Due to the emergence of the SARS-CoV-2 B.1.1.7 (Alpha) variant in the UK in 2020 and its risk of increased transmission, the Ministry of Health in Tunisia implemented a sequencing surveillance strategy for SARS-CoV-2. The aim of this study was to analyze SARS-CoV-2 genomic surveillance data in Tunisia (January 2021–February 2022) and to assess the implementation of the sequencing strategy for SARS-CoV-2 in accordance with national recommendations and the guidance for SARS-CoV-2 genomic surveillance for public health goals. A descriptive study of all sequenced RT-PCR samples sequenced (January 2021–February2022). An internal audit was also done to assess the compliance against standards covering national recommendations and the Guidance for SARS-CoV-2 genomic surveillance for public health goals. A total of 12 simple or composite requirements related to the following areas were included in the audit standards: sampling (one requirements); data collection/analysis (six requirements); partnership (one requirement); and ethical considerations (one requirement). A total of 4819 samples were sent to laboratories and 4278 samples were sequenced. A total of 3648 samples were classified. Positive variants of concern (VOC) samples were 80.92%, differentiated as follows: Alpha, 40.24%; Beta, 0.24%; Gamma, 0.03%; Delta, 45.26%; and Omicron, 14.19%. Three principal phases of VOCs per ISO-week were shown: Alpha 3/2021–25/2021; Delta 26/2021–2/2022; and Omicron 3/2022–6/2022. Levels of compliance were identified; from a total of 12 requirements, 7 were considered as “not met”, 4 as “partially met”, and 1 as “fully met” but including not totally achieved objectives. In conclusion, the internal audit of the national SARS-CoV-2 sequencing strategy revealed an overall “not met” level of compliance. The results offered a trigger to collaborate with all stakeholders to develop a surveillance strategy for early detection and response to outbreaks caused by VOCs.

Background Tunisia was one of the most affected nations with COVID-19 disease. The clinical features of this illness range from asymptomatic illness to death. Aim To analyse the survival of patients admitted to a Tunisian tertiary care center (Sahloul University Hospital) and identify independent predictive factors for hospital COVID-19 mortality. Methods A longitudinal study was conducted among confirmed COVID-19 patients hospitalized in Sahloul University Hospital between September 2020 and September 2022. Cox univariate regression was used to calculate the Hazard Ratio (HR) of death for patient characteristics regarding the time at risk. Risk factors with a p value of 0.2 or less in the univariate analysis were initially included in the multivariate Cox regression models. Results During the study at Sahloul Hospital, 1978 patients were hospitalized, averaging 55.65 years in age (± 21.39). Among them, 417 deaths occurred, with a median survival of 30 days (± 3.11) [23.904-36.096]. Factors significantly affecting the survival curve were: Age, male gender, comorbidities, diabetes, hypertension, endocrine diseases, obesity, intubation, and ICU admission Multilevel survival analyses revealed that hypertension (aHR 1.24; CI [1.02-1.52]; p=0.028), ICU admission (aHR 12.20- CI [9.56-15.57]; p<10-3), and male gender (HR 1.19; CI [0.98-1.46]; p=0.076) were independent factors associated with COVID-19 mortality. Conclusion Our study concluded the importance of the early identification of high-risk COVID-19 patients to decrease this virus mortality. A good understanding of the possible clinical factors associated with COVID-19 severity is helpful for clinicians in identifying patients who are at high risk and require prioritized treatment to minimize death.

On July 27th and 29th, 2022, the Prevention and Safety of Care Department at Sahloul University Hospital was alerted to an outbreak of invasive infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). The infections were reported in three departments: Post Serious Operations (PSO), Surgical Resuscitation, and Orthopedics. This case study examines the outbreak, focusing on the epidemiological investigation, environmental The teaching approach involves a systematic methodology for conducting outbreak investigations and implementing infection control strategies in a university hospital. Students will describe cases by time, person, and place, and prepare synoptic charts. They will also evaluate adherence to standard hygiene precautions and interpret data from figures and tables, leading to recommendations for corrective actions. This epidemic involved three cases of patients with intrinsic (comorbidities) and extrinsic (invasive procedures: gastrostomy, vascular catheterization, urinary catheter) risk factors. The three isolated strains had the same antibiotype characterized by resistance to all antibiotics except Fosfomycin and colistin. The environmental survey didn´t monitor any Klebsiella pneumoniae in the three patients´ environments. From the six criteria of the standard hygiene precautions, 16 observations were tested in the audit, from which (10; 62.5%) were respected in the Surgical Resuscitation department, (8; 50%) in the PSO department and (2; 12.5%) in orthopedic department. This investigation highlights the need for a proactive surveillance system and strict adherence to infection control measures to prevent the spread of CRKP.

Introduction: Tunisia has made substantial and steady progress in the field of health, enabling considerable improvements in the population-health in general and child health in particular. Aim: This study examines the percentage of infants<5years with acute respiratory illness (ARI) symptoms in the last two weeks and focuses on the use antibiotics. Methods: Our work was based on the Tunisian Multiple Indicator Cluster Surveys (MICS) conducted in 2006(June-August)and 2018(march-May). To collect information about infants<5years, mothers/caretakers were interviewed. A child was considered to have an ARI if he had, during the specified period a coughing and difficult breathing which symptoms were perceived to be due to a chest problem, or both a chest problem and a blocked nose. Results: The number of households surveyed were respectively 8681 and 11225 in 2006 and 2018. The response rate increased from 95.4% to 97.8. The number of infants included went from 3053 in 2006 to 3420 in 2018. The percentage of infants with ARI symptoms in the last two weeks decreased from 6.1% to 6%. The percentage was higher in urban areas in 2006 (6.3vs5.6) and in the rural areas in 2018(7.7% vs. 5%). The age group most affected was 6 to 11 months along the years, with a percentage of 9.8% in 2006 and 8.4% in 2018. In 20018, the percentage of children with ARI symptoms in the last two weeks who had received antibiotics was 65.4%, with a sex ratio (m/f) of 1.08. Infants in urban areas were most affected : 71.4%. Conclusion: Our study showed the high percent of ARI in Tunisian infants and highlights the excessive use of antibiotics.

Context: Tunisia was one of the most affected nations with COVID-19 disease. The clinical features of this illness ranged from asymptomatic illness to death. Aim: To analyse the survival of patients admitted to a Tunisian tertiary care center (Sahloul University Hospital) and identify independent risk factors for hospital COVID-19 mortality. Methods: A longitudinal study was conducted among confirmed COVID -19 patients hospitalized in Sahloul University Hospital between September 2020 and September 2022. Cox univariate regression was used to calculate the Hazard Ratio (HR) of death for patient characteristics regarding the time at risk. Risk factors with a p value of 0.2 or less in the univariate analysis were initially included in the multivariate Cox regression models. Results: During the study at Sahloul Hospital, 1978 patients were hospitalized, averaging 55.65 years in age (± 21.39). Among them, 417 deaths occurred, with a median survival of 30 days (± 3.11) [23.904- 36.096]. Factors significantly affecting the survival curve were : Age, male gender, comorbidities, diabetes, hypertension, endocrine diseases, obesity, intubation, and ICU admission Multilevel survival analyses revealed that hypertension (aHR 1.24; CI [1.02- 1.52]; p=0.028), ICU admission (aHR 12.20- CI [9.56- 15.57]; p<10-3), and male gender (HR 1.19; CI [0.98- 1.46]; p=0.076) were independent factors associated with COVID-19 mortality. Conclusion: Our study concluded the importance of the early identification of high-risk COVID-19 patients to decrease this virus mortality.