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Haseeb A, Faidah HS, Algethamy M, Alghamdi S, Alhazmi GA, Alshomrani AO, Alqethami BR, Alotibi HS, Almutiri MZ, Almuqati KS, Albishi AA, Elrggal ME, Mahrous AJ, Khogeer AA, Saleem Z, Iqbal MS, Sheikh A. Antimicrobial Usage and Resistance in Makkah Region Hospitals: A Regional Point Prevalence Survey of Public Hospitals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010254. [PMID: 35010512 PMCID: PMC8782433 DOI: 10.3390/ijerph19010254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 11/23/2022]
Abstract
(1) Background: Inappropriate use of antimicrobials and subsequently rise of antimicrobial resistance (AMR) remains a major public health priority. Over-prescribing of broad-spectrum antibiotics is one of the main contributing factors for the emergence of AMR. We sought to describe antimicrobial prescribing trends among patients in public hospitals in Makkah hospitals. (2) Method: We undertook a point prevalence survey (PPS) in six hospitals in Makkah, Saudi Arabia, from January 2019 to July 2019. The survey included all the inpatients receiving antimicrobials on the day of PPS. Data was collected using the Global point prevalence survey (PPS) tool developed by the University of Antwerp, Belgium. (3) Results: Of 710 hospitalized patients, 447 patients (61.9%) were treated with one or more antimicrobials during the study period. The average bed occupancy among six hospitals was 74.4%. The majority of patients received antimicrobials parenterally (90.3%). Of the total prescribed antimicrobials, 415 (53.7%) antimicrobials were used in medical departments, 183 (23.7%) in surgical departments, and 175 (22.6%) in ICUs. Pneumonia (17.3%), skin and soft tissue infections (10.9%), and sepsis (6.6.%) were three common clinical indications. Ceftriaxones were the most commonly used antibiotics that were prescribed in 116 (15%) of patients, followed by piperacillin, with an enzyme inhibitor in 84 (10.9%). (4) Conclusion: There was a high prevalence of antibiotic use in the hospitals of Makkah, which could be a potential risk factor for the incidence of resistant strains, particularly MRSA infection. Public health decision-makers should take these findings into consideration to update national policies for antibiotic use in order to reduce the risks of further increases of AMR.
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Affiliation(s)
- Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia; (M.E.E.); (A.J.M.)
- Correspondence: ; Tel.: +966-568560776
| | - Hani Saleh Faidah
- Department of Microbiology, Faculty of Medicine, Umm Al Qura University, Makkah 21955, Saudi Arabia;
| | - Manal Algethamy
- Department of Infection Prevention and Control Program, Alnoor Specialist Hospital Makkah, Makkah 24382, Saudi Arabia;
| | - Saleh Alghamdi
- Department of Clinical Pharmacy, Faculty of Clinical Pharmacy, Al Baha University, Al Baha 65779, Saudi Arabia;
| | - Ghaidaa Ali Alhazmi
- Departments of Pharmacy, King Abdullah Medical City, Ministry of Health, Makkah 21955, Saudi Arabia;
| | - Afnan Owedah Alshomrani
- King Abdul Aziz Medical City, WR, Jeddah, Ministry of National Guard, Jeddah 21423, Saudi Arabia;
| | | | - Hind Saeed Alotibi
- Prince Meshari Bin Saud- General Baljarshi Hospital, Al Baha 65779, Saudi Arabia;
| | | | - Khawlah Saad Almuqati
- King Faisal Specialist Hospital and Research Centre (Gen. Org.), Riyadh 11211, Saudi Arabia;
| | | | - Mahmoud Essam Elrggal
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia; (M.E.E.); (A.J.M.)
| | - Ahmad Jamal Mahrous
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia; (M.E.E.); (A.J.M.)
| | - Asim Abdulaziz Khogeer
- Plan and Research Department, General Directorate of Health Affairs of Makkah Region, Ministry of Health, Makkah 21955, Saudi Arabia;
- Medical Genetics Unit, Maternity and Children Hospital, Makkah Healthcare Cluster, Ministry of Health, Makkah 21955, Saudi Arabia
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, New Campus, The University of Lahore, Lahore 54000, Pakistan;
| | - Muhammad Shahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia;
| | - Aziz Sheikh
- Usher Institute, Old Medical School, The University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK;
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Youssouf BM, Alfalati B, Alqthmi R, Alqthmi R, Alsehly LM. Causes of Upper Gastrointestinal Bleeding Among Pilgrims During the Hajj Period in the Islamic Years 1437-1439 (2016-2018). Cureus 2020; 12:e10873. [PMID: 33178526 PMCID: PMC7652364 DOI: 10.7759/cureus.10873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Approximately 3.5 million pilgrims perform Hajj every year. Planning for their healthcare requires knowledge of the pattern of diseases and risk factors of pilgrims who require hospitalization during the Hajj period. The aim of the current study was to evaluate common causes and risk factors of upper gastrointestinal bleeding (UGIB) among pilgrims during the Hajj season. Method We conducted a retrospective cross-sectional study using a data collection checklist to collect data from medical records. We included all patients who had UGIB and attended the endoscopy department of the King Abdulaziz Hospital, Mecca, in the AL-Hajj season of the Islamic years 1437-1439 (2016-2018). Results A total of 93 patients were included in the current study; of those, 65.59% were males. The mean age of the patients was 63.37 ± 12.83 years, and about one-third (29.03%) of them were Indonesian. Overall, melena with or without anemia was the most common presentation (44.09%), followed by hematemesis (34.78%), melena with hematemesis (15.05%), hematemesis with ascites (9.68%), and abdominal/epigastric pain (3.23%). The most common cause of UGIB was the presence of gastric origin (erosive gastritis/gastric ulcer/gastric tumor) with 22.58% of the patients presenting with the same. The most common factors were medications, especially non-steroidal anti-inflammatory drugs (NSAIDs) (37.63%) and blood thinners (22.58%). Hypertension (31.18%), diabetes mellitus (DM) (29.03%), and chronic liver disease/failure (27.96%) were the most common chronic conditions in the studied population. Conclusion Medical orientation towards high-risk pilgrims prone to developing UGIB who intend to travel may help reduce the risk of developing the condition, by taking proper measurements of those groups by the medical teams, especially in those with preventable factors.
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Affiliation(s)
| | | | - Reem Alqthmi
- Internal Medicine, Umm Al-Qura University, Makkah, SAU
| | - Rahma Alqthmi
- Internal Medicine, Umm Al-Qura University, Makkah, SAU
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Kyasanur Forest Disease and Alkhurma Hemorrhagic Fever Virus-Two Neglected Zoonotic Pathogens. Microorganisms 2020; 8:microorganisms8091406. [PMID: 32932653 PMCID: PMC7564883 DOI: 10.3390/microorganisms8091406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 11/17/2022] Open
Abstract
Kyasanur Forest disease virus (KFDV) and Alkhurma hemorrhagic fever virus (AHFV) are tick-borne flaviviruses that cause life-threatening hemorrhagic fever in humans with case fatality rates of 3-5% for KFDV and 1-20% for AHFV, respectively. Both viruses are biosafety level 4 pathogens due to the severity of disease they cause and the lack of effective countermeasures. KFDV was discovered in India and is restricted to parts of the Indian subcontinent, whereas AHFV has been found in Saudi Arabia and Egypt. In recent years, both viruses have spread beyond their original endemic zones and the potential of AHFV to spread through ticks on migratory birds is a public health concern. While there is a vaccine with limited efficacy for KFDV used in India, there is no vaccine for AHFV nor are there any therapeutic concepts to combat infections with these viruses. In this review, we summarize the current knowledge about pathogenesis, vector distribution, virus spread, and infection control. We aim to bring attention to the potential public health threats posed by KFDV and AHFV and highlight the urgent need for the development of effective countermeasures.
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Lami F, Jewad AW, Hassan A, Kadhim H, Alharis S. Noncommunicable Disease Emergencies During Arbaeenia Mass Gathering at Public Hospitals in Karbala, Najaf, and Babel Governorates, Iraq, 2014: Cross-Sectional Study. JMIR Public Health Surveill 2019; 5:e10890. [PMID: 31573917 PMCID: PMC6792027 DOI: 10.2196/10890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 11/25/2018] [Accepted: 12/03/2018] [Indexed: 12/19/2022] Open
Abstract
Background Arbaeenia is the largest religious mass gathering (MG) in Iraq where millions of people from Iraq and many other countries visit Karbala city, south Iraq. MGs are associated with high rates of morbidity and mortality from different noncommunicable diseases (NCDs) such as cardiovascular diseases, diabetes mellitus, and asthma. There is a scarcity of publications that address MGs in Iraq. Objective This study aimed to explore the NCD emergencies in public hospitals in Karbala, Najaf, and Babel governorates in Iraq, during the Arbaeenia MG and assess predisposing factors for NCD emergencies. Methods The study was conducted from November 27 to December 16, 2014. Data were collected in the pre-event and during MG event from 7 selected hospitals. The pre-event data were collected from emergency room (ER) registers and logbooks, and the data on the MG event were collected daily through direct interview with patients and treating physicians using a structured questionnaire. Results In total, 4425 NCD emergencies were recorded. Of these, 80.13% (3546/4425) were collected during the MG event. The NCD emergencies attended at ER hospitals during MG were severe hypertension (HT), diabetes (hyperglycemia), ischemic heart disease (IHD), asthma, and pulmonary edema. The load of NCD emergencies and the daily average emergencies increased 4-fold and 2-fold during the MG event, respectively. Most of the NCD emergencies were treated at ER departments, and a few were hospitalized. Intense physical activities and poor adherence to diet and medication were risk factors for IHD, severe HT, and hyperglycemic diabetes emergencies. Exposure to noxious gases or fumes and recent respiratory infections were risk factors for asthma emergencies. Conclusions As the pilgrims approached Karbala city during the Arbaeenia MG, the hospitals on the roads leading to the city experienced an increased load of patients because of different NCD emergencies. Although hospitals should be equipped with the necessary supplies, health education for pilgrims is mandatory, particularly on the factors that can exacerbate their diseases.
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Affiliation(s)
- Faris Lami
- Department of Community and Family Medicine, College of Medicine, University of Baghdad, Baghdad, , Iraq
| | | | - Abulameer Hassan
- Najaf Directorate of Health, Iraq Ministry of Health, Najaf, , Iraq
| | - Hadeel Kadhim
- Najaf Directorate of Health, Iraq Ministry of Health, Najaf, , Iraq
| | - Sura Alharis
- Najaf Directorate of Health, Iraq Ministry of Health, Najaf, , Iraq
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Al-Tawfiq JA, Memish ZA. The Hajj 2019 Vaccine Requirements and Possible New Challenges. J Epidemiol Glob Health 2019; 9:147-152. [PMID: 31529930 PMCID: PMC7310822 DOI: 10.2991/jegh.k.190705.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/05/2019] [Indexed: 01/02/2023] Open
Abstract
Each year millions of pilgrims perform the annual Hajj from more than 180 countries around the world. This is one of the largest mass gathering events and may result in the occurrence and spread of infectious diseases. As such, there are mandatory vaccinations for the pilgrims such as meningococcal vaccines. The 2019 annual Hajj will take place during August 8-13, 2019. Thus, we review the recommended and mandated vaccinations for the 2019 Hajj and Umrah. The mandatory vaccines required to secure the visa include the quadrivalent meningococcal vaccine for all pilgrims, while yellow fever, and poliomyelitis vaccines are required for pilgrims coming from countries endemic or with disease activity. The recommended vaccines are influenza, pneumococcal, in addition to full compliance with basic vaccines for all pilgrims against diphtheria, tetanus, pertussis, polio, measles, and mumps. It is imperative to continue surveillance for the spread of antimicrobial resistance and occurrence of all infectious diseases causing outbreaks across the globe in the last year, like Zika virus, MDR-Typhoid, Nipah, Ebola, cholera, chikungunya and Middle East Respiratory Syndrome Coronavirus.
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Affiliation(s)
- Jaffar A. Al-Tawfiq
- Infectious Disease Section, Specialty Medicine Department, Johns Hopkins Aramco Healthcare, Dhahran, Kingdom of Saudi Arabia
- Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ziad A. Memish
- Department of Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Infectious Diseases Division, Department of Medicine, Prince Mohammed Bin Abdulaziz Hospital (PMAH), Ministry of Health, Riyadh, Saudi Arabia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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AlSahafi AJ, Shah HBU, AlSayali MM, Mandoura N, Assiri M, Almohammadi EL, Khalawi A, AlGarni A, Filemban MK, AlOtaibe AK, AlFaifi AWA, AlGarni F. High non-compliance rate with anti-tuberculosis treatment: a need to shift facility-based directly observed therapy short course (DOTS) to community mobile outreach team supervision in Saudi Arabia. BMC Public Health 2019; 19:1168. [PMID: 31455324 PMCID: PMC6712871 DOI: 10.1186/s12889-019-7520-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/20/2019] [Indexed: 11/21/2022] Open
Abstract
Background Tuberculosis (TB) remains a major global public health problem in many developing countries including Kingdom of Saudi Arabia (KSA). Patient compliance with anti-tuberculosis treatment is a determining factor in controlling the spread of TB. This study compares the default rate and the perception of their treatment among TB patients being treated by means of a community mobile outreach approach, with those of patients being treated by means of a facility-based Directly Observed Treatment Short course (DOTS) in the Jeddah region of Saudi Arabia. Methods A comparative cross-sectional study of 200 TB patients who presented at the Madain Alfahd Primary Health Care Center (PHCC) Jeddah, between January 2018 and November 2018 was undertaken. In one group, randomly assigned patients were served by mobile outreach teams who administered oral anti-TB treatment under the DOTS regime. In the other group, the patients were treated by means of the traditional facility-based DOTS treatment. A questionnaire measuring patient attitudes and understanding of the disease and their treatment modes was completed by patients at the beginning of their treatment, and again after 3 months. The results were analysed by means of independent and Paired T Tests, along with chi square analysis. Results We found that the overall default rate among those patients served by our mobile outreach team was only 3%, compared with a 22% default rate among non-mobile team treated patients (p = < 0.001). A major change in the attitude and understanding scores of patients was noted in both groups after 3 months. A significant difference was also noted in the mean compliance scores (mobile team served =58.43 and facility-based =55.55, p < 0.001) after 3 months of treatment. Conclusion Our study indicated that treatment by means of our mobile outreach DOTS can offer an effective strategy for the treatment of TB patients. A reduced patient default rate and a better understanding of the disease and its treatment confirmed a positive impact of mobile outreach teams on these patients. Treating TB patients by means of mobile outreach teams can thus be recommended as a means for the cure and prevention of the further spread of the disease.
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Affiliation(s)
| | - Hassan Bin Usman Shah
- Research Department, Directorate of Health Affairs for Public Health Division, Jeddah, Saudi Arabia.
| | | | - Najlaa Mandoura
- Research Department, Directorate of Health Affairs for Public Health Division, Jeddah, Saudi Arabia
| | - Mohammed Assiri
- TB DOTS program, Department of Public Health, Jeddah, Saudi Arabia
| | | | - Alaa Khalawi
- TB control program, Department of Public Health, Jeddah, Saudi Arabia
| | - Abdullah AlGarni
- Communicable Diseases Department- Public Health, Jeddah, Saudi Arabia
| | | | | | | | - Fatima AlGarni
- TB DOTS program, Department of Public Health, Jeddah, Saudi Arabia
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Al-Tayib OA. An Overview of the Most Significant Zoonotic Viral Pathogens Transmitted from Animal to Human in Saudi Arabia. Pathogens 2019; 8:E25. [PMID: 30813309 PMCID: PMC6471281 DOI: 10.3390/pathogens8010025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 02/01/2023] Open
Abstract
Currently, there has been an increasing socioeconomic impact of zoonotic pathogens transmitted from animals to humans worldwide. Recently, in the Arabian Peninsula, including in Saudi Arabia, epidemiological data indicated an actual increase in the number of emerging and/or reemerging cases of several viral zoonotic diseases. Data presented in this review are very relevant because Saudi Arabia is considered the largest country in the Peninsula. We believe that zoonotic pathogens in Saudi Arabia remain an important public health problem; however, more than 10 million Muslim pilgrims from around 184 Islamic countries arrive yearly at Makkah for the Hajj season and/or for the Umrah. Therefore, for health reasons, several countries recommend vaccinations for various zoonotic diseases among preventive protocols that should be complied with before traveling to Saudi Arabia. However, there is a shortage of epidemiological data focusing on the emerging and reemerging of zoonotic pathogens transmitted from animal to humans in different densely populated cities and/or localities in Saudi Arabia. Therefore, further efforts might be needed to control the increasing impacts of zoonotic viral disease. Also, there is a need for a high collaboration to enhance the detection and determination of the prevalence, diagnosis, control, and prevention as well as intervention and reduction in outbreaks of these diseases in Saudi Arabia, particularly those from other countries. Persons in the health field including physicians and veterinarians, pet owners, pet store owners, exporters, border guards, and people involved in businesses related to animal products have adopted various preventive strategies. Some of these measures might pave the way to highly successful prevention and control results on the different transmission routes of these viral zoonotic diseases from or to Saudi Arabia. Moreover, the prevention of these viral pathogens depends on socioeconomic impacts, available data, improved diagnosis, and highly effective therapeutics or prophylaxis.
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Affiliation(s)
- Omar A Al-Tayib
- Abdullah Bagshan for Dental and Oral Rehabilitation (DOR), Dental College Research Center, King Saud University, Riyadh 12372, Saudi Arabia.
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Khartoum, Khartoum 11111, Sudan.
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Abd El Ghany M, Alsomali M, Almasri M, Regalado EP, Naeem R, Tukestani A, Asiri A, Hill-Cawthorne GA, Pain A, Memish ZA. Enteric Infections Circulating during Hajj Seasons, 2011-2013. Emerg Infect Dis 2018; 23. [PMID: 28930004 PMCID: PMC5621540 DOI: 10.3201/eid2310.161642] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Foodborne-associated bacteria with increased incidence of antimicrobial drug resistance were the most common cause. Hajj, the annual Muslim pilgrimage to Mecca, Saudi Arabia, is a unique mass gathering event that raises public health concerns in the host country and globally. Although gastroenteritis and diarrhea are common among Hajj pilgrims, the microbial etiologies of these infections are unknown. We collected 544 fecal samples from pilgrims with medically attended diarrheal illness from 40 countries during the 2011–2013 Hajj seasons and screened the samples for 16 pathogens commonly associated with diarrheal infections. Bacteria were the main agents detected, in 82.9% of the 228 positive samples, followed by viral (6.1%) and parasitic (5.3%) agents. Salmonella spp., Shigella/enteroinvasive Escherichia coli, and enterotoxigenic E. coli were the main pathogens associated with severe symptoms. We identified genes associated with resistance to third-generation cephalosporins ≈40% of Salmonella- and E. coli–positive samples. Hajj-associated foodborne infections pose a major public health risk through the emergence and transmission of antimicrobial drug–resistant bacteria.
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Khraif R, Abdul Salam A, Al-Mutairi A, Elsegaey I. Fertility behaviour of working women in Saudi Arabia: a special case of King Saud University, Riyadh. HUM FERTIL 2018. [PMID: 29540089 DOI: 10.1080/14647273.2018.1449971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Fertility levels and their determinants in Saudi Arabia have not been studied sufficiently for formulating family policy, although some attention has been paid to rapid fertility transitions in the context of socioeconomic and cultural change. This study focused on the fertility of a particular occupational category in the Kingdom of Saudi Arabia to assess determinants of fertility, measured as the number of children. The sample was drawn from the King Saud University staff - ever-married Saudi Arabian women. Results found that proximate factors (age, age at first marriage, intended number of children, length of marriage and contraceptive use) were significant in predicting fertility behaviour, whereas geographic, social and economic factors were insignificant. Thus, the fertility behaviour of this occupational group seems unique. This might be due to the special characteristics and lifestyle of this particular occupational group. The effect of the intended number of children on the actual number signified the fertility behaviour of this group of women. This, expectedly, should improve the influence of social and economic factors on fertility behaviour, in the future. Thus, advocates, policies and programmes (population and public health) at the societal and familial levels, should consider the demographic change in the social and economic context.
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Affiliation(s)
- Rshood Khraif
- King Saud University, Center for Population Studies, Riyadh, Saudi Arabia
| | | | | | - Ibrahim Elsegaey
- King Saud University, Center for Population Studies, Riyadh, Saudi Arabia
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Yavarian J, Shafiei Jandaghi NZ, Naseri M, Hemmati P, Dadras M, Gouya MM, Mokhtari Azad T. Influenza virus but not MERS coronavirus circulation in Iran, 2013-2016: Comparison between pilgrims and general population. Travel Med Infect Dis 2018; 21:51-55. [PMID: 29031546 PMCID: PMC7110681 DOI: 10.1016/j.tmaid.2017.10.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/27/2017] [Accepted: 10/09/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND The pilgrimage to Mecca and Karbala bring many Muslims to a confined area. Respiratory tract infections are the most common diseases transmitted during mass gatherings in Hajj, Umrah and Karbala. The aim of this study was to determine and compare the prevalence of Middle East respiratory syndrome coronavirus (MERS-CoV) and influenza virus infections among Iranian general population and pilgrims with severe acute respiratory infections (SARI) returning from Mecca and Karbala during 2013-2016. METHODS During 2013-2016, a total of 42351 throat swabs were examined for presence of influenza viruses and MERS-CoV in Iranian general population and pilgrims returning from Mecca and Karbala with SARI by using one step RT-PCR kit. RESULTS None of the patients had MERS-CoV but influenza viruses were detected in 12.7% with high circulation of influenza A/H1N1 (47.1%). CONCLUSION This study showed the prevalence of influenza infections among Iranian pilgrims and general population and suggests continuing surveillance, infection control and appropriate vaccination especially nowadays that the risk of influenza pandemic threatens the world, meanwhile accurate screening for MERS-CoV is also recommended.
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Affiliation(s)
- Jila Yavarian
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Iran
| | | | - Maryam Naseri
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Iran
| | - Peyman Hemmati
- Iranian Center for Communicable Disease Control, Tehran, Iran
| | | | | | - Talat Mokhtari Azad
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Iran.
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Al-Tawfiq JA, Gautret P, Memish ZA. Expected immunizations and health protection for Hajj and Umrah 2018 -An overview. Travel Med Infect Dis 2017; 19:2-7. [PMID: 29037978 PMCID: PMC7110709 DOI: 10.1016/j.tmaid.2017.10.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND The annual Hajj and Umrah are one of the largest recurring religious mass gatherings across the globe drawing pilgrims from more than 185 countries. The living circumstances and activities of the pilgrims may create an environment for the occurrence and spread of communicable diseases. Each year, the Health authority of the Kingdom of Saudi Arabia, in coordination with international health authorities, updates health requirements for pilgrims. The Hajj for 2017 took place from August 24 to September 5, 2017. Here, we review the expected obligations for immunizations for the 2018 Hajj and Umrah. RESULTS The Hajj and Umrah vaccine requirements include mandatory vaccinations against yellow fever, quadrivalent meningococcal polysaccharide (every 3 years) or conjugated (every 5 years) vaccines and poliomyelitis vaccine. Influenza vaccine utilizing the 2016 (Southern Hemisphere vaccine to all pilgrims) was recommended but was not obligatory for pilgrims. Ciprofloxacin is required for individuals >12 years excluding pregnant women as chemoprophylaxis to be given at the port of entry for Pilgrims coming from the meningitis belt. With the ongoing outbreaks of measles in Europe, it is recommended that all pilgrims have an updated immunization against vaccine-preventable diseases (diphtheria, tetanus, pertussis, polio, measles and mumps). CONCLUSION The mandatory vaccines remain the same with continued vigilance for the development of any new or emerging infectious diseases. Continuing surveillance for Zika virus, cholera and MERS-CoV are ongoing.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Philippe Gautret
- Unité de Recherche sur Les Maladies Infectieuses et Tropicales émergentes (URMITE) CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille-Université, Marseille, France
| | - Ziad A Memish
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Infectious Diseases Division, Department of Medicine, Prince Mohamed Bin Abdulaziz Hospital ("PMAH"), Ministry of Health, Riyadh, Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Evaluation of Hospitals' Disaster Preparedness Plans in the Holy City of Makkah (Mecca): A Cross-Sectional Observation Study. Prehosp Disaster Med 2016; 32:33-45. [PMID: 27964768 DOI: 10.1017/s1049023x16001229] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Makkah (Mecca) is a holy city located in the western region of the Kingdom of Saudi Arabia. Each year, millions of pilgrims visit Makkah. These numbers impact both routine health care delivery and disaster response. This study aimed to evaluate hospitals' disaster plans in the city of Makkah. METHODS Study investigators administered a questionnaire survey to 17 hospitals in the city of Makkah. Data on hospital characteristics and three key domains of disaster plans (general evaluation of disaster planning, structural feasibility of the hospitals, and health care worker knowledge and training) were collated and analyzed. RESULTS A response rate of 82% (n=14) was attained. Ten (71%) of the hospitals were government hospitals, whereas four were private hospitals. Eleven (79%) hospitals had a capacity of less than 300 beds. Only nine (64%) hospitals reviewed their disaster plan within the preceding two years. Nine (64%) respondents were drilling for disasters at least twice per year. The majority of hospitals did not rely on a hazard vulnerability analysis (HVA) to develop their Emergency Operations Plan. Eleven (79%) hospitals had the Hospital Incident Command Systems (HICS) present in their plans. All hospitals described availability of some supplies required for the first 24 hours of a disaster response, such as: N95 masks, antidotes for nerve agents, and antiviral medications. Only five (36%) hospitals had a designated decontamination area. Nine (64%) hospitals reported ability to re-designate inpatient wards into an intensive care unit (ICU) format. Only seven (50%) respondents had a protocol for increasing availability of isolation rooms to prevent the spread of airborne infection. Ten (71%) hospitals had a designated disaster-training program for health care workers. CONCLUSIONS Makkah has experienced multiple disaster incidents over the last decade. The present research suggests that Makkah hospitals are insufficiently prepared for potential future disasters. This may represent a considerable threat to the health of both residents and visitors to Makkah. This study demonstrated that there is significant room for improvement in most aspects of hospital Emergency Operations Plans, in particular: reviewing the plan and increasing the frequency of multi-agency and multi-hospital drills. Preparedness for terrorism utilizing chemical, biologic, radiation, nuclear, explosion (CBRNE) and infectious diseases was found to be sub-optimal and should be assessed further. Al-Shareef AS , Alsulimani LK , Bojan HM , Masri TM , Grimes JO , Molloy MS , Ciottone GR . Evaluation of hospitals' disaster preparedness plans in the holy city of Makkah (Mecca): a cross-sectional observation study. Prehosp Disaster Med. 2017;32 (1):33-45.
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El Zowalaty ME, Belkina T, Bahashwan SA, El Zowalaty AE, Tebbens JD, Abdel-Salam HA, Khalil AI, Daghriry SI, Gahtani MA, Madkhaly FM, Nohi NI, Khodari RH, Sharahili RM, Dagreery KA, Khormi M, Habibah SA, Medrba BA, Gahtani AA, Hifthi RY, Zaid JM, Amshan AW, Alneami AA, Noreddin A, Vlček J. Knowledge, awareness, and attitudes toward antibiotic use and antimicrobial resistance among Saudi population. Int J Clin Pharm 2016; 38:1261-8. [PMID: 27573719 DOI: 10.1007/s11096-016-0362-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 07/22/2016] [Indexed: 11/29/2022]
Abstract
Background Inappropriate use of antibiotics is a public health problem of great concern. Objective To evaluate knowledge of antibiotics, race, gender and age as independent risk factors for self-medication. Setting Residents and population from different regions of Saudi Arabia. Methods We conducted a cross sectional survey study among residents. Data were collected between June 2014 to May, 2015 from 1310 participants and data were recorded anonymously. The questionnaire was randomly distributed by interview of participants and included sociodemographic characteristics, antibiotics knowledge, attitudes and behavior with respect to antibiotics usage. Main outcome measure Population aggregate scores on questions and data were analyzed using univariate logistic regression to evaluate the influence of variables on self-prescription of antibiotics. Results The response rate was 87.7 %. A cumulative 63.6 % of participants reported to have purchased antibiotics without a prescription from pharmacies; 71.1 % reported that they did not finish the antibiotic course as they felt better. The availability of antibiotics without prescription was found to be positively associated with self-medication (OR 0.238, 95 % CI 0.17-0.33). Of those who used prescribed or non-prescribed antibiotics, 44.7 % reported that they kept left-over antibiotics from the incomplete course of treatment for future need. Interestingly, 62 % of respondents who used drugs without prescription agreed with the statement that antibiotics should be access-controlled prescribed by a physician. We also found significant association between storage, knowledge/attitudes and education. Conclusions The overall level of awareness on antibiotics use among residents in Saudi Arabia is low. This mandates public health awareness intervention programs to be implemented on the use of antibiotics.
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Affiliation(s)
- Mohamed E El Zowalaty
- School of Health Sciences, University of KwaZulu Natal, Westville, Durban, 4000, South Africa.
- Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia.
| | - Tatiana Belkina
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy, Charles University, 50005, Prague, Hradec Kralove, Czech Republic.
| | - Saleh A Bahashwan
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Taibah University, Al Madina Al Munawarah, Kingdom of Saudi Arabia
| | - Ahmed E El Zowalaty
- Department of Physiology & Pharmacology, College of Veterinary Medicine, University of Georgia, Athens, Georgia, 30602, USA
- Interdisciplinary Toxicology Program, University of Georgia, Athens, Georgia, 30602, USA
| | - Jurjen Duintjer Tebbens
- Department of Biophysics and Physical Chemistry, Faculty of Pharmacy, Charles University, 50005, Prague, Hradec Kralove, Czech Republic
| | - Hassan A Abdel-Salam
- Department of Microbiology, Faculty of Pharmacy, Taibah University, Al Madina Al Munawarah, Saudi Arabia
| | - Adel I Khalil
- Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Safaa I Daghriry
- Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Mona A Gahtani
- Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | - Nahed I Nohi
- Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Rafaa H Khodari
- Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Reem M Sharahili
- Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Khlood A Dagreery
- Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Mayisah Khormi
- Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Sarah Abuo Habibah
- Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Bayan A Medrba
- Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Amal A Gahtani
- Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Rasha Y Hifthi
- Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Jameelah M Zaid
- Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Arwa W Amshan
- Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Alqasim A Alneami
- Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Ayman Noreddin
- Faculty of Pharmacy, Chapman University, Irvine, CA, 92618, USA
| | - Jiří Vlček
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy, Charles University, 50005, Prague, Hradec Kralove, Czech Republic
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Abd El Ghany M, Sharaf H, Hill-Cawthorne GA. Hajj vaccinations-facts, challenges, and hope. Int J Infect Dis 2016; 47:29-37. [PMID: 27260241 DOI: 10.1016/j.ijid.2016.05.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/19/2016] [Accepted: 05/23/2016] [Indexed: 12/13/2022] Open
Abstract
Vaccination is an effective preventive measure that has been used in the unique Hajj pilgrimage setting to control the transmission of infectious diseases. The current vaccination policy applied during Hajj is reviewed herein, highlighting the effectiveness of the approaches applied and identifying research gaps that need to be filled in order to improve the development and dissemination of Hajj vaccination strategies.
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Affiliation(s)
- Moataz Abd El Ghany
- The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia; The Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia.
| | | | - Grant A Hill-Cawthorne
- The Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia; School of Public Health, The University of Sydney, Australia.
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Olaitan AO, Dia NM, Gautret P, Benkouiten S, Belhouchat K, Drali T, Parola P, Brouqui P, Memish Z, Raoult D, Rolain JM. Acquisition of extended-spectrum cephalosporin- and colistin-resistant Salmonella enterica subsp. enterica serotype Newport by pilgrims during Hajj. Int J Antimicrob Agents 2015; 45:600-4. [PMID: 25769786 DOI: 10.1016/j.ijantimicag.2015.01.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 01/13/2015] [Indexed: 12/30/2022]
Abstract
Gatherings like the Hajj involving many people who travel from different parts of the world represent a risk for the acquisition and dissemination of infectious diseases. In this study, acquisition of multidrug-resistant (MDR) Salmonella spp. in 2013 Hajj pilgrims from Marseille, France, was investigated. In total, 267 rectal swabs were collected from 129 participants before their departure and after their return from the pilgrimage as well as during the pilgrimage from patients with diarrhoea. Samples were screened for the presence of Salmonella using quantitative real-time PCR and culture. Whole-genome sequencing was performed to characterise one of the isolates, and the mechanism leading to colistin resistance was investigated. Six post-Hajj samples and one sample collected during a diarrhoea episode in Hajj were positive for Salmonella by real-time PCR, with five Salmonella enterica belonging to several serotypes recovered by culture, whereas no pre-Hajj sample was positive. Two of the isolates belonged to the epidemic Newport serotype, were resistant to cephalosporins, gentamicin and colistin, and harboured the bla(CTX-M-2) gene and a 12-nucleotide deletion in the pmrB gene leading to colistin resistance. This study shows that pilgrims acquired Salmonella bacteria, including a novel MDR clone, during the Hajj pilgrimage. This calls for more improved public health surveillance during Hajj because Salmonella is one of the most common diarrhoea-causing bacteria worldwide. Therefore, returning pilgrims could disseminate MDR bacteria worldwide upon returning to their home countries.
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Affiliation(s)
- Abiola Olumuyiwa Olaitan
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France
| | - Ndèye Méry Dia
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France
| | - Philippe Gautret
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France
| | - Samir Benkouiten
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France
| | - Khadidja Belhouchat
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France
| | - Tassadit Drali
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France
| | - Philippe Parola
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France
| | - Philippe Brouqui
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France
| | - Ziad Memish
- Alfaisal University, Riyadh 11176, Saudi Arabia
| | - Didier Raoult
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France; Special Infectious Agents Unit, King Fahd Medical Research Centre, King Abdul Aziz University, Jeddah, Saudi Arabia
| | - Jean-Marc Rolain
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France.
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Tabatabaei A, Heidarzadeh A, Shamspour N, Kolivand P. The efficacy of systemic corticosteroids in treatment of respiratory tract infections during hajj 2012. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e12859. [PMID: 25763272 PMCID: PMC4341496 DOI: 10.5812/ircmj.12859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 01/28/2014] [Accepted: 11/01/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Diagnosis and treatment of respiratory tract infections (RTI) in a mass-gathering situation such as hajj is a medical challenge that requires quick decision-making and considerable knowledge about its etiology and treatment methods. High prevalence of RTI during Hajj and tendency of caravan physicians to treat of patients quickly in such situation lead to prescription of parenteral steroids. Nonetheless, no study has focused on the short-term and long-term effects of systemic steroids in Hajj pilgrims with RTI. OBJECTIVES This study focuses on efficacy of systemic consumption of corticosteroids in alleviating symptoms of RTI. PATIENTS AND METHODS This clinical trial was included 1671 pilgrims in Hajj 2012 who had symptoms of RTI based on caravan physician's findings. The patients were divided to two groups to receive either parenteral corticosteroid or other drugs. Patients who received antibiotics for bacterial infections were excluded. This survey concentrated on general symptoms of RTI during Hajj such as fever, musculoskeletal pain, coryza, sore throat, cough, dyspnea, and hoarseness before, 24 hours after, and five days after drug consumption. For classification and analysis of data, SPSS 17 was used. Descriptive statistical and Chi square test were used to compare variables. RESULTS In comparison to corticosteroid injection, treatment without systemic corticosteroids could reduce the fever more significantly within five days (P < 0.05), while it had no effect after 48 hours (P > 0.05). Although corticosteroids alleviated the symptoms during the first 48 hours (P > 0.05), they had no more effect after five days of consumption (P > 0.05). Treatment with medications other than corticosteroid had less effect on reducing coryza (P > 0.05) while corticosteroids had significant alleviating effect on coryza, cough, and musculoskeletal pain (P < 0.05). CONCLUSIONS There is a need to conduct more comprehensive studies on effect of combination therapy with corticosteroids and antibiotics as well as their short-term and long-term adverse effects on the immune system. While injecting corticosteroids is commonly administered in patients with RTI, they are not recommended due to the lack of data on their long-term therapeutic and adverse effects.
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Affiliation(s)
- Aminreza Tabatabaei
- Department of Education and Research, Hajj and Pilgrimage Medical Center, Tehran, IR Iran
| | - Abbas Heidarzadeh
- Department of Pharmacutical, Hajj and Pilgrimage Medical Center, Tehran, IR Iran
| | - Navvab Shamspour
- Department of Education and Research, Hajj and Pilgrimage Medical Center, Tehran, IR Iran
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Altuwairgi O, Baharoon S, Alkabab Y, Alsafi E, Almoweqel M, AL-Jahdali H. Ultrasound-guided core biopsy in the diagnostic work-up of tuberculous lymphadenitis in Saudi Arabia, refining the diagnostic approach. Case series and review of literature. J Infect Public Health 2014; 7:371-6. [DOI: 10.1016/j.jiph.2014.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 03/05/2014] [Accepted: 03/07/2014] [Indexed: 11/24/2022] Open
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Hedari CP, Khinkarly RW, Dbaibo GS. Meningococcal serogroups A, C, W-135, and Y tetanus toxoid conjugate vaccine: a new conjugate vaccine against invasive meningococcal disease. Infect Drug Resist 2014; 7:85-99. [PMID: 24729718 PMCID: PMC3979687 DOI: 10.2147/idr.s36243] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Invasive meningococcal disease is a serious infection that occurs worldwide. It is caused by Neisseria meningitidis, of which six serogroups (A, B, C, W-135, X, and Y) are responsible for most infections. The case fatality rate of meningococcal disease remains high and can lead to significant sequelae. Vaccination remains the best strategy to prevent meningococcal disease. Polysaccharide vaccines were initially introduced in the late 1960s but their limitations (poor immunogenicity in infants and toddlers and hyporesponsiveness after repeated doses) have led to the development and use of meningococcal conjugate vaccines, which overcome these limitations. Two quadrivalent conjugated meningococcal vaccines – MenACWY-DT (Menactra®) and MenACWY-CRM197 (Menveo®) – using diphtheria toxoid or a mutant protein, respectively, as carrier proteins have already been licensed in the US. Recently, a quadrivalent meningococcal vaccine conjugated to tetanus toxoid (MenACWY-TT; Nimenrix®) was approved for use in Europe in 2012. The immunogenicity of MenACWY-TT, its reactogenicity and safety profile, as well as its coadministration with other vaccines are discussed in this review. Clinical trials showed that MenACWY-TT was immunogenic in children above the age of 12 months, adolescents, and adults, and has an acceptable reactogenicity and safety profile. Its coadministration with several other vaccines that are commonly used in children, adolescents, and adults did not affect the immunogenicity of MenACWY-TT or the coadministered vaccine, nor did it affect its reactogenicity and safety. Other studies are now ongoing in order to determine the immunogenicity, reactogenicity, and safety of MenACWY-TT in infants from the age of 6 weeks.
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Affiliation(s)
- Carine P Hedari
- Center for Infectious Diseases Research, Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rima W Khinkarly
- Center for Infectious Diseases Research, Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghassan S Dbaibo
- Center for Infectious Diseases Research, Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Zahlanie YC, Hammadi MM, Ghanem ST, Dbaibo GS. Review of meningococcal vaccines with updates on immunization in adults. Hum Vaccin Immunother 2014; 10:995-1007. [PMID: 24500529 PMCID: PMC4896590 DOI: 10.4161/hv.27739] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 12/31/2013] [Accepted: 01/06/2014] [Indexed: 11/19/2022] Open
Abstract
Meningococcal disease is a serious and global life-threatening disease. Six serogroups (A, B, C, W-135, X, and Y) account for the majority of meningococcal disease worldwide. Meningococcal polysaccharide vaccines were introduced several decades ago and have led to the decline in the burden of disease. However, polysaccharide vaccines have several limitations, including poor immunogenicity in infants and toddlers, short-lived protection, lack of immunologic memory, negligible impact on nasopharyngeal carriage, and presence of hyporesponsiveness after repeated doses. The chemical conjugation of plain polysaccharide vaccines has the potential to overcome these drawbacks. Meningococcal conjugate vaccines include the quadrivalent vaccines (MenACWY-DT, MenACWY-CRM, and MenACWY-TT) as well as the monovalent A and C vaccines. These conjugate vaccines were shown to elicit strong immune response in adults. This review addresses the various aspects of meningococcal disease, the limitations posed by polysaccharide vaccines, the different conjugate vaccines with their immunogenicity and reactogenicity in adults, and the current recommendations in adults.
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Affiliation(s)
- Yorgo C Zahlanie
- Center for Infectious Diseases Research; Division of Pediatric Infectious Diseases; Department of Pediatrics and Adolescent Medicine; American University of Beirut Medical Center; Beirut, Lebanon
| | - Moza M Hammadi
- Center for Infectious Diseases Research; Division of Pediatric Infectious Diseases; Department of Pediatrics and Adolescent Medicine; American University of Beirut Medical Center; Beirut, Lebanon
| | - Soha T Ghanem
- Department of Pediatrics; Makassed General Hospital; Beirut, Lebanon
| | - Ghassan S Dbaibo
- Center for Infectious Diseases Research; Division of Pediatric Infectious Diseases; Department of Pediatrics and Adolescent Medicine; American University of Beirut Medical Center; Beirut, Lebanon
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Al-Bishri J, Masoodi I, Adnan M, Tariq M, Abdullah H, Abdulgoni T, Bander G, Altalhi M. Population dynamics and tuberculosis: a cross sectional study of an overlooked disease in Saudi Arabia. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2014; 12:Doc02. [PMID: 24454274 PMCID: PMC3895866 DOI: 10.3205/000187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 11/30/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND International travel, migration and human population movements facilitate the spread of tuberculosis (TB). OBJECTIVE To study the impact of poorly screened expatriates working in Saudi Arabia on the local incidence of TBs. PATIENTS AND METHODS This cross sectional study was carried out in the Chest Disease Hospital, Taif. All confirmed cases of TB from June 2009 to May 2010 admitted to the hospital were enrolled. Inclusion criteria were diagnosed cases of TB (pulmonary & extra-pulmonary) in patients between the ages of 14 to 65 years. Patients with HIV and coexistent malignancies were excluded. The age, gender and ethnic group of each patient was recorded, and patients were divided into two groups. Of the two groups, Group A consisted of Taif residents and group B of patients referred from other cities in the country. RESULTS Of the 686 cases studied, 370 (54%) were Saudi nationals (Group A = 80 & Group B = 290) and 316 (46%) cases were from other countries. Males outnumbered females and most of the patients were aged 20 to 29 years. The number of cases from the areas close to the pilgrimage sites, i.e. Makah (233) and Jeddah (275), outnumbered those in Taif (110). CONCLUSIONS Our study identifies an increased prevalence of TB cases in areas close to the pilgrimage (Group B). The higher proportion of non-Saudi TB patients in group B is most likely explained by the higher number of poorly screened illegal expatriates in the region.
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Affiliation(s)
- Jamal Al-Bishri
- Dept. of Medicine, College of Medicine, Taif University, Saudi Arabia
| | - Ibrahim Masoodi
- Dept. of Medicine, College of Medicine, Taif University, Saudi Arabia
| | - Mubarki Adnan
- Dept. of Medicine, College of Medicine, Taif University, Saudi Arabia
| | - Malik Tariq
- Dept. of Medicine, Chest Disease Hospital, Taif, Saudi Arabia
| | - Harthi Abdullah
- Dept. of Medicine, Chest Disease Hospital, Taif, Saudi Arabia
| | | | - Guraibi Bander
- Dept. of Medicine, College of Medicine, Taif University, Saudi Arabia
| | - Mansoor Altalhi
- Dept. of Medicine, Chest Disease Hospital, Taif, Saudi Arabia
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Memish ZA, Al-Rabeeah AA. Public health management of mass gatherings: the Saudi Arabian experience with MERS-CoV. Bull World Health Organ 2013; 91:899-899A. [PMID: 24347725 PMCID: PMC3845273 DOI: 10.2471/blt.13.132266] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Ziad A Memish
- Ministry of Health of Saudi Arabia, PO Box 54146, Riyadh 11514, Saudi Arabia
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Respiratory tract infections during the annual Hajj: potential risks and mitigation strategies. Curr Opin Pulm Med 2013; 19:192-7. [PMID: 23429098 DOI: 10.1097/mcp.0b013e32835f1ae8] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Mass gatherings such as religious pilgrimages, sporting events and music concerts are becoming larger and more frequent. The scale and frequency of large-scale international events pose substantial risks to the spread of infectious diseases. The available literature on respiratory tract infections at the Hajj pilgrimage - annually attended by 3 million pilgrims from all over the globe - are reviewed. RECENT FINDINGS The most common respiratory tract infection viruses are influenza and rhinovirus. Despite the occurrence of the Hajj during the 2009 H1N1 pandemic the available literature did not show an increased rate of infection. In hospitalized patients, pneumonia is a significant cause of admission accounting for 20-50% of such admissions. SUMMARY The use of masks may reduce exposure to droplet nuclei, the main mode of transmission of most respiratory tract infections. The practice of social distancing, hand hygiene, and contact avoidance was associated with reduced risk of respiratory illness. In addition, utilizing the recommended vaccines would decrease the risk of acquiring respiratory tract pathogens.
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Memish Z, Al Hakeem R, Al Neel O, Danis K, Jasir A, Eibach D. Laboratory-confirmed invasive meningococcal disease: effect of the Hajj vaccination policy, Saudi Arabia, 1995 to 2011. ACTA ACUST UNITED AC 2013; 18. [PMID: 24079399 DOI: 10.2807/1560-7917.es2013.18.37.20581] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Saudi Arabia (SA) experienced two large invasive meningococcal disease (IMD) outbreaks during the 2000 and 2001 Hajj pilgrimages. In 2002, polysaccharide quadrivalent ACWY vaccines became mandatory for Mecca and Medina pilgrims/residents older than two years. This study aimed to analyse IMD surveillance data among citizens, residents and pilgrims in SA from 1995 to 2011, focusing on changes before and after the new vaccination policy. For all laboratory-confirmed IMD cases in the national surveillance database from 1995 to 2011, serogroup and age were retrieved. The cases' seasonal distribution as well as the case fatality ratios (CFR) were obtained. For Saudi citizens/residents and Hajj pilgrims, annual rates were calculated using mid-year population estimates. The Student's t-test was used to compare means between the pre-epidemic (1995-1999) and post-epidemic (2002-2011) periods, excluding outbreak years. From 1995 to 2011, laboratories notified 1,103 cases. Between the pre- and post-epidemic periods, mean annual IMD rates decreased from 0.20 (standard deviation (SD): 0.1) to 0.06 cases/100,000 (SD: 0.06; p=0.02), mean numbers of Hajj-related cases from 13 (SD: 9.3) to 2 cases/year (SD: 2.3; p=0.02) and the mean age from 31 (SD: 1.3) to 18 years (SD: 1.4; p<0.01). The CFR in Saudi citizens (10.4) was lower than among foreign pilgrims (28.9) and decreased from 19.3% (SD: 1.8) in the pre-epidemic to 11.4% (SD: 7.0; p=0.04) in the post-epidemic phase. The decrease of annual IMD rates, CFR and Hajj-related cases between the pre- and post- vaccine era suggests a possible positive effect of the mandatory ACWY vaccination for pilgrims/residents in Mecca and Medina. Regular surveillance with an annual data analysis is necessary to monitor trends and circulating serotypes and to implement appropriate public health measures to avoid new IMD epidemics during upcoming Hajj seasons.
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Affiliation(s)
- Z Memish
- Public Health Directorate, WHO Collaborating Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
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Khan K, Sears J, Hu VW, Brownstein JS, Hay S, Kossowsky D, Eckhardt R, Chim T, Berry I, Bogoch I, Cetron M. Potential for the international spread of middle East respiratory syndrome in association with mass gatherings in saudi arabia. PLOS CURRENTS 2013; 5. [PMID: 23884087 PMCID: PMC3714242 DOI: 10.1371/currents.outbreaks.a7b70897ac2fa4f79b59f90d24c860b8] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: A novel coronavirus (MERS-CoV) causing severe, life-threatening respiratory disease has emerged in the Middle East at a time when two international mass gatherings in Saudi Arabia are imminent. While MERS-CoV has already spread to and within other countries, these mass gatherings could further amplify and/or accelerate its international dissemination, especially since the origins and geographic source of the virus remain poorly understood.
Methods: We analyzed 2012 worldwide flight itinerary data and historic Hajj pilgrim data to predict population movements out of Saudi Arabia and the broader Middle East to help cities and countries assess their potential for MERS-CoV importation. We compared the magnitude of travel to countries with their World Bank economic status and per capita healthcare expenditures as surrogate markers of their capacity for timely detection of imported MERS-CoV and their ability to mount an effective public health response.
Results: 16.8 million travelers flew on commercial flights out of Saudi Arabia, Jordan, Qatar, and the United Arab Emirates between June and November 2012, of which 51.6% were destined for India (16.3%), Egypt (10.4%), Pakistan (7.8%), the United Kingdom (4.3%), Kuwait (3.6%), Bangladesh (3.1%), Iran (3.1%) and Bahrain (2.9%). Among the 1.74 million foreign pilgrims who performed the Hajj last year, an estimated 65.1% originated from low and lower-middle income countries.
Conclusion: MERS-CoV is an emerging pathogen with pandemic potential with its apparent epicenter in Saudi Arabia, where millions of pilgrims will imminently congregate for two international mass gatherings. Understanding global population movements out of the Middle East through the end of this year's Hajj could help direct anticipatory MERS-CoV surveillance and public health preparedness to mitigate its potential global health and economic impacts.
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Affiliation(s)
- Kamran Khan
- Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
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Human Stampedes: A Systematic Review of Historical and Peer-Reviewed Sources. Disaster Med Public Health Prep 2013; 3:191-5. [DOI: 10.1097/dmp.0b013e3181c5b494] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Emamian MH, Mohammad Mohammadi G. An Outbreak of Gastroenteritis Among Iranian Pilgrims of Hajj during 2011. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:317-9. [PMID: 24083005 PMCID: PMC3785906 DOI: 10.5812/ircmj.3681] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Revised: 01/03/2013] [Accepted: 01/20/2013] [Indexed: 11/16/2022]
Abstract
Background Hajj is the largest annual mass gathering of muslims. The exorbitant crowd of pilgrims and the poor condition of personal hygiene and nutrition are the main predisposing factors for different infections and food poisonings. Objectives This study investigates a gastroenteritis outbreak among an Iranian caravan of hajj pilgrims. Materials and Methods Studying the outbreak was carried out through a cohort study and it investigated the attack rates of the two groups of pilgrims who had consumed or had not consumed various food products. The relative risk and 95% confidence interval of each food product was then calculated. Results Only canned rice and fish had a relative risk higher than one, although both were not statistically significant. Therefore, it could be stated that the consumed foodstuffs have not caused this outbreak. Conclusions None of the foodstuffs distributed among the pilgrims were the reason for this disease, and studying outbreaks in caravans with higher sample sizes is suggested.
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Affiliation(s)
- Mohammad Hassan Emamian
- Shahroud University of Medical Sciences, Shahroud, IR Iran
- Corresponding author: Mohammad Hassan Emamian, Shahroud University of Medical Sciences, Shahroud, IR Iran, Tel: +98-2733395006, Fax: +98-2733395009, E-mail:
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Caracterización epidemiológica y factores de riesgo asociados a la peregrinación religiosa a Arabia Saudí. Resultados de una cohorte prospectiva 2008-2009. GACETA SANITARIA 2012; 26:251-5. [DOI: 10.1016/j.gaceta.2011.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 09/02/2011] [Accepted: 09/05/2011] [Indexed: 11/21/2022]
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Tuberculosis Trends in the Kingdom of Saudi Arabia, 2005 to 2009. Ann Epidemiol 2012; 22:264-9. [DOI: 10.1016/j.annepidem.2012.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 01/18/2012] [Accepted: 01/30/2012] [Indexed: 11/17/2022]
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Memish ZA, Assiri AM, Hussain R, Alomar I, Stephens G. Detection of respiratory viruses among pilgrims in Saudi Arabia during the time of a declared influenza A(H1N1) pandemic. J Travel Med 2012; 19:15-21. [PMID: 22221807 PMCID: PMC7537650 DOI: 10.1111/j.1708-8305.2011.00575.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The objectives of this study were to determine whether pilgrim attendance at the Hajj was associated with an increased risk of acquiring influenza, and other respiratory viruses, and to evaluate the compliance of pilgrims with influenza vaccination and other recommended preventive measures. METHODS A cross-sectional survey was conducted among pilgrims as they arrived at the King Abdulaziz International Airport in Jeddah for the 2009 Hajj and as they departed from the same airport during the week after the Hajj. Nasopharyngeal and throat swabs were tested for 18 respiratory virus types and subtypes using the xTAG Respiratory Viral Panel FAST assay. RESULTS A total of 519 arriving pilgrims and 2,699 departing pilgrims were examined. Their mean age was 49 years and 58% were male. In all, 30% of pilgrims stated that they had received pandemic influenza A(H1N1) vaccine before leaving for the Hajj and 35% of arriving pilgrims reported wearing a face mask. Only 50% of arriving pilgrims were aware of preventive measures such as hand hygiene and wearing a mask. The prevalence of any respiratory-virus infection was 14.5% (12.5% among arriving pilgrims and 14.8% among departing pilgrims). The main viruses detected (both groups combined) were rhinovirus-enterovirus (N = 414, 12.9%), coronaviruses (N = 27, 0.8%), respiratory syncytial virus (N = 8, 0.2%), and influenza A virus (N = 8, 0.2%) including pandemic influenza A(H1N1) (N = 3, 0.1%). The prevalence of pandemic influenza A(H1N1) was 0.2% (N = 1) among arriving pilgrims and 0.1% (N = 2) among departing pilgrims. The prevalence of any respiratory virus infection was lower among those who said they received H1N1 vaccine compared to those who said they did not receive it (11.8% vs 15.6%, respectively, p = 0.009). CONCLUSION We found very low pandemic influenza A(H1N1) prevalence among arriving pilgrims and no evidence that amplification of transmission had occurred among departing pilgrims.
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Affiliation(s)
- Ziad A Memish
- Department of Preventive Medicine, Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
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Memish ZA, Shibl AM. Consensus building and recommendations based on the available epidemiology of meningococcal disease in Gulf Cooperation Council States. Travel Med Infect Dis 2011; 9:60-6. [PMID: 21345738 DOI: 10.1016/j.tmaid.2011.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 01/07/2011] [Accepted: 01/24/2011] [Indexed: 01/16/2023]
Abstract
The Gulf Cooperation Council (GCC) States share concerns about meningococcal disease, particularly in association with the Hajj and Umrah pilgrimages, which have been connected with outbreaks within the Kingdom of Saudi Arabia and among contacts of the pilgrims in their countries of origin. Currently, the most prevalent meningococcal serogroup in the GCC States is W-135. Although vaccination with polysaccharide vaccines has protected pilgrims and their close contacts from invasive disease, the potential availability of novel conjugate vaccines, such as the one currently used for vaccination of military personnel in the Kingdom of Saudi Arabia, prompted an evaluation of disease epidemiology in the region. For several countries, published data on recent epidemiology are not available. We report findings from a meeting of the GCC States Meningitis Study Group, which comprised experts from the Kingdom of Saudi Arabia, the Kingdom of Bahrain, Kuwait, Qatar, the Sultanate of Oman, and the United Arab Emirates. These experts provided an update on epidemiology and current vaccination practices in the GCC States, and discussed new approaches to more effective disease prevention.
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Affiliation(s)
- Ziad A Memish
- Ministry of Health, Preventive Medicine Directorate, P.O. Box 54146, Riyadh 11514, Saudi Arabia.
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Kalimuddin S, Seow CJ, Barkham T, Deepak RN, Li L, Tan TT. Hidden health risks of the Hajj--a report of two cases of brucellosis contracted by pilgrims during the Hajj. ACTA ACUST UNITED AC 2010; 42:228-30. [PMID: 20085421 DOI: 10.3109/00365540903402971] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Commonly occurring health hazards associated with the Hajj have been well described in the literature. However, there remain other serious but less well known health risks. We present here 2 cases of brucellosis contracted from drinking unpasteurised camel's milk during the Hajj.
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Affiliation(s)
- Shirin Kalimuddin
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
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Al-Hajoj SA. Tuberculosis in Saudi Arabia: can we change the way we deal with the disease? J Infect Public Health 2010; 3:17-24. [PMID: 20701887 DOI: 10.1016/j.jiph.2009.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 09/28/2009] [Accepted: 12/13/2009] [Indexed: 11/17/2022] Open
Abstract
Infection from Mycobacterium tuberculosis results in the death of three million people worldwide per annum of which an estimated one thousand are in Saudi Arabia. The WHO has set a target for successful treatment of 85% but Saudi Arabia is currently not meeting that target. We believe that the first step in improving the control of tuberculosis in Saudi Arabia is to improve and unify the standards of diagnostic services and laboratories responsible for tuberculosis. This paper reviews the current status and suggests possible improvements.
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Affiliation(s)
- Sahal Abdulaziz Al-Hajoj
- Department of Comparative Medicine, King Faisal Specialist Hospital & Research Centre (MBC 03), PO Box 3354, Riyadh 11211, Saudi Arabia.
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Memish ZA, McNabb SJN, Mahoney F, Alrabiah F, Marano N, Ahmed QA, Mahjour J, Hajjeh RA, Formenty P, Harmanci FH, El Bushra H, Uyeki TM, Nunn M, Isla N, Barbeschi M. Establishment of public health security in Saudi Arabia for the 2009 Hajj in response to pandemic influenza A H1N1. Lancet 2009; 374:1786-91. [PMID: 19914707 DOI: 10.1016/s0140-6736(09)61927-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Mass gatherings of people challenge public health capacities at host locations and the visitors' places of origin. Hajj--the yearly pilgrimage by Muslims to Saudi Arabia--is one of the largest, most culturally and geographically diverse mass gatherings in the world. With the 2009 pandemic influenza A H1N1 and upcoming Hajj, the Saudi Arabian Ministry of Health (MoH) convened a preparedness consultation in June, 2009. Consultants from global public health agencies met in their official capacities with their Saudi Arabian counterparts. The MoH aimed to pool and share public health knowledge about mass gatherings, and review the country's preparedness plans, focusing on the prevention and control of pandemic influenza. This process resulted in several practical recommendations, many to be put into practice before the start of Hajj and the rest during Hajj. These preparedness plans should ensure the optimum provision of health services for pilgrims to Saudi Arabia, and minimum disease transmission on their return home. Review of the implementation of these recommendations and their effect will not only inform future mass gatherings in Saudi Arabia, but will also strengthen preparedness efforts in other settings.
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Affiliation(s)
- Z A Memish
- Ministry of Health, Riyadh, Saudi Arabia.
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Rafiq SM, Rashid H, Haworth E, Booy R. Hazards of hepatitis at the Hajj. Travel Med Infect Dis 2009; 7:239-46. [DOI: 10.1016/j.tmaid.2008.09.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Accepted: 09/08/2008] [Indexed: 12/18/2022]
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Baharoon S, Al-Jahdali H, Al Hashmi J, Memish ZA, Ahmed QA. Severe sepsis and septic shock at the Hajj: etiologies and outcomes. Travel Med Infect Dis 2008; 7:247-52. [PMID: 19717109 DOI: 10.1016/j.tmaid.2008.09.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2008] [Accepted: 09/08/2008] [Indexed: 12/26/2022]
Abstract
BACKGROUND The Hajj represents the largest mass migration on earth, during which several million Muslims travel across the planet to descend on specific holy sites at Makkah in the Hijaz area of the Kingdom of Saudi Arabia. Since sepsis syndrome is a major worldwide cause of morbidity and mortality we decided to study the incidence, etiologies, complications and outcome of severe sepsis and septic shock among Hajjees patients in two major intensive care units (ICUs) in Makkah for the Hajj season 2004. METHOD A prospective observational study was conducted during the 2004 Hajj season between 8 January and 21 February in two major hospitals in Makkah. RESULTS Severe sepsis and septic shock accounts for 25.4% of admission to the ICU during Hajj. The mean age of hajjees was 65.45 (+/-14.0) years. Chronic respiratory illness was the leading comorbidity present in more than 70% of hajjees and pneumonia was the leading cause of sever sepsis and septic shock. Gram-negative organisms were the most frequently isolated pathogen in this subset of patients. Acute renal failure is common among pilgrims who presented with septic shock, and carries high mortality. CONCLUSION Septic shock is a major cause of admission to the ICU during Hajj and carries a poor outcome. More studies are needed to evaluate modifiable factors that are associated with this high mortality.
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Affiliation(s)
- Salim Baharoon
- Department of Critical Care & Internal Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh 11426, Saudi Arabia.
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Rashid H, Shafi S, Haworth E, El Bashir H, Memish ZA, Sudhanva M, Smith M, Auburn H, Booy R. Viral respiratory infections at the Hajj: comparison between UK and Saudi pilgrims. Clin Microbiol Infect 2008; 14:569-74. [PMID: 18373688 PMCID: PMC7129001 DOI: 10.1111/j.1469-0691.2008.01987.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
A high incidence of respiratory infection, including influenza, has been reported at the Hajj in Mecca, Saudi Arabia. Reported rates of influenza have been higher among UK than among domestic pilgrims, but this could be explained by methodological differences among studies. Accordingly, the present study compared the frequencies of respiratory viruses among UK and Saudi pilgrims using the same study design. Pilgrims with upper respiratory tract symptoms were recruited from Mecca and the neighbouring valley Mina during the Hajj 2006. Nasal swabs were used for point-of-care influenza testing and real-time RT-PCR (rtRT-PCR) tests for influenza virus, rhinovirus, parainfluenza virus, adenovirus, human metapneumovirus and respiratory syncytial virus. Of 260 pilgrims investigated, 150 were from the UK and 110 were Saudi; of these, 38 (25%) UK pilgrims and 14 (13%) Saudi pilgrims had respiratory infections detectable by rtRT-PCR (p 0.01). In the UK group, there were 19 (13%) cases of rhinovirus infection, 15 (10%) cases of influenza virus infection, two (1%) cases of dual infections with influenza virus and rhinovirus, one (3%) case of parainfluenza virus infection, and one (1%) case of respiratory syncytial virus infection. Fifty-six (37%) UK pilgrims had been vaccinated against influenza virus, with the rates of influenza in the vaccinated and unvaccinated group being 7% and 14%, respectively (p 0.19). In the Saudi group, there were three (3%) cases of rhinovirus infection and 11 (10%) cases of influenza. Only four (4%) Saudi pilgrims had been vaccinated against influenza virus, and none of these was infected with influenza virus. Overall, a significantly higher proportion of the UK pilgrims had detectable respiratory infections (25% vs. 13%, p 0.01). Influenza rates were similar in both groups, but the reported rates of influenza vaccination differed.
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Affiliation(s)
- H. Rashid
- Academic Unit of Child Health, Barts and the London Queen Mary’s School of Medicine and Dentistry
| | - S. Shafi
- Clinical Microbiology & HPA Collaborating Laboratory, North West London Hospitals NHS Trust
| | - E. Haworth
- Health Protection Agency South East, London, UK
| | - H. El Bashir
- Academic Unit of Child Health, Barts and the London Queen Mary’s School of Medicine and Dentistry
| | - Z. A. Memish
- Departments of Medicine, Infection Prevention and Control, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - M. Sudhanva
- South London Specialist Virology Centre, Health Protection Agency London Regional Laboratory, Kings College NHS Foundation Trust, London, UK
| | - M. Smith
- South London Specialist Virology Centre, Health Protection Agency London Regional Laboratory, Kings College NHS Foundation Trust, London, UK
| | - H. Auburn
- South London Specialist Virology Centre, Health Protection Agency London Regional Laboratory, Kings College NHS Foundation Trust, London, UK
| | - R. Booy
- Academic Unit of Child Health, Barts and the London Queen Mary’s School of Medicine and Dentistry
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children’s Hospital at Westmead and The University of Sydney, New South Wales, Australia
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Memish ZA, Osoba AO, Shibl AM, Mokaddas E, Venkatesh S, Rotimi VO. Emergence and trends of penicillin non-susceptible Streptococcus pneumoniae in Saudi Arabia and Kuwait - perspective and outstanding issues. J Chemother 2008; 19:471-81. [PMID: 18073145 DOI: 10.1179/joc.2007.19.5.471] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
For many years in the past Streptococcus pneumoniae was uniformly susceptible to penicillin until the sudden and unexpected emergence of clinical infections caused by penicillin-resistant S. pneumoniae (PRSP) in 1967. Within the following decade, reports of nosocomial and community outbreaks of infections due to PRSP became widespread all over the world. Recent reports suggest that the incidence of resistance rates is rising in many countries although there are geographical variations in the prevalence and patterns of resistance between countries. The problem of antibiotic resistance is further compounded by the emergence of resistance to many beta-lactam antibiotics. The first report of PRSP in Saudi Arabia was in 1991. Barely a year after, PRSP infection was reported in Kuwait in 1992. Since then, studies from various parts of these countries have recorded prevalence rates ranging from 6.2% in Riyadh to 34% in Jeddah and 20% to 56% in neighboring Kuwait. These suggest considerable variation in the prevalence of PRSP in different cities in the Saudi Kingdom and Kuwait. The mechanism of resistance is due to chromosomally mediated alteration of penicillin-binding proteins (PBPs), which are target sites for beta-lactam antibiotics. It would appear that the spread of PRSP strains in Saudi Arabia is driven by the selective pressure created by excessive use and misuse of antimicrobial agents made possible by the easy availability of these agents, often frequently obtainable over the counter. In Kuwait, irrational and misguided use of antibiotics may be the major driving force favoring the spread of PRSP. The serotypes of strains encountered in Saudi Arabia and Kuwait are almost identical, with serotypes 19, 6, 15, 14 and 23 being the most common; together they constitute about 70% of the isolates circulating in these countries. In general, almost 90% of the serotypes included in the 23-polyvalent vaccine are present in the general population. However, a much lower percentage of these serotypes is found in the conjugated vaccines, which are more relevant to our communities. This paper reviews the emergence and the steady increase in the prevalence of penicillin-resistant pneumococcal strains in Saudi Arabia and Kuwait during the last 10 years. It discusses the trends, mechanisms of resistance and factors associated with the emergence, dissemination, and colonization of resistant organisms and suggests options available to clinicians for management of infections due to PRSP.
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Affiliation(s)
- Z A Memish
- Department of Infectious Prevention and Control, King Abdulaziz Medical City, King Fahad National Guard Hospital, Riyadh, Saudi Arabia.
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Avnon LS, Jotkowitz A, Smoliakov A, Flusser D, Heimer D. Can the routine use of fluoroquinolones for community-acquired pneumonia delay the diagnosis of tuberculosis? A salutary case of diagnostic delay in a pilgrim returning from Mecca. Eur J Intern Med 2006; 17:444-6. [PMID: 16962957 DOI: 10.1016/j.ejim.2006.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Revised: 02/12/2006] [Accepted: 02/20/2006] [Indexed: 11/29/2022]
Abstract
Guidelines advocate using fluoroquinolones as first-line treatment for community-acquired pneumonia (CAP). However, the use of fluoroquinolones in patients with undiagnosed tuberculosis may cause a delay in the diagnosis of tuberculosis and may also promote the development of resistance to these drugs if used as monotherapy in undiagnosed tuberculosis. We illustrate the former with the following case report of a patient who developed tuberculosis after a pilgrimage to Mecca.
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Affiliation(s)
- L Sølling Avnon
- Pulmonary Clinic, Soroka University Hospital, Ben Gurion University of the Negev, Faculty of Health Sciences, Beer Sheva, Israel
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Moore JE, Barton MD, Blair IS, Corcoran D, Dooley JSG, Fanning S, Kempf I, Lastovica AJ, Lowery CJ, Matsuda M, McDowell DA, McMahon A, Millar BC, Rao JR, Rooney PJ, Seal BS, Snelling WJ, Tolba O. The epidemiology of antibiotic resistance in Campylobacter. Microbes Infect 2006; 8:1955-66. [PMID: 16716632 DOI: 10.1016/j.micinf.2005.12.030] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2005] [Accepted: 12/28/2005] [Indexed: 11/25/2022]
Abstract
Antibiotic resistance, particularly with the fluoroquinolones and macrolide antibiotics, has now emerged globally with thermophilic campylobacters, including Campylobacter jejuni and C. coli, giving rise to concerns about how these organisms have acquired such resistance characteristics, as well as consequences for human and animal treatment. This review examines (i) the clinical epidemiology of antibiotic resistance in human and animal thermophilic campylobacters, (ii) an update on resistance rates globally, (iii) surveillance of antimicrobial resistance in campylobacters originating from animals, particularly poultry, (iv) the role of the environment in the acquisition and transmission of antibiotic-resistant campylobacters, as well as (v) issues of biocide resistance in campylobacters.
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Affiliation(s)
- John E Moore
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Belfast, Northern Ireland, UK.
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Abstract
Annually, millions of Muslims embark on a religious pilgrimage called the "Hajj" to Mecca in Saudi Arabia. The mass migration during the Hajj is unparalleled in scale, and pilgrims face numerous health hazards. The extreme congestion of people and vehicles during this time amplifies health risks, such as those from infectious diseases, that vary each year. Since the Hajj is dictated by the lunar calendar, which is shorter than the Gregorian calendar, it presents public-health policy planners with a moving target, demanding constant preparedness. We review the communicable and non-communicable hazards that pilgrims face. With the rise in global travel, preventing disease transmission has become paramount to avoid the spread of infectious diseases, including SARS (severe acute respiratory syndrome), avian influenza, and haemorrhagic fever. We examine the response of clinicians, the Saudi Ministry of Health, and Hajj authorities to these unique problems, and list health recommendations for prospective pilgrims.
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Affiliation(s)
- Qanta A Ahmed
- Medical University of South Carolina, Charleston, SC, USA
| | - Yaseen M Arabi
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ziad A Memish
- Internal Medicine Department and Department of Infection Prevention and Control, King Abdulaziz Medical City, PO Box 22490, King Fahad National Guard Hospital, Riyadh 11426, Saudi Arabia
- Correspondence to: Prof Ziad A Memish
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