Introduction: During the global coronavirus 2019 (COVID-19) pandemic, there were multiple reports of burnout among healthcare workers. A series of spikes in COVID-19 cases in Qatar led to increased efforts to track down, isolate, and test the close contacts of confirmed positive cases. The Department of Health Protection and Communicable Disease Control of the Ministry of Public Health (MOPH) established the Track and Trace (T&T) team at five different geographical locations in Qatar from March 2020 to December 2022. The aim of the present study was to examine the degree of burnout among MOPH nurses working in the T&T team in Qatar. Methods: A cross-sectional study was conducted among 105 nurses from a total of 258 members of the swabbing team across five T&T field stations from October 1 to October 20, 2021. The degree of burnout—specifically personal accomplishment (PA), depersonalization (DEP), and emotional exhaustion (EE)—was measured using the Maslach Burnout Inventory-Health Services Survey. Descriptive statistics, including frequency, percentages, mean, and standard deviation, were used to define participant profiles. Analysis of Variance (ANOVA) and Scheffe’s test were used to determine significant variations in burnout scores across participants’ profile categories at the 5% significance level. Analysis of Variance (ANOVA) was used to identify a significant relationship between participant profiles and burnout levels. Scheffe’s test was then performed to determine which pairs of burnout score means differ significantly at the 5% level Results: A total of 101 nurses were eligible for and enrolled in the analysis. The majority were female ( n = 69, 68%), married, aged 31–40 years (74%), and Filipino ( n = 39, 39%) or Indian ( n = 38, 38%) nationals. Most were living with their families ( n = 86, 85%). Additionally, most of them had more than 10 years of professional experience and had been part of the T&T swabbing field team for over 11 months. The nurses in the T&T team exhibited an average burnout level ranging from low to moderate. Regarding the three domains of burnout, 81% of nurses had low EE ( n = 82%, x = 12.8, SD = 9.25), 48% had low DEP ( n = 49%, x = 5.56, SD = 4.64), and 50% had a moderate level of PA ( n = 51%, x = 38.01, SD = 7.26). Filipino nurses and those categorized under “other nationalities” reported higher levels of EE and DEP compared to Indian nurses. Conclusion: Despite the multiple surges of COVID-19 cases in Qatar and the physical and emotional stress they caused among nurses in the swabbing field, only low to moderate burnout was recorded. Furthermore, the results showed no substantial correlation between lack of PA and EE, regardless of gender or nationality, or between DEP and nationality. To successfully manage burnout among nurses in the T&T swabbing field teams, periodic burnout evaluations and debriefing were proposed.

Objectives:To identify key risk factors, disease patterns, and prevention interventions for communicable diseases among migrant populations. Study design:Systematic review and meta-analysis. Methods:Following PRISMA 2020 guidelines, we searched multiple databases for studies published 1990-2024. Random effects models estimated pooled odds ratios from 30 studies with quantitative data. Results:Among 14,250 participants, migration status doubled communicable disease odds (OR = 2.161, 95% CI 1.780-2.622, p < 0.001; I2 = 58.7%). Regional variation was significant for the Gulf Cooperation Council (OR = 2.89, 95% CI 2.34-3.57) and Sub-Saharan Africa (OR = 1.87, 95% CI 1.45-2.41), but not for Europe (OR = 1.34, 95% CI 0.98-1.83). Forced migration showed highest risk (OR = 2.87, 95% CI 2.23-3.69) versus economic migration (OR = 1.89, 95% CI 1.54-2.32). Conclusions:Migration constitutes a fundamental social determinant of communicable disease risk. Downstream interventions (treatment 86.8%, surveillance 78.1%) vastly outnumber upstream approaches (community-based 2.6%, policy 0.9%), representing a critical implementation gap. Context-specific, migration-aware health systems addressing structural determinants are urgently needed.

Background:Tuberculosis (TB) remained the deadliest infectious disease in 2023, with 8.2 million newly diagnosed cases-the highest number recorded since 1995. In Qatar, the estimated TB incidence was 37 per 100,000 population in 2024. This review aimed to identify gaps in TB research conducted in Qatar and inform future research priorities. Methods:PubMed, Scopus, Web of Science, and the Cochrane Library were systematically searched using relevant Medical Subject Headings (MeSH) terms and keywords. Peer-reviewed original research articles on TB with data from Qatar published between 1993 and 2022 were included, while reviews and editorials were excluded. Results:Thirty-six studies met the inclusion criteria. Most were retrospective observational studies focusing on extrapulmonary TB and used nonprobability purposive sampling. The most common research theme was clinical and diagnostic research. Conclusion:Key research gaps include the evaluation of TB treatment, the epidemiology of drug-resistant TB, and delays in TB diagnosis. The absence of studies on pediatric TB highlights the need to prioritize this population. Strengthening TB research in Qatar will require dedicated funding and a focus on underexplored and high-priority areas.

Preventing local transmission of malaria from imported cases is crucial for achieving and maintaining malaria elimination. This study aimed to investigate the epidemiological characteristics of imported malaria cases and assess the distribution of malaria vectors in Qatar. Data from January 2016 to December 2022 on imported malaria, including demographic and epidemiological characteristics, travel-related information, and diagnostic results, were collected and analysed using descriptive statistics. Field surveys conducted in 2021-22 collected mosquitoes using various traps across Qatar. The collected samples underwent morphological and molecular characterization at Qatar University. A total of 2693 cases were reported, with a mean incidence of 13.5/100 000 population, decreasing from 18.8/100 000 in 2016 to 5.5/100 000 in 2020. Most cases were Plasmodium vivax (57.4%) followed by P. falciparum (40.4%). The median age was 32.9 +/- 12.5 years, primarily males (86.7%), expatriates (99.6%) and notified during the hot months (July to September). Cases were mainly imported from the Eastern Mediterranean Region followed by the African and South-East Asia Region with no deaths and indigenous cases. Anopheles stephensi was identified as a widely distributed species, but none carried the Plasmodium pathogen. Despite no reports of local transmission, the presence of An. stephensi and favourable environmental conditions pose a risk in Qatar. Strengthening surveillance for imported malaria and reviewing epidemic protocols are necessary. Conventional field studies are imperative to address knowledge gaps in Anopheles mosquito ecology and biting habits in Qatar, accurately assessing the risk of local malaria transmission to support Qatar's malaria-free status.

Coxiellosis, a zoonotic bacterial infection caused by Coxiella burnetii, affects diverse mammalian hosts and is prevalent worldwide, including in South Asia. This study aimed to investigate the epidemiology of Coxiellosis in South Asia, focusing on distribution, host diversity, prevalence, and associated risk factors at the human-animal-environment interface. Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines and a registered protocol, online searches were conducted in Embase, PubMed, Scopus, and Web of Science on August 6, 2023, to retrieve articles from the South Asian countries without restrictions on hosts or timeframe. Two authors independently reviewed, extracted data, and assessed quality based on predefined criteria, which were then evaluated and compiled into a single document and analyzed. The review identified 112 articles published between 1954 and 2023. Among humans, the estimated pooled seroprevalence (EPSP) was 9.2%, and the estimated pooled carrier prevalence (EPCP) was 6.2%. Ruminant herd-level EPSP and EPCP were 77.3% and 74.6%, and at the individual level, were 11.9% and 5.3%, respectively. Seroprevalence was significantly influenced by country, tick infestation, reproductive disorders, age, and body condition of ruminants. Nonruminant mammals, such as dogs (16.8%), horses (6.0%), pigs (3.9%), and rodents (14.8%), were also seropositive. Several avian and reptile species showed EPSP rates of 14.5% and 29.2%, respectively. Bacterial DNA was detected in ticks and soil samples, with EPCP of 1.0% and 3.3%, respectively. We recommend prioritizing One Health surveillance and intervention to prevent infections among humans, livestock, poultry, pets, and wildlife. Special emphasis should be placed on aged and emaciated animals, tick infestations, and animals with reproductive disorders.

Hepatitis C virus (HCV) infection poses a global health challenge, yet its epidemiology in Qatar remains underexplored. This study estimated HCV antibody (Ab) prevalence in Qatar and examined associated socio-demographic factors. From January 2017 to December 2019, the Ministry of Public Health conducted a national HCV awareness and surveillance campaign. A total of 81,615 individuals, including both Qatari nationals and expatriate residents from 137 countries, underwent HCV antibody testing using the Elecsys Anti-HCV II electrochemiluminescence immunoassay. Probability weights were applied to adjust for age, sex, and nationality, to the testing sample. Logistic regression assessed factors associated with HCV Ab positivity. Among individuals tested, 1149 were positive, 80,299 were negative, and 167 were indeterminate. The estimated HCV Ab prevalence in the study sample was 1.4% (95% CI 1.3-1.5%). The weighted HCV Ab prevalence in the resident population of Qatar was also estimated at 1.4% (95% CI 1.2-1.7%). HCV Ab positivity was strongly associated with age, with higher adjusted odds ratios (AORs) in older individuals. Disparities were noted among certain nationalities, with Bangladeshis and Tunisians having lower odds of infection, while Pakistanis, Egyptians, and Yemenis had higher odds of being infected. Males had a 1.97-fold (95% CI 1.47-2.65) higher odds of being HCV Ab positive compared to females. The considerable HCV Ab prevalence in Qatar underscores the need for targeted interventions, prevention and harm reduction strategies, and expanded testing and treatment programs to advance progress toward the 2030 elimination target.

Despite global initiatives to eliminate dog-mediated human rabies by 2030, the Arabian Peninsula faces challenges due to insufficient data. This review addresses the current rabies situation and knowledge gaps in the region and proposes One Health interventions. Employing a mixed-method approach combining scoping and systematic review, the study commenced with a Delphi discussion to identify knowledge gaps and set objectives. The literature search encompassed published articles and grey literature. The spatial and temporal distribution of rabies was analysed, alongside quantitative meta-analyses to assess prevalence. Rabies virus gene sequences from the NCBI database were examined for reservoir hosts and evolutionary patterns. The final Delphi discussion with experts focused on addressing knowledge gaps and formulating One Health interventions. The first reported human rabies case in this region occurred in Saudi Arabia in 1980. Yemen reported the highest number of cases (439), followed by Iraq (249), Saudi Arabia (91), Jordan (14), and Oman (9). Fox bites accounted for the most cases (47.4%), followed by dog (36.8%) and wild animal (15.8%) bites. The virus was detected in at least 21 animal species. Phylogenetic analysis detected a single strain with two clades, with foxes being the primary virus reservoir. However, the experts expressed scepticism about the accuracy of rabies reports in scientific literature. To achieve the 2030 goal of eliminating dog-mediated human rabies, a stepwise approach towards rabies elimination assessment is crucial in the region. Enhanced surveillance, awareness campaigns, and access to post exposure prophylaxis are essential to address the disease burden.

BACKGROUND:The Gulf Cooperation Council region hosts large numbers of migrant workers, which has important implications for public health. Studies have documented varied disease risks among these populations. This paper examines risk factors for communicable diseases among migrant workers in this region. It darws on a social-ecological model to explore the interplay of individual, social, environmental, and structural factors. The paper also outlines policy areas where action may strengthen public health outcomes. METHODS:This study conducted a systematic review following PRISMA guidelines. We searched PubMed, Scopus, Embase, Web of Science, CINAHL, and Global Health. We identified 113 records through database searches, screened 72 unique records after duplicate removal, and assessed 24 at full-text for eligibility. Extracted data were managed using standardized Excel-based forms, cross-checked for accuracy, and synthesised narratively by grouping studies according to disease type and risk-factor domains following established guidance. We applied co-occurrence analysis of risk factors across studies. Data synthesis used a narrative approach to compare findings across heterogeneous study designs, focusing on recurring patterns in reported. RESULTS:Co-occurrence analysis using Pearson correlations, Jaccard coefficients, and phi coefficients (bootstrap 95% CIs) showed susbtantial convergent validity. Healthcare access and language barriers each appeared frequently alongside labour camps. Crowded conditions were often linked with low awareness. Migration from endemic countries showed little overlap with occupational exposure. CONCLUSIONS:Communicable disease risks among migrant workers in the GCC arise from multiple, interacting factors. Healthcare access barriers and labour camp housing repeatedly emerged among the most prominent co-occurring risk factors. Communicable disease risks among migrant workers in the GCC largely reflect structural conditions, particularly housing, healthcare access, and legal and occupational vulnerabilities, highlighting the need for coordinated regional policies that strengthen surveillance, improve living conditions, and expand equitable access to care.

Rodents are known reservoirs for a diverse group of zoonotic pathogens that can pose a threat to human health. Therefore, it is crucial to investigate these pathogens to institute prevention and control measures. To achieve this, the current study was conducted to investigate the frequency of different parasites in commensal rodents in Qatar. A total of 148 rodents, including Rattus norvegicus, Rattus rattus, and Mus musculus were captured using traps placed in different habitats such as agricultural and livestock farms, residential areas, and other localities. Blood, feces, ectoparasite, and visceral organs were collected for gross, microscopic, immunological, and molecular analysis. The study identified 10 different parasites, including Capillaria annulosa, Eimeria spp., Giardia spp., Hymenolepis diminuta, Mastophorus muris, Ornithonyssus bacoti, Taenia taeniaeformis, Toxoplasma gondii, Trypanosoma lewisi, and Xenopsylla astia. Overall, 62.2% of the rodents tested positive for at least one parasite species. Helminths were found to be the most prevalent parasites (46.0%), followed by ectoparasites (31.8%), and protozoa (10.1%). However, individually, X. astia was the most prevalent (31.8%), whereas C. annulosa was the least common (0.7%). The prevalence of X. astia and H. diminuta significantly differed between habitats (p < 0.05). The sequence analysis of Hymenolepis spp. was closely related to the previously reported H. diminuta in Iran, China, and Mexico. In conclusion, the study identified a diverse range of rodent-borne parasites that are important to public health, with most of them being recorded for the first time among commensal rodents in Qatar.

African nations have experienced various environmental and anthropological changes, including climate change, natural disasters, food safety issues, and increased industrial waste. These changes have increased the risk of emerging endemic microorganisms and intensified the transmission and impact of existing endemic communicable diseases (ECDs). This paper reviews the literature on the repercussions of ECDs, such as malaria, neglected tropical diseases (NTDs), human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), tuberculosis (TB), and viral hepatitis diseases (VHD) in Africa. The narrative review involved an extensive search of published articles and grey literature on these selected ECDs in Africa between January 2000 and December 2022. Through case studies on malaria, NTDs, HIV/AIDS, TB, and VHD, the effects of these ECDs on public health, economic development, and social systems in Africa were demonstrated, as they continue to be major causes of morbidity and mortality in the African region. It was emphasized that underlying social and economic factors contribute to the vulnerabilities associated with these diseases. In conclusion, providing services through community care workers can improve families’ trust, awareness of social support, and recognition of domestic vulnerabilities.

Background Coronavirus disease (COVID-19) is a highly infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and it has resulted in a global pandemic. The COVID-19 pandemic has resulted in numerous reports on clinical outcomes and risk factors associated with morbidity and mortality. However, the extent to which nationality influences the severity of COVID-19 is not fully understood. Therefore, this study aimed to explore disparities in COVID-19 severity among individuals of different nationalities in Qatar. Methods This is a retrospective study. Secondary data were obtained from the Ministry of Public Health in Qatar. Patients of different nationalities were categorized into different groups based on the WHO regional classification, and the severity of COVID-19 across these groups was analyzed. Results Data were obtained for 96,728 patients. This study found a statistically significant difference in disease severity among nationalities. The highest number of patients were from the Eastern Mediterranean group (42.3%), followed by Southeast Asia (39.4%). The severity of COVID-19 was highest among the Eastern Mediterranean groups (40%), followed by those from Southeast Asia (38.5%) and the Western Pacific (12.4%). There was a significant correlation between disease severity and vaccination status. Conclusion The findings of this study provide novel perspectives on the severity of COVID-19 among individuals of various nationalities. Moreover, it emphasizes the importance of healthcare interventions to address disparities in COVID-19 morbidity and mortality within these groups. The results of this study provide a useful foundation for developing approaches to prevent and manage pandemics more effectively and reduce the number of cases and fatalities during future health crises.

One Health is increasingly recognized as an optimal approach to address the global risk of health threats originating at the human, animal, and ecosystem interface, and their impact. Qatar has successfully practiced One Health approach for investigation and surveillance of zoonotic diseases such as MERS-CoV, and other health threats. However, the current gaps at institution and policy level hinder the sustainment of One Health. In this paper, we have assessed the potential for implementation of One Health Framework to reinforce and sustain One Health capacities in Qatar for 2022–2027. To implement One Health Framework in the country, Qatar Joint External Evaluation (JEE) report, lessons learnt during One Health experiences on zoonotic, vector-borne, and food borne diseases were used to present an outline for multisectoral coordination. In addition, technical capacities of One Health and factors that are required to operationalize it in the country were also assessed in series of meetings and workshops held at Ministry of Public Health on March 2022. Present health care infrastructure and resources were found to be conducive for effective management and response to shared health threats as evident during MERS-CoV, despite being more event based. Regardless, the need for more sustainable capacity development was unanimously emphasized. The consensus between all relevant stakeholders and partners was that there is a need for better communication channels, policies and protocols for data sharing, and the need to invest more resources for better sustainability. The proposed framework is expected to strengthen and facilitate multilateral coordination, enhanced laboratory capacity and network, improve active surveillance and response, risk communication, community engagement, maximize applied research, and build One Health technical work force. This would enable advancement and sustainment of One Health activities to prevent and control health threats shared between humans-animals-ecosystem interface.

The increasing frequency of spillover of zoonotic pathogens from animals to humans in recent years highlights a need to develop a more comprehensive framework to investigate and prevent pathogens of animal origin, including rodents. Despite the presence of several species of rodents, there is a certain knowledge gap regarding rodent-borne zoonoses in Qatar. The current review provides an update on rodent-borne zoonoses in Qatar, its possible drivers and transmission dynamics, and proposed a One Health framework for intervention. Following an extensive literature review, we conducted a field investigation. Then the qualitative information and knowledge gaps were addressed with a virtual discussion with national, regional, and international experts in the relevant field. Overall, Rattus norvegicus population was found to be more prevalent, followed by Rattus rattus, and M. musculus, which are mainly found in animal farms, followed by agricultural farms, residential areas, and other facilities. Over 50% of rodents carry at least one pathogen of public health importance. Several pathogens were identified at the human, animal, and ecosystem interface, which can be mediated in transmission by rodents. E. coli, Salmonella spp., and Campylobacter spp. are the frequently reported bacteria. Hymenolepis spp., Cryptosporidium spp., Giardia spp., Entamoeba spp., and Toxoplasma spp. are the major parasites. In addition, many vectors, including Ornithonyssus bacoti and Xenopsylla astia were reported in this country. Based on the changes over the past 70 years in Qatar, seven drivers have been identified, which could be important in rodent-borne disease emergences, such as the Oil and gas revolution, fast population growth, rapid urbanization, importation of food and agricultural products, agricultural and livestock development, farm biosecurity, and stray animals. The experts emphasized that mixed-species animal farming with poor biosecurity and management can be associated to increase the risk of zoonoses. Moreover, rapid urbanization and global climate change together can alter the ecosystem of the country and impact on vectors and vector-borne diseases. Finally, the One Health framework has been proposed for the surveillance, and mitigation of any future spillover or epidemic of rodent-borne zoonoses.

Monkeypox (Mpox) was mostly limited to Central and Western Africa, but recently it has been reported globally. The current review presents an update on the virus, including ecology and evolution, possible drivers of transmission, clinical features and management, knowledge gaps, and research priorities to reduce the disease transmission. The origin, reservoir(s) and the sylvatic cycle of the virus in the natural ecosystem are yet to be confirmed. Humans acquire the infection through contact with infected animals, humans, and natural hosts. The major drivers of disease transmission include trapping, hunting, bushmeat consumption, animal trade, and travel to endemic countries. However, in the 2022 epidemic, the majority of the infected humans in non-endemic countries had a history of direct contact with clinical or asymptomatic persons through sexual activity. The prevention and control strategies should include deterring misinformation and stigma, promoting appropriate social and behavioural changes, including healthy life practices, instituting contact tracing and management, and using the smallpox vaccine for high-risk people. Additionally, longer-term preparedness should be emphasized using the One Health approach, such as systems strengthening, surveillance and detection of the virus across regions, early case detection, and integrating measures to mitigate the socio-economic effects of outbreaks.

Rodents serve as an important reservoir or carrier of zoonotic pathogens on a global scale [...].

This study assessed the association between multimorbidity and mortality from COVID-19 in the Middle East and North Africa region, where such data are scarce. We conducted a cross-sectional study using data of all cases with COVID-19 reported to the Ministry of Public Health of Qatar from March to September 2020. Data on pre-existing comorbidities were collected using a questionnaire and multimorbidity was defined as having at least two comorbidities. Proportions of deaths were compared by comorbidity and multimorbidity status and multivariable logistic regression analyses were carried out. A total of 92,426 participants with a mean age of 37.0 years (SD 11.0) were included. Mortality due to COVID-19 was associated with gastrointestinal diseases (aOR 3.1, 95% CI 1.16–8.30), respiratory diseases (aOR 2.9, 95% CI 1.57–5.26), neurological diseases (aOR 2.6, 95% CI 1.19–5.54), diabetes (aOR 1.8, 95% CI 1.24–2.61), and CVD (aOR 1.5, 95% CI 1.03–2.22). COVID-19 mortality was strongly associated with increasing multimorbidity; one comorbidity (aOR 2.0, 95% CI 1.28–3.12), two comorbidities (aOR 2.8, 95% CI 1.79–4.38), three comorbidities (aOR 6.0, 95% 3.34–10.86) and four or more comorbidities (aOR 4.15, 95% 1.3–12.88). This study demonstrates a strong association between COVID-19 mortality and multimorbidity in Qatar.

There is limited seroepidemiological evidence on the magnitude and long-term durability of antibody titers of mRNA and non-mRNA vaccines in the Qatari population. This study was conducted to generate evidence on long-term anti-S IgG antibody titers and their dynamics in individuals who have completed a primary COVID-19 vaccination schedule. A total of 300 male participants who received any of the following vaccines BNT162b2/Comirnaty, mRNA-1273, ChAdOx1-S/Covishield, COVID-19 Vaccine Janssen/Johnson, or BBIBP-CorV or Covaxin were enrolled in our study. All sera samples were tested by chemiluminescent microparticle immunoassay (CMIA) for the quantitative determination of IgG antibodies to SARS-CoV-2, receptor-binding domain (RBD) of the S1 subunit of the spike protein of SARS-CoV-2. Antibodies against SARS-CoV-2 nucleocapsid (SARS-CoV-2 N-protein IgG) were also determined. Kaplan–Meier survival curves were used to compare the time from the last dose of the primary vaccination schedule to the time by which anti-S IgG antibody titers fell into the lowest quartile (range of values collected) for the mRNA and non-mRNA vaccines. Participants vaccinated with mRNA vaccines had higher median anti-S IgG antibody titers. Participants vaccinated with the mRNA-1273 vaccine had the highest median anti-S-antibody level of 13,720.9 AU/mL (IQR 6426.5 to 30,185.6 AU/mL) followed by BNT162b2 (median, 7570.9 AU/mL; IQR, 3757.9 to 16,577.4 AU/mL); while the median anti-S antibody titer for non-mRNA vaccinated participants was 3759.7 AU/mL (IQR, 2059.7–5693.5 AU/mL). The median time to reach the lowest quartile was 3.53 months (IQR, 2.2–4.5 months) and 7.63 months (IQR, 6.3–8.4 months) for the non-mRNA vaccine recipients and Pfizer vaccine recipients, respectively. However, more than 50% of the Moderna vaccine recipients did not reach the lowest quartile by the end of the follow-up period. This evidence on anti-S IgG antibody titers should be considered for informing decisions on the durability of the neutralizing activity and thus protection against infection after the full course of primary vaccination in individuals receiving different type (mRNA verus non-mRNA) vaccines and those with natural infection.

AbstractMonkeypox (Mpox) was mostly limited to Central and Western Africa, but recently it has been reported globally. The current review presents an update on the virus, including ecology and evolution, possible drivers of transmission, clinical features and management, knowledge gaps, and research priorities to reduce the disease transmission. The origin, reservoir(s) and the sylvatic cycle of the virus in the natural ecosystem are yet to be confirmed. Humans acquire the infection through contact with infected animals, humans, and natural hosts. The major drivers of disease transmission include trapping, hunting, bushmeat consumption, animal trade, and travel to endemic countries. However, in the 2022 epidemic, the majority of the infected humans in non-endemic countries had a history of direct contact with clinical or asymptomatic persons through sexual activity. The prevention and control strategies should include deterring misinformation and stigma, promoting appropriate social and behavioral changes, including healthy life practices, instituting contact tracing and management, and using the smallpox vaccine for high-risk people. Additionally, longer-term preparedness should be emphasized using the One Health approach, such as systems strengthening, surveillance and detection of the virus across regions, early case detection, and integrating measures to mitigate the socio-economic effects of outbreaks.

There is inconclusive evidence whether pregnancy exacerbates COVID-19 symptoms or not, and scarce data from the Middle East and North Africa region. The aim of this study was to investigate the association between pregnancy and COVID-19 symptoms in Qatar. This cross-sectional study was carried out using data of all women with confirmed COVID-19, comparing women of child-bearing age (18-49 years). Data of all COVID-19 cases were collected by the Ministry of Public Health (MoPH) in Qatar, between March and September 2020. Symptoms were compared by pregnancy status and classified into moderate and severe. Multivariable logistic and Poisson regression was carried out to investigate the association between pregnancy and severity of COVID-19 symptoms. During the study period, 105 744 individuals were diagnosed with COVID-19, of which 16 908 were women of childbearing age. From that sample, 799 women were pregnant (mean age 29.9 years (SD 5.2)) and 16109 women were not pregnant (mean age 33.1 years (SD 7.8)). After multivariable logistic regression, pregnancy was associated with 1.4-fold higher odds of reporting any symptoms of COVID-19 (OR 1.41, 95% CI 1.18-1.68), and 1.3-fold higher odds of reporting shortness of breath (OR 1.29, 95% CI 1.02-1.63). In a multivariable Poisson regression, pregnancy was also associated with a higher count of symptoms (IRR 1.03, 95%CI 0.98-1.08), although with weak evidence against the null hypothesis. Our findings suggest that, in this setting, pregnant women are more likely to have symptomatic COVID-19, and shortness of breath, compared to women with no pregnancy.