cases [20,551 (50.2%)] were less than 5 years of age. Influenza virus was detected in 3995 patients, 2849 (11.8%) were influenza A and1146 (4.8%) were influenza B. Influenza A(H1N1)pdm09 was the predominant circulating subtype with 1666 cases (58.5%). Other than influenza, respiratory syncytial virus was the most common respiratory infection circulating, with 277 cases (35.9%). Influenza viruses cause a high number of severe respiratory infections in EMR. It is crucial for the countries to continue improving their influenza surveillance capacity in order detect any unusual influenza activity or new strain that may cause a pandemic.
Oxford Academic - Journal of Public Health, 2019
Sentinel surveillance for severe acute respiratory infection (SARI) in Egypt began in 2006 and oc... more Sentinel surveillance for severe acute respiratory infection (SARI) in Egypt began in 2006 and occurs at eight sites. Avian influenza is endemic, and human cases of influenza A (H5N1) have been reported annually since 2006. This study aimed to describe the epidemiology of SARI at a major sentinel site in the country. Data included in the study were collected from a major SARI sentinel site in Egypt during three consecutive years (2013–15). A total of 1254 SARI patients conforming to the WHO case definition were admitted to the sentinel site, representing 5.6% of admitted patients for all causes and 36.6% of acute respiratory infection patients. A total of 99.7% of the patients were tested, and 21.04% tested positive; 48.7% of cases involved influenza A viruses, while 25% involved influenza B. The predominant age group was under 5 years of age, accounting for 443 cases. The seasonality of the influenza data conformed to the Northern Hemisphere pattern. The present study’s results show that SARI leads to substantial morbidity in Egypt. There is a great need for high-quality data from the SARI surveillance system in Egypt, especially with endemic respiratory threats such as influenza A (H5N1) in Egypt.
ELSEVIER - Journal of Infection and Public Health, 2019
Approximately half of the reported laboratory-confirmed infections of Middle East respiratory syn... more Approximately half of the reported laboratory-confirmed infections of Middle East respiratory syndrome coronavirus (MERS-CoV) have occurred in healthcare settings, and healthcare workers constitute over one third of all secondary infections. This study aimed to describe secondary cases of MERS-CoV infection among healthcare workers and to identify risk factors for death. Methods: A retrospective analysis was conducted on epidemiological data of laboratory-confirmed MERS-CoV cases reported to the World Health Organization from September 2012 to 2 June 2018. We compared all secondary cases among healthcare workers with secondary cases among non-healthcare workers. Multivariable logistic regression identified risk factors for death. Results: Of the 2223 laboratory-confirmed MERS-CoV cases reported to WHO, 415 were healthcare workers and 1783 were non-healthcare workers. Compared with non-healthcare workers cases, healthcare workers cases were younger (P < 0.001), more likely to be female (P < 0.001), non-nationals (P < 0.001) and asymptomatic (P < 0.001), and have fewer comorbidities (P < 0.001) and higher rates of survival (P < 0.001). Year of infection (2013-2018) and having no comorbidities were independent protective factors against death among secondary healthcare workers cases. Conclusion: Being able to protect healthcare workers from high threat respiratory pathogens, such as MERS-CoV is important for being able to reduce secondary transmission of MERS-CoV in healthcare-associated outbreaks. By extension, reducing infection in healthcare workers improves continuity of care for all patients within healthcare facilities.
ELSEVIER - Journal of Infection and Public Health, 2019
Influenza viruses with pandemic potential have been detected in humans in the Eastern Mediterrane... more Influenza viruses with pandemic potential have been detected in humans in the Eastern Mediterranean Region. The Pandemic Influenza Preparedness (PIP) Framework aims to improve the sharing of influenza viruses with pandemic potential and increase access of developing countries to vaccines and other life-saving products during a pandemic. Under the Framework, countries have been supported to enhance their capacities to detect, prepare for and respond to pandemic influenza. In the Eastern Mediterranean Region, seven countries are priority countries for Laboratory and Surveillance (L&S) support: Afghanistan,Djibouti, Egypt, Jordan, Lebanon, Morocco and Yemen. During 2014–2017, US$ 2.7 million was invested in regional capacity-building and US$ 4.6 million directly in the priority countries. Countries were sup-ported to strengthen influenza diagnostic capacities to improve detection, enhance influenza surveillance systems including sentinel surveillance for severe acute respiratory infection and influenza-like illness,and increase global sharing of surveillance data and influenza viruses. This paper highlights the progress made in improving influenza preparedness and response capacities in the Region from 2014 to 2017,and the challenges faced. By 2017, 18 of the 22 countries of the Region had laboratory-testing capacity,19 had functioning sentinel influenza surveillance systems and 22 had trained national rapid response teams. The number of countries correctly identifying all influenza viruses in the WHO external quality assurance panel increased from 9 countries scoring 100% in 2014 to 15 countries in 2017, and the number sharing influenza viruses with WHO collaborating centres increased by 75% (from eight to 14 countries);more than half now share influenza data with regional or global surveillance platforms. Seven countries have estimated influenza disease burden and seven have introduced influenza vaccination for high-riskg roups. Challenges included: protracted complex emergencies faced by nine countries which hindered implementation of influenza surveillance in areas with the most needs, high staff turnover, achieving timely virus sharing and limited utilization of influenza data where they are available to inform vaccine policies or establish threshold values to measure the start and severity of influenza seasons.
Viruses, 2018
Dromedary camels (Camelus dromedarius) are now known to be the vertebrate animal reservoir that i... more Dromedary camels (Camelus dromedarius) are now known to be the vertebrate animal reservoir that intermittently transmits the Middle East respiratory syndrome coronavirus (MERS-CoV) to humans. Yet, details as to the specific mechanism(s) of zoonotic transmission from dromedaries to humans remain unclear. The aim of this study was to describe direct and indirect contact with dromedaries among all cases, and then separately for primary, non-primary, and unclassified cases of laboratory-confirmed MERS-CoV reported to the World Health Organization (WHO) between 1 January 2015 and 13 April 2018. We present any reported dromedary contact: direct, indirect, and type of indirect contact. Of all 1125 laboratory-confirmed MERS-CoV cases reported to WHO during the time period, there were 348 (30.9%) primary cases, 455 (40.4%) non-primary cases, and 322 (28.6%) unclassified cases. Among primary cases, 191 (54.9%) reported contact with dromedaries: 164 (47.1%) reported direct contact, 155 (44.5%) reported indirect contact. Five (1.1%) non-primary cases also reported contact with dromedaries. Overall, unpasteurized milk was the most frequent type of dromedary product consumed. Among cases for whom exposure was systematically collected and reported to WHO, contact with dromedaries or dromedary products has played an important role in zoonotic transmission.
Frontiers in Public Health, 2017
The Eastern Mediterranean Region (EMR) of the World Health Organization (WHO) continues to be a h... more The Eastern Mediterranean Region (EMR) of the World Health Organization (WHO) continues to be a hotspot for emerging and reemerging infectious diseases and the need to prevent, detect, and respond to any infectious diseases that pose a threat to global health security remains a priority. Many risk factors contribute in the emergence and rapid spread of epidemic diseases in the Region including acute and protracted humanitarian emergencies, resulting in fragile health systems, increased population mobility, rapid urbanization, climate change, weak surveillance and limited laboratory diagnostic capacity, and increased human–animal interaction. In EMR, several infectious disease outbreaks were detected, investigated, and rapidly contained over the past 5 years including: yellow fever in Sudan, Middle East respiratory syndrome in Bahrain, Oman, Qatar, Saudi Arabia, United Arab Emirates, and Yemen, cholera in Iraq, avian influenza A (H5N1) infection in Egypt, and dengue fever in Yemen, Sudan, and Pakistan. Dengue fever remains an important public health concern, with at least eight countries in the region being endemic for the disease. The emergence of MERS-CoV in the region in 2012 and its continued transmission currently poses one of the greatest threats. In response to the growing frequency, duration, and scale of disease outbreaks, WHO has worked closely with member states in the areas of improving public health preparedness, surveillance systems, outbreak response, and addressing critical knowledge gaps. A Regional network for experts and technical institutions has been established to facilitate support for international outbreak response. Major challenges are faced as a result of protracted humanitarian crises in the region. Funding gaps, lack of integrated approaches, weak surveillance systems, and absence of comprehensive response plans are other areas of concern. Accelerated efforts are needed by Regional countries, with the continuous support of WHO, to build and maintain a resilient public health system for detection and response to all acute public health events.
Eastern Mediterranean Health Journal (EMHJ), 2013
The Eastern Mediterranean Region of World Health Organization has been an emerging focus for glob... more The Eastern Mediterranean Region of World Health Organization has been an emerging focus for global health after the discovery of a novel coronavirus infection in some countries in the Region. The Region has already witnessed a number of emerging zoonoses with epidemic potential. In view of this new virus, there is now an urgent need for strong public health vigilance and monitoring of the evolution of the virus in the Region. The situation will challenge and test the national health authorities' resilience and ability to respond in a timely manner. This review summarizes the evidence related to the emergence in the Region of new epidemic diseases of predominantly zoonotic origin and the challenges posed by the discovery of the novel coronavirus infection, and outlines recommendations for the countries for early detection, prevention and control of public health threats from this novel coronavirus infection.
Conference Presentations by Mohamed Elhakim
Background: The aim of this task is to assess the feasibility to establish a sentinel site for IL... more Background: The aim of this task is to assess the feasibility to establish a sentinel site for ILI and SARI surveillance including the influenza sample collection, shipment and transfer of samples for laboratory testing to a reference influenza laboratory in the WHO Eastern Mediterranean Region. Methods: The two sentinel sites proposed by the MoH namely Peltier hospital, a university hospital and Doctor Chakib hospital, a respiratory diseases hospital, were assessed using a WHO prescribed checklist for selection of sentinel sites for influenza surveillance. Results: The sentinel site selected was the Peltier hospital and the National Public Health Institute of Djibouti was identified as laboratory to ensure the virological diagnosis of influenza. In addition, an activity plan to use funds available under Pandemic Influenza Preparedness (PIP) for 2014-2015, was developed and agreed with the MoH and other stockholders involved in influenza surveillance. Conclusion: For successful implementation of ILI and SARI surveillance and to ensure its sustainability, it is necessary to use and build upon the existing MoH surveillance system. The implementation must be accompanied by training of medical personnel, laboratory workers and Epi-surveillance officers.
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Papers by Mohamed Elhakim
Conference Presentations by Mohamed Elhakim