Emerging and Re-emerging Infectious Diseases in the WHO Eastern Mediterranean Region, 2001-2018

Document Type : Review Article


1 Department of Epidemiology and Biostatistics, Research Centre for Emerging and Re-emerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran

2 Infectious Hazards Management, World Health Organization, Eastern Mediterranean Regional Office, Cairo, Egypt

3 Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College, London, UK

4 Department of Arboviruses and Viral Hemorrhagic Fevers, Research Centre for Emerging and Re-emerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran

5 Centre for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran

6 Office of Health Affairs, Ministry of Health, Muscat, Oman

7 Department of Animal Resources, Ministry of Municipality and Environment, Doha, Qatar

8 School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa

9 Ministry of Public Health, Doha, Qatar

10 Laboratory of Community Medicine, Preventive Medicine and Hygiene, Public Health Department, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco

11 Laboratory of Epidemiology, Biostatistics and Clinical Research, Public Health Department, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco

12 Department of Experimental Pathology, Immunology and Microbiology Center for Infectious Diseases Research, American University of Beirut & Medical Center, Beirut, Lebanon

13 University of Nebraska Medical Center, Omaha, NE, USA

14 Global Health Strategists & Implementers (GHSI), Islamabad, Pakistan

15 Infectious Hazard Management Department, World Health Organization, Kabul, Afghanistan

16 Communicable Diseases Control Department, Public Health Directorate Unit, Ministry of Health, Kuwait City, Kuwait

17 Centre for Public Health, Queen’s University Belfast, Belfast, UK


Countries in the World Health Organization (WHO) Eastern Mediterranean Region (EMR) are predisposed to highly contagious, severe and fatal, emerging infectious diseases (EIDs), and re-emerging infectious diseases (RIDs). This paper reviews the epidemiological situation of EIDs and RIDs of global concern in the EMR between 2001 and 2018.
To do a narrative review, a complete list of studies in the field was we prepared following a systematic search approach. Studies that were purposively reviewed were identified to summarize the epidemiological situation of each targeted disease. A comprehensive search of all published studies on EIDs and RIDs between 2001 and 2018 was carried out through search engines including Medline, Web of Science, Scopus, Google Scholar, and ScienceDirect.
Leishmaniasis, hepatitis A virus (HAV) and hepatitis E virus (HEV) are reported from all countries in the region. Chikungunya, Crimean Congo hemorrhagic fever (CCHF), dengue fever, and H5N1 have been increasing in number, frequency, and expanding in their geographic distribution. Middle East respiratory syndrome (MERS), which was reported in this region in 2012 is still a public health concern. There are challenges to control cholera, diphtheria, leishmaniasis, measles, and poliomyelitis in some of the countries. Moreover, Alkhurma hemorrhagic fever (AHF), and Rift Valley fever (RVF) are limited to some countries in the region. Also, there is little information about the real situation of the plague, Q fever, and tularemia.
EIDs and RIDs are prevalent in most countries in the region and could further spread within the region. It is crucial to improve regional capacities and capabilities in preventing and responding to disease outbreaks with adequate resources and expertise.


1. Woolhouse ME. Population biology of emerging and re-emerging pathogens. Trends Microbiol. 2002;10(10 Suppl):S3-7. doi:10.1016/s0966-842x(02)02428-9
2. Petersen E, Petrosillo N, Koopmans M. Emerging infections-an increasingly important topic: review by the Emerging Infections Task Force. Clin Microbiol Infect. 2018;24(4):369-375. doi:10.1016/j.cmi.2017.10.035
3. World Health Organization (WHO). The Work of WHO in the Eastern Mediterranean Region: Annual Report of the Regional Director 2014. World Health Organization. Regional Office for the Eastern Mediterranean; 2015.
4. Morens DM, Folkers GK, Fauci AS. The challenge of emerging and re-emerging infectious diseases. Nature. 2004;430(6996):242-249. doi:10.1038/nature02759
5. The World Bank. Population, Total. The World Bank; 2018. https://data.worldbank.org/indicator/SP.POP.TOTL.  Accessed February 24, 2018.
6. Dabrowski M, De Wulf L. Economic Development, Trade and Investment in the Eastern and Southern Mediterranean Region. SSRN Electronic Journal; 2013. doi:10.2139/ssrn.2202884
7. The World Bank. GDP Growth (Annual %). The World Bank; 2016. https://data.worldbank.org/indicator/NY.GDP.MKTP.KD.ZG.  Accessed February 24, 2018.
8. McMichael AJ. Global climate change and health: an old story writ large. In: Climate Change and Human Health: Risks and Responses. Geneva, Switzerland: WHO; 2003.
9. Mangold KA, Reynolds SL. A review of dengue fever: a resurging tropical disease. Pediatr Emerg Care. 2013;29(5):665-669. doi:10.1097/PEC.0b013e31828ed30e
10. Ahmed QA, Arabi YM, Memish ZA. Health risks at the Hajj. Lancet. 2006;367(9515):1008-1015. doi:10.1016/s0140-6736(06)68429-8
11. Koçarslan S, Turan E, Ekinci T, Yesilova Y, Apari R. Clinical and histopathological characteristics of cutaneous leishmaniasis in Sanliurfa city of Turkey including Syrian refugees. Indian J Pathol Microbiol. 2013;56(3):211-215. doi:10.4103/0377-4929.120367
12. Niazi AU, Jawad MJ, Amirnajad A, Durr PA, Williams DT. Crimean-Congo hemorrhagic fever, Herat province, Afghanistan, 2017. Emerg Infect Dis. 2019;25(8):1596-1598. doi:10.3201/eid2508.181491
13. Rauf M, Fatima Tuz Z, Manzoor S, Mehmood A, Bhatti S. Outbreak of chikungunya in Pakistan. Lancet Infect Dis. 2017;17(3):258. doi:10.1016/s1473-3099(17)30074-9
14. ProMED-mail. Chikungunya - Sudan (05): (Kassala) cases, health workers, MOH. ProMED-mail 2018; 16 Oct: 20181020.6095579. http://www.promedmail.org.  Accessed October 20, 2018.
15. Khalil I, Colombara DV, Forouzanfar MH, et al. Burden of diarrhea in the Eastern Mediterranean Region, 1990-2013: findings from the Global Burden of Disease Study 2013. Am J Trop Med Hyg. 2016;95(6):1319-1329. doi:10.4269/ajtmh.16-0339
16. Berger S. Infectious Diseases of Pakistan: 2017 Edition. GIDEON Informatics Inc; 2017.
17. World Health Organization (WHO). Diphtheria Reported Cases. Geneva: WHO; 2019. https://apps.who.int/immunization_monitoring/globalsummary/timeseries/tsincidencediphtheria.html.
18. Kayali G, Kandeil A, El-Shesheny R, et al. Avian influenza A(H5N1) virus in Egypt. Emerg Infect Dis. 2016;22(3):379-388. doi:10.3201/eid2203.150593
19. Mockenhaupt FP, Barbre KA, Jensenius M, et al. Profile of illness in Syrian refugees: a GeoSentinel analysis, 2013 to 2015. Euro Surveill. 2016;21(10):30160. doi:10.2807/1560-7917.es.2016.21.10.30160
20. Khan NH, Bari AU, Hashim R, et al. Cutaneous leishmaniasis in Khyber Pakhtunkhwa province of Pakistan: clinical diversity and species-level diagnosis. Am J Trop Med Hyg. 2016;95(5):1106-1114. doi:10.4269/ajtmh.16-0343
21. Reithinger R, Aadil K, Kolaczinski J, Mohsen M, Hami S. Social impact of leishmaniasis, Afghanistan. Emerg Infect Dis. 2005;11(4):634-636. doi:10.3201/eid1104.040945
22. Wagner AL, Mubarak MY, Johnson LE, Porth JM, Yousif JE, Boulton ML. Trends of vaccine-preventable diseases in Afghanistan from the Disease Early Warning System, 2009-2015. PLoS One. 2017;12(6):e0178677. doi:10.1371/journal.pone.017/8677
23. Alqahtani AS, Rashid H, Basyouni MH, Alhawassi TM, BinDhim NF. Public response to MERS-CoV in the Middle East: iPhone survey in six countries. J Infect Public Health. 2017;10(5):534-540. doi:10.1016/j.jiph.2016.11.015
24. Carias C, O'Hagan JJ, Jewett A, et al. Exportations of symptomatic cases of MERS-CoV infection to countries outside the Middle East. Emerg Infect Dis. 2016;22(4):723-725. doi:10.3201/eid2204.150976
25. Nowotny N, Kolodziejek J. Middle East respiratory syndrome coronavirus (MERS-CoV) in dromedary camels, Oman, 2013. Euro Surveill. 2014;19(16):20781. doi:10.2807/1560-7917.es2014.19.16.20781
26. Leslie T, Whitehouse CA, Yingst S, et al. Outbreak of gastroenteritis caused by Yersinia pestis in Afghanistan. Epidemiol Infect. 2011;139(5):728-735. doi:10.1017/s0950268810001792
27. Norris A, Hachey K, Curtis A, Bourdeaux M. Crippling violence: conflict and incident polio in Afghanistan. PLoS One. 2016;11(3):e0149074. doi:10.1371/journal.pone.0149074
28. WHO Eastern Mediterranean Region. Polio Eradication Initiative. WHO; 2019. http://www.emro.who.int/polio/countries.  Accessed January 16, 2019.
29. Faix DJ, Harrison DJ, Riddle MS, et al. Outbreak of Q fever among US military in western Iraq, June-July 2005. Clin Infect Dis. 2008;46(7):e65-68. doi:10.1086/528866
30. Saeed KMI, Ansari J, Asghar RJ, Ahadi J. Concurrent brucellosis and Q fever infection: a case control study in Bamyan province, Afghanistan in 2011. Int J Infect Dis. 2012;16:e37. doi:10.1016/j.ijid.2012.05.094
31. Asghar RJ. Hepatitis A and E: not to be forgotten. East Mediterr Health J. 2014;20(3):212-213. 
32. Rezig D, Ouneissa R, Mhiri L, et al. [Seroprevalences of hepatitis A and E infections in Tunisia]. Pathol Biol (Paris). 2008;56(3):148-153. doi:10.1016/j.patbio.2007.09.026
33. Bawazir AA, Hart CA, Sallam TA, Parry CM, Beeching NJ, Cuevas LE. Seroepidemiology of hepatitis A and hepatitis E viruses in Aden, Yemen. Trans R Soc Trop Med Hyg. 2010;104(12):801-805. doi:10.1016/j.trstmh.2010.08.007
34. Turky AM, Akram W, Al-Naaimi AS, Omer AR, Al-Rawi JR. Analysis of acute viral hepatitis (A and E) in Iraq. Glob J Health Sci. 2011;3(1):70-76. doi:10.5539/gjhs.v3n1p70
35. Darwish MA, Faris R, Clemens JD, Rao MR, Edelman R. High seroprevalence of hepatitis A, B, C, and E viruses in residents in an Egyptian village in The Nile Delta: a pilot study. Am J Trop Med Hyg. 1996;54(6):554-558. doi:10.4269/ajtmh.1996.54.554
36. Gebreel AO, Christie AB. Viral hepatitis in children: a study in Libya. Ann Trop Paediatr. 1983;3(1):9-11. doi:10.1080/02724936.1983.11748260
37. Bouskraoui M, Bourrous M, Amine M. [Prevalence of anti-hepatitis A virus antibodies in chidren in Marrakech]. Arch Pediatr. 2009;16 Suppl 2:S132-136. doi:10.1016/s0929-693x(09)75317-5
38. Ghasemian A. Prevalence of hepatitis A across various countries in the Middle East, African and Eastern European countries. Caspian J Intern Med. 2016;7(4):302-303.
39. Pröll S, Nothdurft HD. [The risk of contracting hepatitis A or hepatitis B run by visitors to the Mediterranean and Eastern Europe]. MMW Fortschr Med. 2004;146(20):51-54.
40. Bizri AR, Fares J, Musharrafieh U. Infectious diseases in the era of refugees: hepatitis A outbreak in Lebanon. Avicenna J Med. 2018;8(4):147-152. doi:10.4103/ajm.AJM_130_18
41. Miri SM, Alavian SM. Epidemiology of hepatitis a virus infections in Syria, 2017; war and asylum seekers: a global threat. Iran Red Crescent Med J. 2017;19(11):e63622. doi:10.5812/ircmj.63622
42. Esmaeilzadeh A, Ganji A, Bahari A, Goshayeshi L. Prevalence of hepatitis E in Iran: a systematic review of the literature. Rev Clin Med. 2017;4(4):152-159. doi:10.22038/rcm.2017.20169.1187
43. Kumar RM, Uduman S, Rana S, Kochiyil JK, Usmani A, Thomas L. Sero-prevalence and mother-to-infant transmission of hepatitis E virus among pregnant women in the United Arab Emirates. Eur J Obstet Gynecol Reprod Biol. 2001;100(1):9-15. doi:10.1016/s0301-2115(01)00448-1
44. Saad MD, Hussein HA, Bashandy MM, et al. Hepatitis E virus infection in work horses in Egypt. Infect Genet Evol. 2007;7(3):368-373. doi:10.1016/j.meegid.2006.07.007
45. Bryan JP, Iqbal M, Tsarev S, et al. Epidemic of hepatitis E in a military unit in Abbotrabad, Pakistan. Am J Trop Med Hyg. 2002;67(6):662-668. doi:10.4269/ajtmh.2002.67.662
46. Ayoola EA, Want MA, Gadour MO, Al-Hazmi MH, Hamza MK. Hepatitis E virus infection in haemodialysis patients: a case-control study in Saudi Arabia. J Med Virol. 2002;66(3):329-334. doi:10.1002/jmv.2149
47. Madani TA. Alkhumra virus infection, a new viral hemorrhagic fever in Saudi Arabia. J Infect. 2005;51(2):91-97. doi:10.1016/j.jinf.2004.11.012
48. Madani TA, Azhar EI, Abuelzein el TM, et al. Alkhumra (Alkhurma) virus outbreak in Najran, Saudi Arabia: epidemiological, clinical, and laboratory characteristics. J Infect. 2011;62(1):67-76. doi:10.1016/j.jinf.2010.09.032
49. Al-Tawfiq JA, Memish ZA. Alkhurma hemorrhagic fever virus. Microbes Infect. 2017;19(6):305-310. doi:10.1016/j.micinf.2017.04.004
50. Memish ZA, Fagbo SF, Osman Ali A, AlHakeem R, Elnagi FM, Bamgboye EA. Is the epidemiology of alkhurma hemorrhagic fever changing?: a three-year overview in Saudi Arabia. PLoS One. 2014;9(2):e85564. doi:10.1371/journal.pone.0085564
51. Carletti F, Castilletti C, Di Caro A, et al. Alkhurma hemorrhagic fever in travelers returning from Egypt, 2010. Emerg Infect Dis. 2010;16(12):1979-1982. doi:10.3201/eid1612.101092
52. Musso M, Galati V, Stella MC, Capone A. A case of Alkhumra virus infection. J Clin Virol. 2015;66:12-14. doi:10.1016/j.jcv.2015.02.019
53. Horton KC, Fahmy NT, Watany N, et al. Crimean Congo hemorrhagic fever virus and Alkhurma (Alkhumra) virus in ticks in Djibouti. Vector Borne Zoonotic Dis. 2016;16(10):680-682. doi:10.1089/vbz.2016.1951
54. Bahgat MM, Kutkat MA, Nasraa MH, et al. Characterization of an avian influenza virus H5N1 Egyptian isolate. J Virol Methods. 2009;159(2):244-250. doi:10.1016/j.jviromet.2009.04.008
55. Young SG, Kitchen A, Kayali G, Carrel M. Unlocking pandemic potential: prevalence and spatial patterns of key substitutions in avian influenza H5N1 in Egyptian isolates. BMC Infect Dis. 2018;18(1):314. doi:10.1186/s12879-018-3222-6
56. Kammon A, Heidari A, Dayhum A, et al. Characterization of avian influenza and Newcastle disease viruses from poultry in Libya. Avian Dis. 2015;59(3):422-430. doi:10.1637/11068-032215-ResNote.1
57. Abubakar A, Elkholy A, Barakat A, et al. Pandemic influenza preparedness (PIP) framework: Progress challenges in improving influenza preparedness response capacities in the Eastern Mediterranean Region, 2014-2017. J Infect Public Health. 2020;13(3):446-450. doi:10.1016/j.jiph.2019.03.006
58. World Health Organization (WHO). Cumulative Number of Confirmed Human Cases of Avian Influenza A(H5N1) Reported to WHO (2003-2016). WHO; 2016. http://www.who.int/influenza/human_animal_interface/H5N1_cumulative_table_archives/en/.  Accessed November 1, 2016.
59. World Health Organization (WHO). Avian Influenza A(H5N1) Situation Update, Egypt, September 2016. WHO; 2016. http://www.emro.who.int/surveillance-forecasting-response/surveillance-news/avian-influenza-ah5n1-situation-update-egypt-september-2016.html.  Accessed  November 1, 2016.
60. Alkhamis M, Hijmans RJ, Al-Enezi A, Martínez-López B, Perea AM. The use of spatial and spatiotemporal modeling for surveillance of H5N1 highly pathogenic avian influenza in poultry in the Middle East. Avian Dis. 2016;60(1 Suppl):146-155. doi:10.1637/11106-042115-Reg
61. Khan W, El Rifay AS, Malik M, Kayali G. Influenza research in the Eastern Mediterranean Region: a review. Oman Med J. 2017;32(5):359-364. doi:10.5001/omj.2017.70
62. Al-Abri SS, Abdel-Hady DM, Al Mahrooqi SS, Al-Kindi HS, Al-Jardani AK, Al-Abaidani IS. Epidemiology of travel-associated infections in Oman 1999-2013: a retrospective analysis. Travel Med Infect Dis. 2015;13(5):388-393. doi:10.1016/j.tmaid.2015.08.006
63. Humphrey JM, Cleton NB, Reusken C, Glesby MJ, Koopmans MPG, Abu-Raddad LJ. Urban chikungunya in the Middle East and North Africa: a systematic review. PLoS Negl Trop Dis. 2017;11(6):e0005707. doi:10.1371/journal.pntd.0005707
64. Malik MR, Mnzava A, Mohareb E, et al. Chikungunya outbreak in Al-Hudaydah, Yemen, 2011: epidemiological characterization and key lessons learned for early detection and control. J Epidemiol Glob Health. 2014;4(3):203-211. doi:10.1016/j.jegh.2014.01.004
65. Mansoor H. Alarming Rise in Chikungunya Virus Cases in Sindh. DAWN website. https://www.dawn.com/news/1357922. Published September 16, 2017.
66. World Health Organization (WHO). Weekly Epidemiological Monitor. WHO; 2017.
67. Al-Abri SS, Abaidani IA, Fazlalipour M, et al. Current status of Crimean-Congo haemorrhagic fever in the World Health Organization Eastern Mediterranean Region: issues, challenges, and future directions. Int J Infect Dis. 2017;58:82-89. doi:10.1016/j.ijid.2017.02.018
68. Wasfi F, Dowall S, Ghabbari T, et al. Sero-epidemiological survey of Crimean-Congo hemorrhagic fever virus in Tunisia. Parasite. 2016;23:10. doi:10.1051/parasite/2016010
69. Aziz TA, Ali DJ, Jaff DO. Molecular and serological detection of Crimean-Congo hemorrhagic fever virus in Sulaimani province, Iraq. J Biosci Med. 2016;4(4):36-42. doi:10.4236/jbm.2016.44006
70. Al-Abri SS, Hewson R, Al-Kindi H, et al. Molecular epidemiology and high mortality of Crimean-Congo hemorrhagic fever in Oman: a re-emerging infection. bioRxiv. 2018:502641. doi:10.1101/502641
71. Sahak MN, Arifi F, Saeedzai SA. Descriptive epidemiology of Crimean-Congo Hemorrhagic Fever (CCHF) in Afghanistan: reported cases to National Surveillance System, 2016-2018. Int J Infect Dis. 2019;88:135-140. doi:10.1016/j.ijid.2019.08.016
72. Mostafavi E, Haghdoost A, Khakifirouz S, Chinikar S. Spatial analysis of Crimean Congo hemorrhagic fever in Iran. Am J Trop Med Hyg. 2013;89(6):1135-1141. doi:10.4269/ajtmh.12-0509
73. Karim AM, Hussain I, Lee JH, Park KS, Lee SH. Surveillance of Crimean-Congo haemorrhagic fever in Pakistan. Lancet Infect Dis. 2017;17(4):367-368. doi:10.1016/s1473-3099(17)30119-6
74. Palomar AM, Portillo A, Santibáñez P, et al. Crimean-Congo hemorrhagic fever virus in ticks from migratory birds, Morocco. Emerg Infect Dis. 2013;19(2):260-263. doi:10.3201/eid1902.121193
75. Široký P, Bělohlávek T, Papoušek I, et al. Hidden threat of tortoise ticks: high prevalence of Crimean-Congo haemorrhagic fever virus in ticks Hyalomma aegyptium in the Middle East. Parasit Vectors. 2014;7:101. doi:10.1186/1756-3305-7-101
76. Al-Abri SS, Hewson R, Al-Kindi H, et al. Clinical and molecular epidemiology of Crimean-Congo hemorrhagic fever in Oman. PLoS Negl Trop Dis. 2019;13(4):e0007100. doi:10.1371/journal.pntd.0007100
77. Humphrey JM, Cleton NB, Reusken CB, Glesby MJ, Koopmans MP, Abu-Raddad LJ. Dengue in the Middle East and North Africa: a systematic review. PLoS Negl Trop Dis. 2016;10(12):e0005194. doi:10.1371/journal.pntd.0005194
78. Shahhosseini N, Chinikar S, Nowotny N, Fooks AR, Schmidt-Chanasit J. Genetic analysis of imported dengue virus strains by Iranian travelers. Asian Pac J Trop Dis. 2016;6(11):850-853. doi:10.1016/S2222-1808(16)61144-1
79. Al Awaidy ST, Khamis F. Dengue fever: an emerging disease in Oman requiring urgent public health interventions. Oman Med J. 2019;34(2):91-93. doi:10.5001/omj.2019.18
80. Humphrey JM, Al-Absi ES, Hamdan MM, et al. Dengue and chikungunya seroprevalence among Qatari nationals and immigrants residing in Qatar. PLoS One. 2019;14(1):e0211574. doi:10.1371/journal.pone.0211574
81. Doosti S, Yaghoobi-Ershadi MR, Schaffner F, et al. Mosquito surveillance and the first record of the invasive mosquito species Aedes (Stegomyia) albopictus (Skuse) (Diptera: Culicidae) in southern Iran. Iran J Public Health. 2016;45(8):1064-1073.
82. Ducheyne E, Tran Minh NN, Haddad N, et al. Current and future distribution of Aedes aegypti and Aedes albopictus (Diptera: Culicidae) in WHO Eastern Mediterranean Region. Int J Health Geogr. 2018;17(1):4. doi:10.1186/s12942-018-0125-0
83. Bouattour A, Khrouf F, Rhim A, M'Ghirbi Y. First detection of the Asian tiger mosquito, Aedes (Stegomyia) albopictus (Diptera: Culicidae), in Tunisia. J Med Entomol. 2019;56(4):1112-1115. doi:10.1093/jme/tjz026
84. Kanani K, Amr Z, Katbeh-Bader A, Arbaji M. First record of Aedes albopictus in Jordan. J Am Mosq Control Assoc. 2017;33(2):134-135. doi:10.2987/17-6641.1
85. Alghazali KA, Teoh BT, Loong SK, et al. Dengue outbreak during ongoing civil war, Taiz, Yemen. Emerg Infect Dis. 2019;25(7):1397-1400. doi:10.3201/eid2507.180046
86. World Health Organization (WHO). Measles, Fact Sheet. WHO; 2018. http://www.who.int/en/news-room/fact-sheets/detail/measles.  Accessed July 10, 2018.
87. Teleb N, Lebo E, Ahmed H, et al. Progress toward measles elimination--Eastern Mediterranean Region, 2008-2012. MMWR Morb Mortal Wkly Rep. 2014;63(23):511-515.
88. World Health Organization (WHO). Measles situation in Eastern Mediterranean Region; in: WHO Regional Office for Eastern Mediterranean Report. Vol 12. Cairo, Egypt: WHO; 2019.
89. Alwan A. The Cost of War. WHO; 2015. http://www.who.int/mediacentre/commentaries/war-cost/en/.  Accessed November 26, 2018.
90. ProMED-mail. Measles - Yemen (05): (Amran, Dhamar) fatal, increasing incidence. ProMED-mail 2018; 22 Dec: 20181223.6220714. http://www.promedmail.org.  Accessed December 23, 2018.
91. Raad, II, Chaftari AM, Dib RW, Graviss EA, Hachem R. Emerging outbreaks associated with conflict and failing healthcare systems in the Middle East. Infect Control Hosp Epidemiol. 2018;39(10):1230-1236. doi:10.1017/ice.2018.177
92. Mere MO, Goodson JL, Chandio AK, et al. Progress toward measles elimination-Pakistan, 2000-2018. MMWR Morb Mortal Wkly Rep. 2019;68(22):505-510. doi:10.15585/mmwr.mm6822a4
93. World Health Organization (WHO). Summary Report on the Meeting of the Eastern Mediterranean Regional Technical Advisory Group [RTAG] on Immunization, Muscat, Oman 14 December 2017. World Health Organization, Regional Office for the Eastern Mediterranean; 2018.
94. Zaki AM, van Boheemen S, Bestebroer TM, Osterhaus AD, Fouchier RA. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med. 2012;367(19):1814-1820. doi:10.1056/NEJMoa1211721
95. Hemida MG, Al-Naeem A, Perera RA, Chin AW, Poon LL, Peiris M. Lack of Middle East respiratory syndrome coronavirus transmission from infected camels. Emerg Infect Dis. 2015;21(4):699-701. doi:10.3201/eid2104.141949
96. Zumla A, Hui DS, Perlman S. Middle East respiratory syndrome. Lancet. 2015;386(9997):995-1007. doi:10.1016/s0140-6736(15)60454-8
97. World Health Organization (WHO). Investigation of Cases of Human Infection with Middle East Respiratory Syndrome Coronavirus (‎‎ MERS-Cov)‎‎: Interim Guidance. WHO; 2018.
98. Al-Abaidani IS, Al-Maani AS, Al-Kindi HS, et al. Overview of preparedness and response for Middle East respiratory syndrome coronavirus (MERS-CoV) in Oman. Int J Infect Dis. 2014;29:309-310. doi:10.1016/j.ijid.2014.10.003
99. WHO Eastern Mediterranean Regional office. MERS Situation Update. Vol 10. Cairo, Egypt: WHO; 2017.
100. Poletto C, Boëlle PY, Colizza V. Risk of MERS importation and onward transmission: a systematic review and analysis of cases reported to WHO. BMC Infect Dis. 2016;16(1):448. doi:10.1186/s12879-016-1787-5
101. Farag E, Sikkema RS, Vinks T, et al. Drivers of MERS-CoV emergence in Qatar. Viruses. 2018;11(1):22. doi:10.3390/v11010022
102. Moniri A, Marjani M, Tabarsi P, Yadegarynia D, Nadji SA. Health care associated Middle East respiratory syndrome (MERS): a case from Iran. Tanaffos. 2015;14(4):262-267.
103. Memish ZA, Zumla AI, Al-Hakeem RF, Al-Rabeeah AA, Stephens GM. Family cluster of Middle East respiratory syndrome coronavirus infections. N Engl J Med. 2013;368(26):2487-2494. doi:10.1056/NEJMoa1303729
104. Hunter JC, Nguyen D, Aden B, et al. Transmission of Middle East respiratory syndrome coronavirus infections in healthcare settings, Abu Dhabi. Emerg Infect Dis. 2016;22(4):647-656. doi:10.3201/eid2204.151615
105. World Health Organisation. MERS cluster in Wadi Aldwaser, Saudi Arabia Weekly Epidemiological Report. 2019;12(7).
106. Farag E, Nour M, Islam MM, et al. Qatar experience on One Health approach for Middle-East respiratory syndrome coronavirus, 2012-2017: A viewpoint. One Health. 2019;7:100090. doi:10.1016/j.onehlt.2019.100090
107. Chu DK, Poon LL, Gomaa MM, et al. MERS coronaviruses in dromedary camels, Egypt. Emerg Infect Dis. 2014;20(6):1049-1053. doi:10.3201/eid2006.140299
108. Ali M, El-Shesheny R, Kandeil A, et al. Cross-sectional surveillance of Middle East respiratory syndrome coronavirus (MERS-CoV) in dromedary camels and other mammals in Egypt, August 2015 to January 2016. Euro Surveill. 2017;22(11):30487. doi:10.2807/1560-7917.es.2017.22.11.30487
109. Mohran KA, Farag EA, Reusken CB, et al. The sample of choice for detecting Middle East respiratory syndrome coronavirus in asymptomatic dromedary camels using real-time reversetranscription polymerase chain reaction. Rev Sci Tech. 2016;35(3):905-911. doi:10.20506/rst.35.3.2578
110. Farag EA, Reusken CB, Haagmans BL, et al. High proportion of MERS-CoV shedding dromedaries at slaughterhouse with a potential epidemiological link to human cases, Qatar 2014. Infect Ecol Epidemiol. 2015;5:28305. doi:10.3402/iee.v5.28305
111. Yusof MF, Eltahir YM, Serhan WS, et al. Prevalence of Middle East respiratory syndrome coronavirus (MERS-CoV) in dromedary camels in Abu Dhabi Emirate, United Arab Emirates. Virus Genes. 2015;50(3):509-513. doi:10.1007/s11262-015-1174-0
112. Conzade R, Grant R, Malik MR, et al. Reported direct and indirect contact with dromedary camels among laboratory-confirmed MERS-CoV cases. Viruses. 2018;10(8). doi:10.3390/v10080425
113. Horton DL, McElhinney LM, Freuling CM, et al. Complex epidemiology of a zoonotic disease in a culturally diverse region: phylogeography of rabies virus in the Middle East. PLoS Negl Trop Dis. 2015;9(3):e0003569. doi:10.1371/journal.pntd.0003569
114. Abaidani IA, Abri SA, Prakash KP, Hussain MH, Hussain MH, Rawahi AH. Epidemiology of rabies in Oman: a retrospective study (1991-2013). East Mediterr Health J. 2015;21(8):591-597.
115. Bannazadeh Baghi H, Alinezhad F, Kuzmin I, Rupprecht CE. A perspective on rabies in the Middle East-beyond neglect. Vet Sci. 2018;5(3). doi:10.3390/vetsci5030067
116. Gautret P, Ribadeau-Dumas F, Parola P, Brouqui P, Bourhy H. Risk for rabies importation from North Africa. Emerg Infect Dis. 2011;17(12):2187-2193. doi:10.3201/eid1712.110300
117. Kassir MF, El Zarif T, Kassir G, Berry A, Musharrafieh U, Bizri AR. Human rabies control in Lebanon: a call for action. Epidemiol Infect. 2018;147:1-8. doi:10.1017/s095026881800300x
118. Outbreak of Rift Valley fever--Saudi Arabia, August-October, 2000. MMWR Morb Mortal Wkly Rep. 2000;49(40):905-908.
119. Madani TA, Al-Mazrou YY, Al-Jeffri MH, et al. Rift Valley fever epidemic in Saudi Arabia: epidemiological, clinical, and laboratory characteristics. Clin Infect Dis. 2003;37(8):1084-1092. doi:10.1086/378747
120. Awaidy SA, Al Hashami H. Zoonotic diseases in Oman: successes, challenges, and future directions. Vector Borne Zoonotic Dis. 2020;20(1):1-9. doi:10.1089/vbz.2019.2458
121. Hassan OA, Ahlm C, Evander M. A need for One Health approach-lessons learned from outbreaks of Rift Valley fever in Saudi Arabia and Sudan. Infect Ecol Epidemiol. 2014;4. doi:10.3402/iee.v4.20710
122. Hassan OA, Ahlm C, Sang R, Evander M. The 2007 Rift Valley fever outbreak in Sudan. PLoS Negl Trop Dis. 2011;5(9):e1229. doi:10.1371/journal.pntd.0001229
123. Fakour S, Naserabadi S, Ahmadi E. The first positive serological study on Rift Valley fever in ruminants of Iran. J Vector Borne Dis. 2017;54(4):348-352. doi:10.4103/0972-9062.225840
124. Arsevska E, Hellal J, Mejri S, et al. Identifying areas suitable for the occurrence of Rift Valley fever in North Africa: implications for surveillance. Transbound Emerg Dis. 2016;63(6):658-674. doi:10.1111/tbed.12331
125. Downs JW, Flood DT, Orr NH, Constantineau JA, Caviness JW. Sandfly fever in Afghanistan-a sometimes overlooked disease of military importance: a case series and review of the literature. US Army Med Dep J. 2017(3-17):60-66.
126. Feinsod FM, Ksiazek TG, Scott RM, et al. Sand fly fever-Naples infection in Egypt. Am J Trop Med Hyg. 1987;37(1):193-196. doi:10.4269/ajtmh.1987.37.193
127. Tesh RB, Saidi S, Gajdamovic SJ, Rodhain F, Vesenjak-Hirjan J. Serological studies on the epidemiology of sandfly fever in the Old World. Bull World Health Organ. 1976;54(6):663-674. 
128. Cohen R, Babushkin F, Shimoni Z, Shapiro M, Lustig Y. Sandfly virus encephalitis in Israel: two case reports and a review. J Neuroinfect Dis. 2017;8(1):240. doi:10.4172/2314-7326.1000240
129. Badakhshan M, Yaghoobi-Ershadi MR, Moin-Vaziri V, et al. Spatial distribution of phlebotomine sand flies (Diptera: Psychodidae) as phlebovirus vectors in different areas of Iran. J Med Entomol. 2018;55(4):846-854. doi:10.1093/jme/tjy033
130. Depaquit J, Pesson B, Augot D, Hamilton JG, Lawyer P, Léger N. Proceedings of the IX International Symposium on Phlebotomine Sandflies (ISOPS IX), Reims, France, June 28th-July 1st, 2016. Parasite. 2016;23:E1. doi:10.1051/parasite/2016051
131. Shiraly R, Khosravi A, Farahangiz S. Seroprevalence of sandfly fever virus infection in military personnel on the western border of Iran. J Infect Public Health. 2017;10(1):59-63. doi:10.1016/j.jiph.2016.02.014
132. Andayi F, Charrel RN, Kieffer A, et al. A sero-epidemiological study of arboviral fevers in Djibouti, Horn of Africa. PLoS Negl Trop Dis. 2014;8(12):e3299. doi:10.1371/journal.pntd.0003299
133. Failloux AB, Bouattour A, Faraj C, et al. Surveillance of arthropod-borne viruses and their vectors in the Mediterranean and Black Sea regions within the MediLabSecure Network. Curr Trop Med Rep. 2017;4(1):27-39. doi:10.1007/s40475-017-0101-y
134. Eybpoosh S, Fazlalipour M, Baniasadi V, et al. Epidemiology of West Nile Virus in the Eastern Mediterranean Region: a systematic review. PLoS Negl Trop Dis. 2019;13(1):e0007081. doi:10.1371/journal.pntd.0007081
135. World Health Organization. West Nile fever in Tunisia: update. In: World Health Organization ROfEM, ed. Weekly Epidemiological Monitor. Vol 11. Cairo, Egypt: World Health Organization, Regional Office for Eastern Mediterranean; 2018.
136. Jenabi E, Shirani F, Khazaei S. Alarm of circulating wild poliovirus and of vaccine-derived poliovirus in Middle East countries as a potential risk for re-emerging of polio in Iran. Int J Pediatr. 2019;7(3):9071-9073. doi:10.22038/ijp.2018.35530.3107
137. Mbaeyi C, Wadood ZM, Moran T, et al. Strategic response to an outbreak of circulating vaccine-derived poliovirus type 2-Syria, 2017-2018. MMWR Morb Mortal Wkly Rep. 2018;67(24):690-694. doi:10.15585/mmwr.mm6724a5
138. Kamadjeu R, Gathenji C. Designing and implementing an electronic dashboard for disease outbreaks response-case study of the 2013-2014 Somalia Polio outbreak response dashboard. Pan Afr Med J. 2017;27(Suppl 3):22. doi:10.11604/pamj.supp.2017.27.3.11062
139. Martinez M, Shukla H, Ahmadzai M, et al. Progress toward poliomyelitis eradication-Afghanistan, January 2017-May 2018. MMWR Morb Mortal Wkly Rep. 2018;67(30):833-837. doi:10.15585/mmwr.mm6730a6
140. Ali M, Lopez AL, You YA, et al. The global burden of cholera. Bull World Health Organ. 2012;90(3):209-218A. doi:10.2471/blt.11.093427
141. Bakhshi B, Boustanshenas M, Mahmoudi-aznaveh A. Emergence of Vibrio cholerae O1 classical biotype in 2012 in Iran. Lett Appl Microbiol. 2014;58(2):145-149. doi:10.1111/lam.12167
142. Deen J, Mengel MA, Clemens JD. Epidemiology of cholera. Vaccine. 2020;38 Suppl 1:A31-A40. doi:10.1016/j.vaccine.2019.07.078
143. Disease outbreaks in Eastern Mediterranean Region (EMR), January to December 2018. Weekly Epidemiological Monitor. 2018;2018(11):52.
144. Cholera situation in Eastern Mediterranean Region 2017. Weekly epidemiological monitor. 2018;2018(11):27.
145. Rabaan AA. Cholera: an overview with reference to the Yemen epidemic. Front Med. 2019;13(2):213-228. doi:10.1007/s11684-018-0631-2
146. Clarke KEN. Review of the Epidemiology of Diphtheria 2000-2016. Geneva: World Health Organization; 2016.
147. World Health Organization (WHO). Global Health Observatory Data Repository (Eastern Mediterranean Region), Diphtheria Reported Cases by Country. WHO; 2018. http://apps.who.int/gho/data/view.main-emro.1540_41?lang=en.
148. Ceyhan M, Anis S, Htun-Myint L, Pawinski R, Soriano-Gabarró M, Vyse A. Meningococcal disease in the Middle East and North Africa: an important public health consideration that requires further attention. Int J Infect Dis. 2012;16(8):e574-582. doi:10.1016/j.ijid.2012.03.011
149. Harrison LH, Pelton SI, Wilder-Smith A, et al. The Global Meningococcal Initiative: recommendations for reducing the global burden of meningococcal disease. Vaccine. 2011;29(18):3363-3371. doi:10.1016/j.vaccine.2011.02.058
150. Borrow R, Caugant DA, Ceyhan M, et al. Meningococcal disease in the Middle East and Africa: findings and updates from the Global Meningococcal Initiative. J Infect. 2017;75(1):1-11. doi:10.1016/j.jinf.2017.04.007
151. Hausdorff WP, Hajjeh R, Al-Mazrou A, Shibl A, Soriano-Gabarro M. The epidemiology of pneumococcal, meningococcal, and Haemophilus disease in the Middle East and North Africa (MENA) region--current status and needs. Vaccine. 2007;25(11):1935-1944. doi:10.1016/j.vaccine.2006.11.018
152. Leimkugel J, Racloz V, da Silva LJ, Pluschke G. Global review of meningococcal disease. A shifting etiology. Afr J Bacteriol Res. 2009;1(1):6-18. doi:10.5897/jbr.9000024
153. Cabanel N, Leclercq A, Chenal-Francisque V, et al. Plague outbreak in Libya, 2009, unrelated to plague in Algeria. Emerg Infect Dis. 2013;19(2):230-236. doi:10.3201/eid1902.121031
154. Tarantola A, Mollet T, Gueguen J, Barboza P, Bertherat E. Plague outbreak in the Libyan Arab Jamahiriya. Euro Surveill. 2009;14(26):19258.
155. Malek MA, Bitam I, Drancourt M. Plague in Arab Maghreb, 1940-2015: a review. Front Public Health. 2016;4:112. doi:10.3389/fpubh.2016.00112
156. Esamaeili S, Azadmanesh K, Naddaf SR, Rajerison M, Carniel E, Mostafavi E. Serologic survey of plague in animals, Western Iran. Emerg Infect Dis. 2013;19(9):1549-1551. doi:10.3201/eid1909.121829
157. Hashemi Shahraki A, Carniel E, Mostafavi E. Plague in Iran: its history and current status. Epidemiol Health. 2016;38:e2016033. doi:10.4178/epih.e2016033
158. Esmaeili S, Naddaf SR, Pourhossein B, et al. Seroprevalence of brucellosis, leptospirosis, and Q fever among butchers and slaughterhouse workers in south-eastern Iran. PLoS One. 2016;11(1):e0144953. doi:10.1371/journal.pone.0144953
159. Esmaeili S, Golzar F, Ayubi E, Naghili B, Mostafavi E. Acute Q fever in febrile patients in northwestern of Iran. PLoS Negl Trop Dis. 2017;11(4):e0005535. doi:10.1371/journal.pntd.0005535
160. Bailey MS, Trinick TR, Dunbar JA, et al. Undifferentiated febrile illnesses amongst British troops in Helmand, Afghanistan. J R Army Med Corps. 2011;157(2):150-155. doi:10.1136/jramc-157-02-05
161. Almogren A, Shakoor Z, Hasanato R, Adam MH. Q fever: a neglected zoonosis in Saudi Arabia. Ann Saudi Med. 2013;33(5):464-468. doi:10.5144/0256-4947.2013.464
162. Grace D, Mutua F, Ochungo P, et al. Mapping of Poverty and Likely Zoonoses Hotspots. Nairobi, Kenya: Department for International Development; 2012.
163. Vanderburg S, Rubach MP, Halliday JE, Cleaveland S, Reddy EA, Crump JA. Epidemiology of Coxiella burnetii infection in Africa: a OneHealth systematic review. PLoS Negl Trop Dis. 2014;8(4):e2787. doi:10.1371/journal.pntd.0002787
164. Esmaeili S, Gooya MM, Shirzadi MR, et al. Seroepidemiological survey of tularemia among different groups in western Iran. Int J Infect Dis. 2014;18:27-31. doi:10.1016/j.ijid.2013.08.013
165. Hepburn MJ, Simpson AJ. Tularemia: current diagnosis and treatment options. Expert Rev Anti Infect Ther. 2008;6(2):231-240. doi:10.1586/14787210.6.2.231
166. Rohani M, Mohsenpour B, Ghasemi A, et al. A case report of human tularemia from Iran. Iran J Microbiol. 2018;10(4):250-253.
167. Mostafavi E, Shahraki AH, Japoni-Nejad A, et al. A field study of plague and tularemia in rodents, Western Iran. Vector Borne Zoonotic Dis. 2017;17(4):247-253. doi:10.1089/vbz.2016.2053
168. Montagna M, Chouaia B, Pella F, et al. Screening for bacterial DNA in the hard tick Hyalomma marginatum (Ixodidae) from Socotra Island (Yemen): detection of Francisella-like endosymbiont. J Entomol Acarol Res. 2012;44(3):e13. doi:10.4081/jear.2012.e13
169. Ghoneim NH, Abdel-Moein KA, Zaher HM. Molecular detection of Francisella spp. among ticks attached to camels in Egypt. Vector Borne Zoonotic Dis. 2017;17(6):384-387. doi:10.1089/vbz.2016.2100
170. Alvar J, Vélez ID, Bern C, et al. Leishmaniasis worldwide and global estimates of its incidence. PLoS One. 2012;7(5):e35671. doi:10.1371/journal.pone.0035671
171. Piroozi B, Moradi G, Alinia C, et al. Incidence, burden, and trend of cutaneous leishmaniasis over four decades in Iran. Iran J Public Health. 2019;48(Suppl 1):28-35.
172. World Health Organization (WHO). Leishmaniasis. WHO; 2018. https://www.who.int/news-room/fact-sheets/detail/leishmaniasis.  Accessed December 2018, 2018.
173. Rassi Y, Javadian E, Nadim A, et al. Phlebotomus perfiliewi transcaucasicus, a vector of Leishmania infantum in northwestern Iran. J Med Entomol. 2009;46(5):1094-1098. doi:10.1603/033.046.0516
174. AlSamarai AM, AlObaidi HS. Cutaneous leishmaniasis in Iraq. J Infect Dev Ctries. 2009;3(2):123-129. doi:10.3855/jidc.59
175. Khatri ML, Di Muccio T, Fiorentino E, Gramiccia M. Ongoing outbreak of cutaneous leishmaniasis in northwestern Yemen: clinicoepidemiologic, geographic, and taxonomic study. Int J Dermatol. 2016;55(11):1210-1218. doi:10.1111/ijd.13310
176. Aoun K, Bouratbine A. Cutaneous leishmaniasis in North Africa: a review. Parasite. 2014;21:14. doi:10.1051/parasite/2014014
177. Ali A, Ur Rehman T, Qureshi NA, Ur Rahman H. New endemic focus of cutaneous leishmaniasis in Pakistan and future epidemics threats. Asian Pac J Trop Dis. 2016;6(2):155-159. doi:10.1016/S2222-1808(15)61003-9
178. Khalil MI, Bahnass MM, Abdallah MIM. Epidemiological and serological study of leishmaniasis in Najran Region, Saudi Arabia. J Biol Life Sci. 2017;8(1):59-71. doi:10.5296/jbls.v8i1.10793
179. Al-Salem WS, Pigott DM, Subramaniam K, et al. Cutaneous leishmaniasis and conflict in Syria. Emerg Infect Dis. 2016;22(5):931-933. doi:10.3201/eid2205.160042
180. Rehman K, Walochnik J, Mischlinger J, Alassil B, Allan R, Ramharter M. Leishmaniasis in northern Syria during civil war. Emerg Infect Dis. 2018;24(11):1973-1981. doi:10.3201/eid2411.172146
181. Du R, Hotez PJ, Al-Salem WS, Acosta-Serrano A. Old world cutaneous leishmaniasis and refugee crises in the Middle East and North Africa. PLoS Negl Trop Dis. 2016;10(5):e0004545. doi:10.1371/journal.pntd.0004545
182. ProMED-mail. Leishmaniasis, cutaneous - Libya: (MR), 2018; 13 April:  20180413.5742538. http://www.promedmail.org.  Accessed April 10, 2018.
183. Buliva E, Elhakim M, Tran Minh NN, et al. Emerging and reemerging diseases in the World Health Organization (WHO) Eastern Mediterranean Region-progress, challenges, and WHO initiatives. Front Public Health. 2017;5:276. doi:10.3389/fpubh.2017.00276
184. World Health Organization (WHO). Summary Report on the Intercountry Meeting on the Strategic Framework for Prevention and Control of Emerging and Epidemic-Prone Diseases in the Eastern Mediterranean Region, Amman, Jordan 16-19 December 2018. World Health Organization. Regional Office for the Eastern Mediterranean;2019.
185. WHO Regional Office for the Eastern Mediterranean. Strategic framework for the prevention and control of emerging and Epidemic-Prone diseases in the Eastern Mediterranean Region. WHO Regional Office for the Eastern Mediterranean; 2019.
186. Annual disease outbreak reports, Infectious disease outbreaks reported in the Eastern Mediterranean Region in 2016, 2017, and 2018. http://www.emro.who.int/pandemic-epidemic-diseases/information-resources/annual-disease-outbreak-reports.html
187. Federspiel F, Ali M. The cholera outbreak in Yemen: lessons learned and way forward. BMC Public Health. 2018;18(1):1338. doi:10.1186/s12889-018-6227-6
188. Aungkulanon S, McCarron M, Lertiendumrong J, Olsen SJ, Bundhamcharoen K. Infectious disease mortality rates, Thailand, 1958-2009. Emerg Infect Dis. 2012;18(11):1794-1801. doi:10.3201/eid1811.120637
189. Christou L. The global burden of bacterial and viral zoonotic infections. Clin Microbiol Infect. 2011;17(3):326-330. doi:10.1111/j.1469-0691.2010.03441.x
190. WHO Regional Office for the Eastern Mediterranean, Implementation of the IHR 2005 in the Region with focus on Ebola virus diseases. East Mediterr Health J. 2015;21(10):773-775.
191. Milinovich GJ, Williams GM, Clements AC, Hu W. Internet-based surveillance systems for monitoring emerging infectious diseases. Lancet Infect Dis. 2014;14(2):160-168. doi:10.1016/s1473-3099(13)70244-5
192. Brownstein JS, Freifeld CC, Madoff LC. Digital disease detection--harnessing the Web for public health surveillance. N Engl J Med. 2009;360(21):2153-2155, 2157. doi:10.1056/NEJMp0900702
193. Seimenis A, Battelli G. Main challenges in the control of zoonoses and related foodborne diseases in the South Mediterranean and Middle East region. Vet Ital. 2018;54(2):97-106. doi:10.12834/VetIt.1340.7765.1
194. Mahrous H, Redi N, Nguyen TMN, Al Awaidy S, Mostafavi E, Samhouri D. One Health operational framework for action for the Eastern Mediterranean Region, focusing on zoonotic diseases. East Mediterr Health J. 2020;26(6):720-725. doi:10.26719/emhj.20.017
195. Bandura A. The social and policy impact of social cognitive theory. In: Mark MM, Donaldson SI, Campbell B, eds. Social Psychology and Evaluation. The Guilford Press; 2011:33-70.
196. Alvar J, Vélez ID, Bern C, et al. Leishmaniasis worldwide and global estimates of its incidence. PLoS One. 2012;7(5):e35671. doi:10.1371/journal.pone.0035671
197. Almogren A, Shakoor Z, Hasanato R, Adam MH. Q fever: a neglected zoonosis in Saudi Arabia. Ann Saudi Med. 2013;33(5):464-468. doi:10.5144/0256-4947.2013.464
198. Zargar A, Maurin M, Mostafavi E. Tularemia, a re-emerging infectious disease in Iran and neighboring countrie. Epidemiol Health. 2015;37:e2015011. doi:10.4178/epih/e2015011