The treatment of brain tuberculomas is primarily medical. Surgery, excision or biopsy, is general... more The treatment of brain tuberculomas is primarily medical. Surgery, excision or biopsy, is generally performed when the diagnosis is in doubt or there is no response to medical therapy. The aim of this study was to determine the radiological evolution of intracranial tuberculomas under standard anti-tuberculous drug therapy and to establish guidelines for better management of these patients. Eighteen patients were studied retrospectively. None of them had surgical intervention and all were treated by standard antituberculous drugs and had serial computed tomography (CT) scans until disappearance or stabilization of brain lesions. The regression of lesions' size and number was slow in the first month (mean 27.3%) then became rapid after this (215% to 220% per month). A paradoxical increase in size was noted in three patients in the first month. All three had associated meningitis. All tuberculomas disappeared on CT scan after 12 months of therapy. Most of the edema images disappeared by 6 months. This study would suggest that a long treatment regimen of 15-18 months may not be necessary in most intracranial tuberculomas occurring in non-immunocompromised patients. It also demonstrates that medical trial in well tolerated suspected cases should last for at least 2 months before considering other etiologies or surgical exploration.
International Journal of Infectious Diseases, 2005
Objective: To determine if screening family members of patients with acute brucellosis will enhan... more Objective: To determine if screening family members of patients with acute brucellosis will enhance the detection rate of brucellosis and also to determine the relationship between symptoms and brucella serology. Materials and methods: Family members from patients with acute brucellosis were interviewed and serologically screened. All seropositive family members were clinically and serologically followed for six months. Results: Twenty-five acute brucellosis patients and their 178 family members were enrolled from January 2001 to February 2002. Of the 178 family members, 40 (23%) manifested various symptoms, 138 (77%) were asymptomatic, with an overall seroprevalence rate of 34 (19%). The rate of seropositivity among the symptomatic family members was 23 (58%) and for the asymptomatic was 11 (8%) (P < 0.001). The majority of the symptomatic family members (13 (57%)) had a high Brucella titer in comparison to one (9%) of the asymptomatic group (P < 0.001). Acute brucellosis was diagnosed and treated in 18 (78%) of the symptomatic seropositive family members and in four (36%), of the asymptomatic seropositive family members with an acute brucellosis prevalence rate of 22 (12%). All family members with acute infection recovered without sequelae; one patient relapsed (5%).
Isolated reports of brucellosis among family members have been documented. The aim of this study ... more Isolated reports of brucellosis among family members have been documented. The aim of this study is to determine if active serological screening of the households' members of acute brucellosis cases will detect additional unrecognized cases. From May 2000 to October 2001, patients with acute brucellosis were enrolled and their household members were serologically screened for brucellosis using the Standard Agglutination Test (SAT). Fifty-five index cases with acute brucellosis and 404 household members were enrolled. The majority of index cases (48 %) were young adults, and 79% were illiterate. Ownership of animals and ingestion of unpasteurized raw milk were reported by 45 and 75% of the index cases respectively. Of the 55 families screened, 23 (42 %) had two family members or more with serological evidence of brucellosis and 32 (58 %) had only the index case. Households of o5 members and a history of raw-milk ingestion by family members were risk factors associated with the seropositives (P<0 . 05). Of the 404 household members screened, 53 (13 %) were seropositive ; of these 39 (74 %) were symptomatic, and 9 (35 %) had brucella bacteraemia. Symptomatic seropositives tended to have bacteraemia and higher brucella antibody titres compared to asymptomatic seropositives (Pf0 . 05). Screening family members of an index case of acute brucellosis will detect additional cases.
The Saudi Arabian Ministry of Health implemented a pro-active surveillance programme for Middle E... more The Saudi Arabian Ministry of Health implemented a pro-active surveillance programme for Middle East respiratory syndrome (MERS) coronavirus (MERS-CoV). We report MERS-CoV data from 5065 Kingdom of Saudi Arabia individuals who were screened for MERS-CoV over a 12-month period. From 1 October 2012 to 30 September 2013, demographic and clinical data were prospectively collected from all laboratory forms received at the Saudi Arabian Virology reference laboratory. Data were analysed by referral type, age, gender, and MERS-CoV real-time PCR test results. Five thousand and 65 individuals were screened for MER-CoV: hospitalized patients with suspected MERS-CoV infection (n = 2908, 57.4%), healthcare worker (HCW) contacts (n = 1695; 33.5%), and family contacts of laboratory-confirmed MERS cases (n = 462; 9.1%). Eleven per cent of persons tested were children (<17 years of age). There were 108 cases (99 adults and nine children) of MERS-CoV infection detected during the 12-month period (108/5065, 2% case detection rate). Of 108 cases, 45 were females (six children and 39 adults) and 63 were males (three children and 60 adults). Of the 99 adults with MERS-CoV infection, 70 were hospitalized patients, 19 were HCW contacts, and ten were family contacts. There were no significant increases in MERS-CoV detection rates over the 12-month period: 2.patients had a significantly higher MERS-CoV infection rate (63/2318, 2.7%) than females (45/2747, 1.6%) (p 0.013). MERS-CoV rates remain at low levels, with no significant increase over time. Pro-active surveillance for MERS-CoV in newly diagnosed patients and their contacts will continue.
Background. Analysis of clinical samples from patients with new viral infections is critical to c... more Background. Analysis of clinical samples from patients with new viral infections is critical to confirm the diagnosis, to specify the viral load, and to sequence data necessary for characterizing the viral kinetics, transmission, and evolution. We analyzed samples from 112 patients infected with the recently discovered Middle East respiratory syndrome coronavirus (MERS-CoV).
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, Jan 13, 2015
During the 2012 Hajj season, the acquisition risk of Staphylococcus aureus nasal carriage in a co... more During the 2012 Hajj season, the acquisition risk of Staphylococcus aureus nasal carriage in a cohort of French pilgrims was 22.8%, statistically associated with the acquisition of viral respiratory pathogens (P =0.03). The carriage of S. aureus belonging to the emerging clonal complex 398 significantly increased following the pilgrimage (P < 0.05).
Influenza is an important health hazard among Hajj pilgrims. For the last ten years, pilgrims are... more Influenza is an important health hazard among Hajj pilgrims. For the last ten years, pilgrims are being recommended to take influenza vaccine before attending Hajj. Vaccination coverage has increased in recent years, but whether there has been any change in the prevalence of influenza-like illness (ILI) is not known. In this analysis, we examined the changes in the rate of ILI against seasonal influenza vaccine uptake among Hajj pilgrims over the last decade. Data for this analysis is a synthesis of raw and published data from eleven Hajj seasons between 2005 and 214. For seven Hajj seasons the data were obtained from studies involving pilgrims of UK, Saudi Arabia and Australia; and for the remaining four Hajj seasons data were abstracted from published studies involving pilgrims from multiple countries. The data from both sources were synthesised to estimate the relative risk (RR) of acquisition of ILI in vaccinated versus unvaccinated pilgrims. The pooled sample size of the included studies was 33,213 with most pilgrims being in the age band of 40-60 years (range: 0.5 to 95 years) and a male to female ratio of 1.6. The pilgrims originated, in order of frequency, from Iran, Australia, France, UK, Saudi Arabia, Indonesia, India, Algeria, Ivory Coast, Nigeria, Somalia, Turkey, Syria, Sierra Leone and USA. Except for one year (2008), data from individual years did not demonstrate a noticeable change in the rate of ILI against influenza vaccine coverage, however the combined data from all studies suggest that the prevalence of ILI decreased among Hajj pilgrims as the vaccine coverage increased over the last decade (RR 0.2, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). This analysis suggests that influenza vaccine might be beneficial for Hajj pilgrims. However, controlled trials aided by molecular diagnostic tools could confirm whether such an effect is real or ostensible.
International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, Jan 25, 2015
Rabies is endemic in animals in the Arabian Peninsula. Although Saudi Arabia is the largest count... more Rabies is endemic in animals in the Arabian Peninsula. Although Saudi Arabia is the largest country in the peninsula, little has been published about rabies situation in the country. A total of 11069 animal bites to human were reported during the 2007-2009 and 40 animals suspect of rabies were examined for rabies infection from 2005 through 2010. Results suggest that animal-related injuries in Saudi Arabia remains a public health problem with feral dogs accounting for the majority of bites to humans and for the majority of animals found to be rabid. Over the last 10 years no confirmed human rabies cases have been reported. More detailed information about the epidemiology of animal bites and that of animal rabies in Saudi Arabia would be of great interest, notably to provide elements on which vaccination recommendation could be made for the numerous international travelers visiting the country.
The emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in 2012 result... more The emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in 2012 resulted in an increased concern of the spread of the infection globally. MERS-CoV infection had previously caused multiple health-care-associated outbreaks and resulted in transmission of the virus within families. Community onset MERS-CoV cases continue to occur. Dromedary camels are currently the most likely animal to be linked to human MERS-CoV cases. Serologic tests showed significant infection in adult camels compared to juvenile camels. The control of MERS-CoV infection relies on prompt identification of cases within health care facilities, with institutions applying appropriate infection control measures. In addition, determining the exact route of transmission from camels to humans would further add to the control measures of MERS-CoV infection.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Jan 15, 2014
There is a paucity of data regarding the differentiating characteristics of patients with laborat... more There is a paucity of data regarding the differentiating characteristics of patients with laboratory-confirmed and those negative for Middle East respiratory syndrome coronavirus (MERS-CoV). This is a hospital-based case-control study comparing MERS-CoV-positive patients (cases) with MERS-CoV-negative controls. A total of 17 case patients and 82 controls with a mean age of 60.7 years and 57 years, respectively (P = .553), were included. No statistical differences were observed in relation to sex, the presence of a fever or cough, and the presence of a single or multilobar infiltrate on chest radiography. The case patients were more likely to be overweight than the control group (mean body mass index, 32 vs 27.8; P = .035), to have diabetes mellitus (87% vs 47%; odds ratio [OR], 7.24; P = .015), and to have end-stage renal disease (33% vs 7%; OR, 7; P = .012). At the time of admission, tachypnea (27% vs 60%; OR, 0.24; P = .031) and respiratory distress (15% vs 51%; OR, 0.15; P = .012...
Viral hepatitis is an important health problem worldwide. Globally, three major viruses are the l... more Viral hepatitis is an important health problem worldwide. Globally, three major viruses are the leading cause of hepatitis: hepatitis A, B, and C. In this study, we have investigated the pattern of hepatitis among the National Guard personnel and their extended families seen in the central region of Saudi Arabia. The most dominant type of hepatitis infection was hepatitis B virus (HBV), followed by hepatitis C virus (HCV), and to a lesser extent hepatitis A virus (HAV). Our results showed three different age groups at risk of acquiring the infection: HAV, which is mainly a disease of the young; HBV, a disease of adolescents and adults; and HCV, a disease of the elderly. There was no significant difference in the male:female ratio in HAV and HCV; however, as seen in the developed countries, more males were affected with HBV than females. These data will pave the way for further studies by identifying the risk groups for the three major hepatitis infections and by using the data as a ...
Health care workers (HCWs) are frequently exposed to the danger of infectious agents through need... more Health care workers (HCWs) are frequently exposed to the danger of infectious agents through needlestick and sharps injury (NSSI). In Saudi Arabia, the hepatitis B and C viruses pose a great threat to the HCW because of their high prevalence rate (8%-10% and 2%-6%, respectively). A prospective study on the management of NSSI at King Fahad National Guard Hospital from 1996 to 2000. Data relating to the epidemiology of NSSI were collected with the Exposure Prevention Information Network (EPIN(et)) data collection tool, 1997. The results were compared with data as reported by EPIN(et) 1998. Consistency was demonstrated between King Fahad National Guard Hospital and EPIN(et) 1998 for the occupational categories, locations, and the devices involved. Three anomalies were noted: (1) housekeeping staff injuries ranked third at our facility and eighth as reported by EPIN(et) 1998; (2) injuries caused by devices discarded inappropriately commonly occurred at this facility but were not reporte...
Meningococcal disease occurs as both endemic and epidemic disease in most parts of the world with... more Meningococcal disease occurs as both endemic and epidemic disease in most parts of the world with significant morbidity and mortality. Among the different serogroups of Neisseria meningitidis, serogroups A, B, C account for 90% of the disease. In the last few years there has been a change in the epidemiology of the disease with an increase in the prevalence of serogroup C in Europe and North America, serogroup Y in the United States of America and Sweden, and W135 in the Kingdom of Saudi Arabia. The emergence of Neisseria meningitidis serogroup W135 in the Kingdom of Saudi Arabia has lead to 2 major outbreaks mainly among Pilgrims during the Hajj season of 2000 and 2001. This has lead the health officials in the Kingdom of Saudi Arabia to change their vaccine requirements for the Umra and Hajj to include the quadrivalent meningococcal vaccine (A, C, Y, W135) instead of the bivalent one (A, C). Despite all the advances in prevention, diagnosis and treatment, the disease continues to ...
Hospital-acquired infection poses significant clinical and economic burden worldwide. In the King... more Hospital-acquired infection poses significant clinical and economic burden worldwide. In the Kingdom of Saudi Arabia, infection control is a young, rapidly growing specialty. An infrastructure to expedite the growth of this important discipline is fast being established. The kingdom faces unique challenges when addressing infection control, which are the subject of this review. Much of the policy-making in domestic infection control is driven by the preventive medicine concerns of the annual pilgrimage (Hajj) to Mecca, which are unparalleled. The Saudi Ministry of Health acts to contain and control public health risks at this gathering of 2 million. Infectious hazards at the Hajj include meningococcal meningitis, respiratory tract infections, bloodborne diseases, and zoonotic diseases, all of which have international ramifications as pilgrimaging Muslims return home. In the wake of the extraordinary pace of modernization in Saudi Arabia, deficiencies in infection control remain, whi...
Mammography ensures early diagnosis and a better chance for treatment and recovery from breast ca... more Mammography ensures early diagnosis and a better chance for treatment and recovery from breast cancer. We conducted a national survey to investigate knowledge and practices of breast cancer screening among Saudi women aged 50 years or older in order to inform the breast cancer national health programs. The Saudi Health Interview Survey is a national multistage survey of individuals aged 15 years or older. The survey included questions on socio-demographic characteristics, tobacco consumption, diet, physical activity, health-care utilization, different health-related behaviors, and self-reported chronic conditions. Female respondents were asked about knowledge and practices of self and clinical breast exams, as well as mammography. Between April and June 2013, a total of 10,735 participants completed the survey. Among respondents, 1,135 were women aged 50 years or older and were included in this analysis. About 89% of women reported not having a clinical breast exam in the past year,...
This systematic review aims to summarize the incidence and etiology of diarrheal illness among pi... more This systematic review aims to summarize the incidence and etiology of diarrheal illness among pilgrims attending the Hajj and Umrah. Gastroenteritis and diarrhea have been potential threats during previous Hajj pilgrimages. The last cases of Hajj related cholera were reported in 1989. Currently, respiratory tract infections account for the majority of health problems during the Hajj. This shift in epidemiology reflects the improvement of sanitary conditions in Saudi Arabia in general, and at religious sites in particular. Nevertheless, gastrointestinal diseases, food-poisoning outbreaks, and diarrhea continue to occur among pilgrims. Available studies about diarrhea among Hajj pilgrims indicate a mean prevalence of 2% with the highest prevalence of 23% among a group of French pilgrims in 2013. There is an obvious lack of information about the etiology of diarrheal disease at the Hajj. Further studies addressing this issue in hospitalized patients as well as prospective cohort studies would be of interest. During the Hajj, hand washing is regularly carried out by pilgrims under a ritual purification, often called ablution. We recommend implementation of effective hand hygiene practices focusing on the regular use of alcohol-based hand rubs, as they require less time than traditional hand washing, act more rapidly, and contribute to sustained improvement in compliance associated with decreased infection rates.
Journal of epidemiology and global health, Jan 5, 2015
A study of ailments of the feet in pilgrims of Hajj revealed that 31% of them suffered from blist... more A study of ailments of the feet in pilgrims of Hajj revealed that 31% of them suffered from blisters, and the prevalence was five times higher in females. The presence of comorbidity (diabetes, obesity and advanced age) warrants immediate attention to them to avoid serious complications.
Brucellosis is a zoonotic disease of worldwide distribution that mainly affects persons working w... more Brucellosis is a zoonotic disease of worldwide distribution that mainly affects persons working with domestic animals and animal products. Despite being controlled in many developed countries, the disease remains endemic in many parts of the world, including Latin America, the Middle East, Spain, parts of Africa, and western Asia. The disease is mainly transmitted to humans through the ingestion of raw milk or non-pasteurized cheese contaminated with one of the four Brucella species pathogenic to humans. The clinical presentation can vary from asymptomatic infection with seroconversion to a full-blown clinical picture of fever, night sweats and joint manifestations; rarely, there is hepatic, cardiac, ocular or central nervous system involvement. Since travelers may be affected, travel health physicians need to know the clinical presentation of patients with brucellosis and preventive strategies.
Significant headway has been made in the global fight against malaria in the past decade and as m... more Significant headway has been made in the global fight against malaria in the past decade and as more countries enter the elimination phase, attention is now focused on identifying effective strategies to shrink the malaria map. Saudi Arabia experienced an outbreak of malaria in 1998, but is now on the brink of malaria elimination, with just 82 autochthonous cases reported in 2012. A review of published and grey literature was performed to identify the control strategies that have contributed to this achievement. The number of autochthonous malaria cases in Saudi Arabia decreased by 99.8% between 1998 and 2012. The initial steep decline in malaria cases coincided with a rapid scaling up of vector control measures. Incidence continued to be reported at low levels (between 0.01 and 0.1 per 1,000 of the population) until the adoption of artesunate plus sulfadoxine-pyrimethamine as first line treatment and the establishment of a regional partnership for a malaria-free Arabian Peninsula, ...
The treatment of brain tuberculomas is primarily medical. Surgery, excision or biopsy, is general... more The treatment of brain tuberculomas is primarily medical. Surgery, excision or biopsy, is generally performed when the diagnosis is in doubt or there is no response to medical therapy. The aim of this study was to determine the radiological evolution of intracranial tuberculomas under standard anti-tuberculous drug therapy and to establish guidelines for better management of these patients. Eighteen patients were studied retrospectively. None of them had surgical intervention and all were treated by standard antituberculous drugs and had serial computed tomography (CT) scans until disappearance or stabilization of brain lesions. The regression of lesions' size and number was slow in the first month (mean 27.3%) then became rapid after this (215% to 220% per month). A paradoxical increase in size was noted in three patients in the first month. All three had associated meningitis. All tuberculomas disappeared on CT scan after 12 months of therapy. Most of the edema images disappeared by 6 months. This study would suggest that a long treatment regimen of 15-18 months may not be necessary in most intracranial tuberculomas occurring in non-immunocompromised patients. It also demonstrates that medical trial in well tolerated suspected cases should last for at least 2 months before considering other etiologies or surgical exploration.
International Journal of Infectious Diseases, 2005
Objective: To determine if screening family members of patients with acute brucellosis will enhan... more Objective: To determine if screening family members of patients with acute brucellosis will enhance the detection rate of brucellosis and also to determine the relationship between symptoms and brucella serology. Materials and methods: Family members from patients with acute brucellosis were interviewed and serologically screened. All seropositive family members were clinically and serologically followed for six months. Results: Twenty-five acute brucellosis patients and their 178 family members were enrolled from January 2001 to February 2002. Of the 178 family members, 40 (23%) manifested various symptoms, 138 (77%) were asymptomatic, with an overall seroprevalence rate of 34 (19%). The rate of seropositivity among the symptomatic family members was 23 (58%) and for the asymptomatic was 11 (8%) (P < 0.001). The majority of the symptomatic family members (13 (57%)) had a high Brucella titer in comparison to one (9%) of the asymptomatic group (P < 0.001). Acute brucellosis was diagnosed and treated in 18 (78%) of the symptomatic seropositive family members and in four (36%), of the asymptomatic seropositive family members with an acute brucellosis prevalence rate of 22 (12%). All family members with acute infection recovered without sequelae; one patient relapsed (5%).
Isolated reports of brucellosis among family members have been documented. The aim of this study ... more Isolated reports of brucellosis among family members have been documented. The aim of this study is to determine if active serological screening of the households' members of acute brucellosis cases will detect additional unrecognized cases. From May 2000 to October 2001, patients with acute brucellosis were enrolled and their household members were serologically screened for brucellosis using the Standard Agglutination Test (SAT). Fifty-five index cases with acute brucellosis and 404 household members were enrolled. The majority of index cases (48 %) were young adults, and 79% were illiterate. Ownership of animals and ingestion of unpasteurized raw milk were reported by 45 and 75% of the index cases respectively. Of the 55 families screened, 23 (42 %) had two family members or more with serological evidence of brucellosis and 32 (58 %) had only the index case. Households of o5 members and a history of raw-milk ingestion by family members were risk factors associated with the seropositives (P<0 . 05). Of the 404 household members screened, 53 (13 %) were seropositive ; of these 39 (74 %) were symptomatic, and 9 (35 %) had brucella bacteraemia. Symptomatic seropositives tended to have bacteraemia and higher brucella antibody titres compared to asymptomatic seropositives (Pf0 . 05). Screening family members of an index case of acute brucellosis will detect additional cases.
The Saudi Arabian Ministry of Health implemented a pro-active surveillance programme for Middle E... more The Saudi Arabian Ministry of Health implemented a pro-active surveillance programme for Middle East respiratory syndrome (MERS) coronavirus (MERS-CoV). We report MERS-CoV data from 5065 Kingdom of Saudi Arabia individuals who were screened for MERS-CoV over a 12-month period. From 1 October 2012 to 30 September 2013, demographic and clinical data were prospectively collected from all laboratory forms received at the Saudi Arabian Virology reference laboratory. Data were analysed by referral type, age, gender, and MERS-CoV real-time PCR test results. Five thousand and 65 individuals were screened for MER-CoV: hospitalized patients with suspected MERS-CoV infection (n = 2908, 57.4%), healthcare worker (HCW) contacts (n = 1695; 33.5%), and family contacts of laboratory-confirmed MERS cases (n = 462; 9.1%). Eleven per cent of persons tested were children (<17 years of age). There were 108 cases (99 adults and nine children) of MERS-CoV infection detected during the 12-month period (108/5065, 2% case detection rate). Of 108 cases, 45 were females (six children and 39 adults) and 63 were males (three children and 60 adults). Of the 99 adults with MERS-CoV infection, 70 were hospitalized patients, 19 were HCW contacts, and ten were family contacts. There were no significant increases in MERS-CoV detection rates over the 12-month period: 2.patients had a significantly higher MERS-CoV infection rate (63/2318, 2.7%) than females (45/2747, 1.6%) (p 0.013). MERS-CoV rates remain at low levels, with no significant increase over time. Pro-active surveillance for MERS-CoV in newly diagnosed patients and their contacts will continue.
Background. Analysis of clinical samples from patients with new viral infections is critical to c... more Background. Analysis of clinical samples from patients with new viral infections is critical to confirm the diagnosis, to specify the viral load, and to sequence data necessary for characterizing the viral kinetics, transmission, and evolution. We analyzed samples from 112 patients infected with the recently discovered Middle East respiratory syndrome coronavirus (MERS-CoV).
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, Jan 13, 2015
During the 2012 Hajj season, the acquisition risk of Staphylococcus aureus nasal carriage in a co... more During the 2012 Hajj season, the acquisition risk of Staphylococcus aureus nasal carriage in a cohort of French pilgrims was 22.8%, statistically associated with the acquisition of viral respiratory pathogens (P =0.03). The carriage of S. aureus belonging to the emerging clonal complex 398 significantly increased following the pilgrimage (P < 0.05).
Influenza is an important health hazard among Hajj pilgrims. For the last ten years, pilgrims are... more Influenza is an important health hazard among Hajj pilgrims. For the last ten years, pilgrims are being recommended to take influenza vaccine before attending Hajj. Vaccination coverage has increased in recent years, but whether there has been any change in the prevalence of influenza-like illness (ILI) is not known. In this analysis, we examined the changes in the rate of ILI against seasonal influenza vaccine uptake among Hajj pilgrims over the last decade. Data for this analysis is a synthesis of raw and published data from eleven Hajj seasons between 2005 and 214. For seven Hajj seasons the data were obtained from studies involving pilgrims of UK, Saudi Arabia and Australia; and for the remaining four Hajj seasons data were abstracted from published studies involving pilgrims from multiple countries. The data from both sources were synthesised to estimate the relative risk (RR) of acquisition of ILI in vaccinated versus unvaccinated pilgrims. The pooled sample size of the included studies was 33,213 with most pilgrims being in the age band of 40-60 years (range: 0.5 to 95 years) and a male to female ratio of 1.6. The pilgrims originated, in order of frequency, from Iran, Australia, France, UK, Saudi Arabia, Indonesia, India, Algeria, Ivory Coast, Nigeria, Somalia, Turkey, Syria, Sierra Leone and USA. Except for one year (2008), data from individual years did not demonstrate a noticeable change in the rate of ILI against influenza vaccine coverage, however the combined data from all studies suggest that the prevalence of ILI decreased among Hajj pilgrims as the vaccine coverage increased over the last decade (RR 0.2, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). This analysis suggests that influenza vaccine might be beneficial for Hajj pilgrims. However, controlled trials aided by molecular diagnostic tools could confirm whether such an effect is real or ostensible.
International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, Jan 25, 2015
Rabies is endemic in animals in the Arabian Peninsula. Although Saudi Arabia is the largest count... more Rabies is endemic in animals in the Arabian Peninsula. Although Saudi Arabia is the largest country in the peninsula, little has been published about rabies situation in the country. A total of 11069 animal bites to human were reported during the 2007-2009 and 40 animals suspect of rabies were examined for rabies infection from 2005 through 2010. Results suggest that animal-related injuries in Saudi Arabia remains a public health problem with feral dogs accounting for the majority of bites to humans and for the majority of animals found to be rabid. Over the last 10 years no confirmed human rabies cases have been reported. More detailed information about the epidemiology of animal bites and that of animal rabies in Saudi Arabia would be of great interest, notably to provide elements on which vaccination recommendation could be made for the numerous international travelers visiting the country.
The emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in 2012 result... more The emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in 2012 resulted in an increased concern of the spread of the infection globally. MERS-CoV infection had previously caused multiple health-care-associated outbreaks and resulted in transmission of the virus within families. Community onset MERS-CoV cases continue to occur. Dromedary camels are currently the most likely animal to be linked to human MERS-CoV cases. Serologic tests showed significant infection in adult camels compared to juvenile camels. The control of MERS-CoV infection relies on prompt identification of cases within health care facilities, with institutions applying appropriate infection control measures. In addition, determining the exact route of transmission from camels to humans would further add to the control measures of MERS-CoV infection.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Jan 15, 2014
There is a paucity of data regarding the differentiating characteristics of patients with laborat... more There is a paucity of data regarding the differentiating characteristics of patients with laboratory-confirmed and those negative for Middle East respiratory syndrome coronavirus (MERS-CoV). This is a hospital-based case-control study comparing MERS-CoV-positive patients (cases) with MERS-CoV-negative controls. A total of 17 case patients and 82 controls with a mean age of 60.7 years and 57 years, respectively (P = .553), were included. No statistical differences were observed in relation to sex, the presence of a fever or cough, and the presence of a single or multilobar infiltrate on chest radiography. The case patients were more likely to be overweight than the control group (mean body mass index, 32 vs 27.8; P = .035), to have diabetes mellitus (87% vs 47%; odds ratio [OR], 7.24; P = .015), and to have end-stage renal disease (33% vs 7%; OR, 7; P = .012). At the time of admission, tachypnea (27% vs 60%; OR, 0.24; P = .031) and respiratory distress (15% vs 51%; OR, 0.15; P = .012...
Viral hepatitis is an important health problem worldwide. Globally, three major viruses are the l... more Viral hepatitis is an important health problem worldwide. Globally, three major viruses are the leading cause of hepatitis: hepatitis A, B, and C. In this study, we have investigated the pattern of hepatitis among the National Guard personnel and their extended families seen in the central region of Saudi Arabia. The most dominant type of hepatitis infection was hepatitis B virus (HBV), followed by hepatitis C virus (HCV), and to a lesser extent hepatitis A virus (HAV). Our results showed three different age groups at risk of acquiring the infection: HAV, which is mainly a disease of the young; HBV, a disease of adolescents and adults; and HCV, a disease of the elderly. There was no significant difference in the male:female ratio in HAV and HCV; however, as seen in the developed countries, more males were affected with HBV than females. These data will pave the way for further studies by identifying the risk groups for the three major hepatitis infections and by using the data as a ...
Health care workers (HCWs) are frequently exposed to the danger of infectious agents through need... more Health care workers (HCWs) are frequently exposed to the danger of infectious agents through needlestick and sharps injury (NSSI). In Saudi Arabia, the hepatitis B and C viruses pose a great threat to the HCW because of their high prevalence rate (8%-10% and 2%-6%, respectively). A prospective study on the management of NSSI at King Fahad National Guard Hospital from 1996 to 2000. Data relating to the epidemiology of NSSI were collected with the Exposure Prevention Information Network (EPIN(et)) data collection tool, 1997. The results were compared with data as reported by EPIN(et) 1998. Consistency was demonstrated between King Fahad National Guard Hospital and EPIN(et) 1998 for the occupational categories, locations, and the devices involved. Three anomalies were noted: (1) housekeeping staff injuries ranked third at our facility and eighth as reported by EPIN(et) 1998; (2) injuries caused by devices discarded inappropriately commonly occurred at this facility but were not reporte...
Meningococcal disease occurs as both endemic and epidemic disease in most parts of the world with... more Meningococcal disease occurs as both endemic and epidemic disease in most parts of the world with significant morbidity and mortality. Among the different serogroups of Neisseria meningitidis, serogroups A, B, C account for 90% of the disease. In the last few years there has been a change in the epidemiology of the disease with an increase in the prevalence of serogroup C in Europe and North America, serogroup Y in the United States of America and Sweden, and W135 in the Kingdom of Saudi Arabia. The emergence of Neisseria meningitidis serogroup W135 in the Kingdom of Saudi Arabia has lead to 2 major outbreaks mainly among Pilgrims during the Hajj season of 2000 and 2001. This has lead the health officials in the Kingdom of Saudi Arabia to change their vaccine requirements for the Umra and Hajj to include the quadrivalent meningococcal vaccine (A, C, Y, W135) instead of the bivalent one (A, C). Despite all the advances in prevention, diagnosis and treatment, the disease continues to ...
Hospital-acquired infection poses significant clinical and economic burden worldwide. In the King... more Hospital-acquired infection poses significant clinical and economic burden worldwide. In the Kingdom of Saudi Arabia, infection control is a young, rapidly growing specialty. An infrastructure to expedite the growth of this important discipline is fast being established. The kingdom faces unique challenges when addressing infection control, which are the subject of this review. Much of the policy-making in domestic infection control is driven by the preventive medicine concerns of the annual pilgrimage (Hajj) to Mecca, which are unparalleled. The Saudi Ministry of Health acts to contain and control public health risks at this gathering of 2 million. Infectious hazards at the Hajj include meningococcal meningitis, respiratory tract infections, bloodborne diseases, and zoonotic diseases, all of which have international ramifications as pilgrimaging Muslims return home. In the wake of the extraordinary pace of modernization in Saudi Arabia, deficiencies in infection control remain, whi...
Mammography ensures early diagnosis and a better chance for treatment and recovery from breast ca... more Mammography ensures early diagnosis and a better chance for treatment and recovery from breast cancer. We conducted a national survey to investigate knowledge and practices of breast cancer screening among Saudi women aged 50 years or older in order to inform the breast cancer national health programs. The Saudi Health Interview Survey is a national multistage survey of individuals aged 15 years or older. The survey included questions on socio-demographic characteristics, tobacco consumption, diet, physical activity, health-care utilization, different health-related behaviors, and self-reported chronic conditions. Female respondents were asked about knowledge and practices of self and clinical breast exams, as well as mammography. Between April and June 2013, a total of 10,735 participants completed the survey. Among respondents, 1,135 were women aged 50 years or older and were included in this analysis. About 89% of women reported not having a clinical breast exam in the past year,...
This systematic review aims to summarize the incidence and etiology of diarrheal illness among pi... more This systematic review aims to summarize the incidence and etiology of diarrheal illness among pilgrims attending the Hajj and Umrah. Gastroenteritis and diarrhea have been potential threats during previous Hajj pilgrimages. The last cases of Hajj related cholera were reported in 1989. Currently, respiratory tract infections account for the majority of health problems during the Hajj. This shift in epidemiology reflects the improvement of sanitary conditions in Saudi Arabia in general, and at religious sites in particular. Nevertheless, gastrointestinal diseases, food-poisoning outbreaks, and diarrhea continue to occur among pilgrims. Available studies about diarrhea among Hajj pilgrims indicate a mean prevalence of 2% with the highest prevalence of 23% among a group of French pilgrims in 2013. There is an obvious lack of information about the etiology of diarrheal disease at the Hajj. Further studies addressing this issue in hospitalized patients as well as prospective cohort studies would be of interest. During the Hajj, hand washing is regularly carried out by pilgrims under a ritual purification, often called ablution. We recommend implementation of effective hand hygiene practices focusing on the regular use of alcohol-based hand rubs, as they require less time than traditional hand washing, act more rapidly, and contribute to sustained improvement in compliance associated with decreased infection rates.
Journal of epidemiology and global health, Jan 5, 2015
A study of ailments of the feet in pilgrims of Hajj revealed that 31% of them suffered from blist... more A study of ailments of the feet in pilgrims of Hajj revealed that 31% of them suffered from blisters, and the prevalence was five times higher in females. The presence of comorbidity (diabetes, obesity and advanced age) warrants immediate attention to them to avoid serious complications.
Brucellosis is a zoonotic disease of worldwide distribution that mainly affects persons working w... more Brucellosis is a zoonotic disease of worldwide distribution that mainly affects persons working with domestic animals and animal products. Despite being controlled in many developed countries, the disease remains endemic in many parts of the world, including Latin America, the Middle East, Spain, parts of Africa, and western Asia. The disease is mainly transmitted to humans through the ingestion of raw milk or non-pasteurized cheese contaminated with one of the four Brucella species pathogenic to humans. The clinical presentation can vary from asymptomatic infection with seroconversion to a full-blown clinical picture of fever, night sweats and joint manifestations; rarely, there is hepatic, cardiac, ocular or central nervous system involvement. Since travelers may be affected, travel health physicians need to know the clinical presentation of patients with brucellosis and preventive strategies.
Significant headway has been made in the global fight against malaria in the past decade and as m... more Significant headway has been made in the global fight against malaria in the past decade and as more countries enter the elimination phase, attention is now focused on identifying effective strategies to shrink the malaria map. Saudi Arabia experienced an outbreak of malaria in 1998, but is now on the brink of malaria elimination, with just 82 autochthonous cases reported in 2012. A review of published and grey literature was performed to identify the control strategies that have contributed to this achievement. The number of autochthonous malaria cases in Saudi Arabia decreased by 99.8% between 1998 and 2012. The initial steep decline in malaria cases coincided with a rapid scaling up of vector control measures. Incidence continued to be reported at low levels (between 0.01 and 0.1 per 1,000 of the population) until the adoption of artesunate plus sulfadoxine-pyrimethamine as first line treatment and the establishment of a regional partnership for a malaria-free Arabian Peninsula, ...
Uploads
Papers by Ziad Memish