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Aloushan AF, Alharthi F, Alismail MI, Alhaqbani AA, Almutairi IH, Alashgar S, Ahmed N, Alebrahaimi F. Awareness, Concerns, and Protection Strategies Against Blood-Borne Viruses Among Emergency Medicine Staff. Cureus 2022; 14:e31479. [DOI: 10.7759/cureus.31479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 11/16/2022] Open
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Badur S, Öztürk S, AbdelGhany M, Khalaf M, Lagoubi Y, Ozudogru O, Hanif K, Saha D. Hepatitis A in the Eastern Mediterranean Region: a comprehensive review. Hum Vaccin Immunother 2022; 18:2073146. [PMID: 35617508 PMCID: PMC9621081 DOI: 10.1080/21645515.2022.2073146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction With 583 million inhabitants, the Eastern Mediterranean Region (EMR) is a worldwide hub for travel, migration, and food trade. However, there is a scarcity of data on the epidemiology of the hepatitis A virus (HAV). Methods The MEDLINE and grey literature were systematically searched for HAV epidemiological data relevant to the EMR region published between 1980 and 2020 in English, French, or Arabic. Results Overall, 123 publications were extracted. The proportion of HAV cases among acute viral hepatitis cases was high. HAV seroprevalence rate ranged from 5.7% to 100.0% and it was decreasing over time while the average age at infection increased. Conclusion In the EMR, HAV remains a significant cause of acute viral hepatitis. The observed endemicity shift will likely increase disease burden as the population ages. Vaccinating children and adopting sanitary measures are still essential to disease prevention; vaccinating at-risk groups might reduce disease burden even further.
What is the context?
Hepatitis A is a viral liver disease caused by the hepatitis A virus. It is generally transmitted by ingestion of contaminated food or water or through contact with an infected person. Disease severity increases with age. Children under 6 years of age are usually asymptomatic, while adults are the most affected. Limited information exists on the number of cases and transmission of hepatitis A in the Eastern Mediterranean region, which includes 21 countries and Palestine, as defined by the World Health Organization.
What is new?
We performed a literature review to summarize data on hepatitis A disease in the Eastern Mediterranean region over the last 40 years (1980-2020). As information for many countries is scarce or outdated, most of the data is from Egypt, Iran and Saudi Arabia. We found that:
Hepatitis A virus is the most common cause of acute viral hepatitis. Hepatitis A exposure varied according to the country’s income level. Low- and middle-income countries showed a universal immunity to hepatitis A virus, although this is not the case anymore.
What is the impact?
Hepatitis A infections have decreased worldwide. Lower exposure to the virus has led to an increase in the susceptible population (including adolescent and adults). Hepatitis A vaccination for children and high-risk groups such travelers should be considered in the Eastern Mediterranean region.
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Alghamdi M, Alghamdi AS, Aljedai A, Khathlan AA, Masri NA, Qutub A, Quaiz MA, Sanai F, Subahi G, Sulimani S. Revealing Hepatitis B Virus as a Silent Killer: A Call-to-Action for Saudi Arabia. Cureus 2021; 13:e14811. [PMID: 34094765 PMCID: PMC8170052 DOI: 10.7759/cureus.14811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The Kingdom of Saudi Arabia (KSA) was the first country in the Middle East to adopt the hepatitis B virus (HBV) vaccine. Despite an expanded HBV immunization program and significant progress in HBV prevention in the country, HBV infection is a significant public health burden. This review lists coordinated solutions for healthcare stakeholders, patients, and health authorities to curb HBV and its impact in KSA. It further aims to draw policymakers' attention to key priorities to bridge HBV care gaps in the country. METHODS As part of the pre-engagement activity, medical experts across KSA were interviewed to gain a preliminary understanding of the current unmet needs in HBV management in the country. Top-recommended action points derived from the pre-engagement activity were discussed. Key priority action points to curb the impact of HBV in KSA were identified. RESULTS The priority action points together with the challenges and unmet needs in the management and care of HBV in KSA were: (a) establish a national-level registry, (b) implement screening campaigns, (c) improve linkage of care between primary care physicians (PCPs) and specialists, and (d) increase PCP education and awareness. CONCLUSION This work is an endeavor to set the stage for a strategic policy framework aimed at eliminating HBV in KSA. The action points/steps for the identified priorities must run parallelly across various regions in KSA, to successfully manage and further eliminate the threat of HBV.
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Affiliation(s)
- Mohammed Alghamdi
- Department of Gastroenterology, King Fahad Military Medical Complex, Dahran, SAU
| | - Abdullah S Alghamdi
- Medical Department/Gastroenterology Unit, King Fahad General Hospital, Jeddah, SAU
| | - Ahmed Aljedai
- Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Abdullah A Khathlan
- Gastroenterology and Hepatology Department, King Fahad Medical City, Riyadh, SAU
| | - Nasser A Masri
- Department of Gastroenterology, Prince Sultan Military Medical City, Riyadh, SAU
| | - Adel Qutub
- Gastroenterology and Hepatology Department, King Fahad Medical City, Riyadh, SAU
| | - Mohammed A Quaiz
- Department of Medicine, Section of Gastroenterology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Faisal Sanai
- Department of Medicine, Gastroenterology Unit, King Abdulaziz Medical City, Jeddah, SAU
| | - Ghadi Subahi
- Preventive Medicine, Ministry of Health, Riyadh, SAU
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AlShamlan NA, Al Shammari MA. Hepatitis B-C and human immunodeficiency virus: seroprevalence and associated factors among health students in Saudi Arabia. Hosp Pract (1995) 2021; 49:221-228. [PMID: 33663301 DOI: 10.1080/21548331.2021.1899690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To assess the seroprevalence of Hepatitis B (HBV), Hepatitis C (HCV), and Human Immunodeficiency Virus (HIV) among newly admitted health track students in a large university in the Eastern Province of Saudi Arabia, and determine the students' immunity against HBV, and bloodborne viral infection risk factors or practices among them. METHODS Information about the 1145 students, vaccination history, and exposure to bloodborne viral infections risk factors/practices were collected using a structured questionnaire during August 2020. The results of serological data were obtained from students' electronic files. RESULTS All students tested negative for HBV, HCV, and HIV infections. The seroprevalence of positivity against HBV was 25.8%, and the frequencies of students with protective levels of anti-HBV were inversely related to their age. The majority (70.8%) of students had 1 or 2 identifiable risk factors for bloodborne diseases, and the most frequent risk factor was history of dental intervention. Female students were more than four-times likely to be in the high-risk group for bloodborne infections than males (OR = 4.4; 95% CI: 3.3-5.9). Being from the Central Province of Saudi Arabia (OR = 1.9; 95% CI: 1.2-3.1) and having a mother's educational level of master or doctorate (OR = 3.0; 95% CI: 1.3-6.7) were found to be independent predictors of being in the high-risk group. On the other hand, having a family member in the healthcare field was found as a predictor of being in the low-risk group for bloodborne diseases (OR = 0.7; 95% CI: 0.5-0.9). CONCLUSION About three-fourth of students in this study were susceptible to HBV. Our findings stress the need to develop policies to raise awareness regarding bloodborne infectious diseases, in addition to expanding access to HBV vaccination for healthcare staff, especially in older ages.
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Affiliation(s)
- Nouf A AlShamlan
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Malak A Al Shammari
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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AlMalki WH, Shahid I, Abdalla AN, Johargy AK, Ahmed M, Hassan S. Virological surveillance, molecular phylogeny, and evolutionary dynamics of hepatitis C virus subtypes 1a and 4a isolates in patients from Saudi Arabia. Saudi J Biol Sci 2021; 28:1664-1677. [PMID: 33732052 PMCID: PMC7938134 DOI: 10.1016/j.sjbs.2020.11.089] [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] [Received: 09/28/2020] [Revised: 11/28/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022] Open
Abstract
Hepatitis C virus (HCV) subtypes are pre-requisite to predict endemicity, epidemiology, clinical pathogenesis, diagnosis, and treatment of chronic hepatitis C infection. HCV genotypes 4 and 1 are the most prevalent in Saudi Arabia, however; less consensus data exist on circulating HCV subtypes in infected individuals. This study was aimed to demonstrate the virological surveillance, phylogenetic analysis, and evolutionary relationship of HCV genotypes 4 and 1 subtypes in the Saudi population with the rest of the world. Fifty-five clinical specimens from different parts of the country were analyzed based on 5′ untranslated region (5′ UTR) amplification, direct sequencing, and for molecular evolutionary genetic analysis. Pair-wise comparison and multiple sequence alignment were performed to determine the nucleotide conservation, nucleotide variation, and positional mutations within the sequenced isolates. The evolutionary relationship of sequenced HCV isolates with referenced HCV strains from the rest of the world was established by computing pairwise genetic distances and generating phylogenetic trees. Twelve new sequences were submitted to GenBank, NCBI database. The results revealed that HCV subtype 4a is more prevalent preceded by 1a in the Saudi population. Molecular phylogeny predicts the descendants’ relationship of subtype 4a isolates very close to Egyptian prototype HCV strains, while 1a isolates were homogeneous and clustering to the European and North American genetic lineages. The implications of this study highlight the importance of HCV subtyping as an indispensable tool to monitor the distribution of viral strains, to determine the risk factors of infection prevalence, and to investigate clinical differences of treatment outcomes among intergenotypic and intragenotypic isolates in the treated population.
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Affiliation(s)
- Waleed H AlMalki
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm-Al-Qura University, Al-abidiyah, P.O. Box 13578, Makkah 21955, Saudi Arabia
| | - Imran Shahid
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm-Al-Qura University, Al-abidiyah, P.O. Box 13578, Makkah 21955, Saudi Arabia.,Department of Pharmacology and Toxicology, Faculty of Medicine, Umm-Al-Qura University, Al-abidiyah, P.O. Box 13578, Makkah 21955, Saudi Arabia
| | - Ashraf N Abdalla
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm-Al-Qura University, Al-abidiyah, P.O. Box 13578, Makkah 21955, Saudi Arabia
| | - Ayman K Johargy
- Medical Microbiology Department, Faculty of Medicine, Umm-Al-Qura University, Al-abidiyah, P.O. Box 13578, Makkah 21955, Saudi Arabia
| | - Muhammad Ahmed
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm-Al-Qura University, Al-abidiyah, P.O. Box 13578, Makkah 21955, Saudi Arabia
| | - Sajida Hassan
- Viral Hepatitis Program, Laboratory of Medicine, University of Washington, Seattle, WA, USA
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Ayouni K, Naffeti B, Ben Aribi W, Bettaieb J, Hammami W, Ben Salah A, Ammar H, Ben Miled S, Triki H. Hepatitis a virus infection in Central-West Tunisia: an age structured model of transmission and vaccination impact. BMC Infect Dis 2020; 20:627. [PMID: 32842988 PMCID: PMC7477833 DOI: 10.1186/s12879-020-05318-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 08/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The epidemiological pattern of hepatitis A infection has shown dynamic changes in many parts of the world due to improved socio-economic conditions and the accumulation of seronegative subjects, which leads to possible outbreaks and increased morbidity rate. In Tunisia, the epidemiological status of hepatits A virus is currently unknown. However, over the past years higher numbers of symptomatic hepatitis A virus infection in school attendants and several outbreaks were reported to the Ministry of Health, especially from regions with the lowest socio-economic levels in the country. The aim of this study was to investigate the current seroprevalence of hepatitis A virus antibodies in central-west Tunisia and assess the impact of hepatitis A virus vaccination on hepatitis A epidemiology. METHODS Serum samples from 1379 individuals, aged 5-75 years, were screened for hepatitis A virus antibodies. Adjusted seroprevalence, incidence and force of infection parameters were estimated by a linear age structured SEIR (Susceptible-Exposed-Infectious-Recovered) compartmental model. A vaccine model was then constructed to assess the impact on hepatitis A virus epidemiology of 3 scenarios of vaccination strategies: one dose at 12-months of age, one dose at 6-years and one dose at 12-months and another at 6-years of age during 6 years. RESULTS A rapid increase in anti-hepatitis A virus seroprevalence was noted during infancy and adolescence: 47% of subjects under 10-years-old are infected; the prevalence increases to 77% at 15-years and reaches 97% in subjects aged 30-years. The force of infection is highest between 10 and 30-years of age and the incidence declines with increasing age. The vaccine model showed that the 3-scenarios lead to a significant reduction of the fraction of susceptibles. The two doses scenario gives the best results. Single-dose vaccination at 6-years of age provides more rapid decrease of disease burden in school-aged children, as compared to single-dose vaccination at 12-months, but keeps with a non-negligible fraction of susceptibles among children < 6-years. CONCLUSIONS Our study confirms the epidemiological switch from high to intermediate endemicity of hepatitis A virus in Tunisia and provides models that may help undertake best decisions in terms of vaccinations strategies.
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Affiliation(s)
- Kaouther Ayouni
- Laboratory of Clinical Virology – Pasteur Institute of Tunis, University of Tunis El Manar, 13, Place Pasteur, BP: 74-1002, Tunis, Tunisia
- Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, Street 15 Medenine Bardo, Tunis, Tunisia
- Faculty of Sciences of Tunis, University of Tunis El Manar, Campus Universitaire 2092-El Manar, Tunis, Tunisia
| | - Bechir Naffeti
- Laboratory of Intelligent Networks and Nanotechnology, LARINA, University of Carthage, Tunis, Tunisia
- Faculty of Sciences of Bizerte, University of Carthage, Avenue de la République, P. O. Box 77-1054, Tunis, Amilcar Tunisia
| | - Walid Ben Aribi
- Laboratory of Intelligent Networks and Nanotechnology, LARINA, University of Carthage, Tunis, Tunisia
- Faculty of Sciences of Bizerte, University of Carthage, Avenue de la République, P. O. Box 77-1054, Tunis, Amilcar Tunisia
| | - Jihène Bettaieb
- Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, Street 15 Medenine Bardo, Tunis, Tunisia
- Department of Epidemiology - Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, 13, Place Pasteur, BP: 74-1002, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, 15 Rue Djebel Lakhdhar. La Rabta, 1007 Tunis, Tunisia
| | - Walid Hammami
- Laboratory of Clinical Virology – Pasteur Institute of Tunis, University of Tunis El Manar, 13, Place Pasteur, BP: 74-1002, Tunis, Tunisia
- Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, Street 15 Medenine Bardo, Tunis, Tunisia
| | - Afif Ben Salah
- Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, Street 15 Medenine Bardo, Tunis, Tunisia
- Department of Epidemiology - Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, 13, Place Pasteur, BP: 74-1002, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, 15 Rue Djebel Lakhdhar. La Rabta, 1007 Tunis, Tunisia
| | - Hamadi Ammar
- Laboratory of Intelligent Networks and Nanotechnology, LARINA, University of Carthage, Tunis, Tunisia
- Faculty of Economic Sciences and Management of Nabeul, University of Carthage, Avenue de la République, BP 77-1054, Tunis, Amilcar Tunisia
| | - Slimane Ben Miled
- Laboratory of Bioinformatics, Biomathématics and Biostatistics, Pasteur Institute of Tunis, University of Tunis El Manar, 13, Place Pasteur, BP: 74-1002, Tunis, Tunisia
| | - Henda Triki
- Laboratory of Clinical Virology – Pasteur Institute of Tunis, University of Tunis El Manar, 13, Place Pasteur, BP: 74-1002, Tunis, Tunisia
- Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, Street 15 Medenine Bardo, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, 15 Rue Djebel Lakhdhar. La Rabta, 1007 Tunis, Tunisia
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Hakeem A, Alsaigh S, Alasmari A, Aloushan A, Bin Saleh F, Yousef Z. Awareness, Concerns, and Protection Strategies Against Bloodborne Viruses Among Surgeons. Cureus 2019; 11:e4242. [PMID: 31131165 PMCID: PMC6516613 DOI: 10.7759/cureus.4242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Surgeons are at high risk of contracting infectious viruses such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) through exposure to patients' blood. The purpose of this study was to assess the surgeons' awareness of contracting bloodborne viruses. Methods: A cross-sectional study with a questionnaire distributed to 241 surgeons at King Abdulaziz Medical City - Riyadh (KAMC-R) during the period June 2017 through January 2018. Descriptive statistics were used to analyze data collected using Stata®, v14 (StataCorp LLC, College Station, Texas, USA). Categorical variables were analyzed using Pearson chi-square test. P-value of < 0.05 was considered significant. RESULTS A total of 241 surgeons answered the questionnaire, 179 (74.3%) surgeons were male and 62 (25.7%) were female. The mean age ± standard deviation (SD) of male surgeons was 35.8 ± 11.0 years while for females was 33.3 ± 9.1 years. The majority of our cohort were vaccinated for HBV (96% in males and 97% in females). Two-thirds of the study cohort did not know the conversion rate post-needlestick injury by HIV, HBV, and HCV. Two-thirds of the study cohort think there is a need for HIV screening before surgery. Mixed answers were received from the cohort when asked about their concern regarding contracting HIV infection from their patients; only one-third of the surgeons were extremely concerned. When asked about the risk of needlestick injury during treating patients positive for HBV, the majority of the surgeons said no. However, a significant difference between the female and male surgeons was found in which 12 of the 62 female surgeons answered yes (19.4%) compared to 11 of the 179 male surgeons (6.1%) (p = 0.002). CONCLUSION The majority of our surgeons are vaccinated for HBV. However, female surgeons appear to be at higher risk of needlestick injury from HBV patients. This requires further investigation into the reasons for such high incidents. More education is needed about bloodborne viruses.
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Affiliation(s)
- Anadel Hakeem
- Internal Medicine, King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, SAU
| | - Shahad Alsaigh
- Surgery, King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, SAU
| | - Amal Alasmari
- Dermatology, King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, SAU
| | - Amairah Aloushan
- Emergency Medicine, King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, SAU
| | - Fatemah Bin Saleh
- Pediatrics, King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, SAU
| | - Zeyad Yousef
- Surgery, King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, SAU
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Aljumah AA, Babatin M, Hashim A, Abaalkhail F, Bassil N, Safwat M, Sanai FM. Hepatitis B care pathway in Saudi Arabia: Current situation, gaps and actions. Saudi J Gastroenterol 2019; 25:73-80. [PMID: 30720000 PMCID: PMC6457186 DOI: 10.4103/sjg.sjg_421_18] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Hepatitis B virus (HBV) infection remains a public health problem worldwide. In this review, we aim to assess the current situation of the HBV care pathway in the Kingdom of Saudi Arabia (KSA), identify gaps/barriers therein, and recommend initiatives to be taken to improve the management of such patients. Towards this end, a literature search was conducted in PubMed and free Internet searches. Interviews with individuals and focus group discussions were held with HBV experts in KSA. Although significant improvements have been made in the past 30 years in KSA in terms of the decline in prevalence (currently estimated to be around 1.3%), the morbidity and mortality related to the disease have not shown a parallel decline. This makes HBV an important public health concern. Furthermore, poor disease awareness, low diagnosis rates, and nonadherence to therapy amplify the disease burden. There are several mandated national screening structures present; however, established protocols for those who test positive and subsequent linkage-to-care are inadequate. In the absence of a virologic cure, a concerted effort should be made to provide safe and effective lifelong treatment. This review provides recommendations to reduce the HBV disease burden in the Saudi population.
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Affiliation(s)
- Abdulrahman A. Aljumah
- Hepatology Division, Department of Hepatobiliary Sciences and Organ transplant Center, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Mohamed Babatin
- Department of Medicine, Gastroenterology Unit, King Fahad Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Almoataz Hashim
- Department of Medicine, Gastroenterology Unit, University of Jeddah, Jeddah, Kingdom of Saudi Arabia
| | - Faisal Abaalkhail
- Division of Organ Transplant Center, Department of Liver Transplantation and Hepatobiliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Center; Department of Medicine, College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | | | | | - Faisal M. Sanai
- Gastroenterology Unit, Department of Medicine, King Abdulaziz Medical City, Jeddah, Riyadh, Kingdom of Saudi Arabia,Liver Disease Research Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia,Address for correspondence: Dr. Faisal M. Sanai, Gastroenterology Unit, Department of Gastroenterology, King Abdulaziz Medical City, PO Box 9515, Jeddah - 21423, Kingdom of Saudi Arabia. E-mail:
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Alaidarous M, Choudhary RK, Waly MI, Mir S, Bin Dukhyil A, Banawas SS, Alshehri BM. The prevalence of transfusion-transmitted infections and nucleic acid testing among blood donors in Majmaah, Saudi Arabia. J Infect Public Health 2018; 11:702-706. [DOI: 10.1016/j.jiph.2018.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 03/26/2018] [Accepted: 04/08/2018] [Indexed: 01/04/2023] Open
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Al-Humayed SM. Hepatitis B and C Viral Infections in Tihamet Aseer, South-Western Saudi Arabia: Are There Gender Differences? SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2017; 5:110-115. [PMID: 30787767 PMCID: PMC6298365 DOI: 10.4103/1658-631x.204853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Hepatitis B virus (HBV) infection is endemic in Saudi Arabia. Many studies have shown varying results in gender differences in HBV and hepatitis C virus (HCV) infection. The objective of this study was to determine if gender differences exist in HBV and HCV infection and to elucidate any related risk factors in Tihamet Aseer, south-western Saudi Arabia. Materials and Methods The study was a cross-sectional study of a representative sample of males and females in Tihamet Aseer, south-western Saudi Arabia. A comprehensive questionnaire was completed by all participants. Blood samples were taken and sera were tested for hepatitis B surface antigen and HCV antibodies by fourth-generation enzyme immunoassays. Results The study included 1532 participants from the Tihamet Aseer area. An overall seroprevalence of 7.9% and 1.7% was found for HBV and HCV infections, respectively. In logistic regression analysis, no gender differences were found for HBV seroprevalence. Identified risk factors for HBV infection included a history of blood transfusion and lack of hepatitis B vaccination. On the other hand, females were more prone to become seropositive for HCV (adjusted odds ratio = 5.034, 95% confidence interval: 1.042-9.321). Other identified risk factors for HCV infection were illiteracy and a history of blood transfusion. Conclusion The prevalence and HBV and HCV infection is high compared to the national figures. Gender differences were only observed in HCV infection. It is recommended to have an active educational and media campaign. A "catch-up" vaccination program against HBV should be introduced for adults as a strategy to achieve the herd immunity effect in the affected area.
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Affiliation(s)
- Suliman M Al-Humayed
- Department of Internal Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
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Al Humayed SM, El-Mekki AA, Mahfouz AA. Hepatitis C virus infection in southwestern Saudi Arabia: Are we still in the plateau phase? J Med Virol 2016; 89:867-871. [PMID: 27735998 DOI: 10.1002/jmv.24712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2016] [Indexed: 12/15/2022]
Abstract
The aim was to study the seroprevalence of Hepatitis C virus (HCV) infection and related risk factors in Aseer region in southwestern Saudi Arabia, the region known to be of the highest endemicity of viral hepatitis. In a cross-sectional study, all participants were interviewed using structured questionnaire. HCV infection was diagnosed using fourth-generation ELISA. All positive and equivocal HCV serology results were further confirmed by using a qualitative confirmatory RT-PCR. The study enrolled 10,234 participants. A seroprevalence of 2.2% (95%CI: 1.9-2.5%) was found. In multivariate logistic regression analysis, the study showed that males had significantly more risk to become seropositive for HCV (aOR = 1.437, 95%CI: 1.071-1.927) compared to females. Similarly, participants having history of blood transfusion had more than two times the risk of becoming seropositive for HCV (aOR = 2.079, 95%CI: 1.037-4.149). HCV infection in the study area is still high in the plateau phase. It is recommended to have an active educational and media campaign about the risks of HCV infections. Workshops and training of qualified laboratory staff related to blood banking seem mandatory. J. Med. Virol. 89:867-871, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Suliman M Al Humayed
- Department of Internal Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Awad A El-Mekki
- Department of Clinical Microbiology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Ahmed A Mahfouz
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
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Siddiqui MH, Alamri SA, Al-Whaibi MH, Hussain Z, Ali HM, El-Zaidy ME. A mini-review of anti-hepatitis B virus activity of medicinal plants. BIOTECHNOL BIOTEC EQ 2016. [DOI: 10.1080/13102818.2016.1240593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Manzer H. Siddiqui
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Saud A. Alamri
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed H. Al-Whaibi
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Zahid Hussain
- Centre of Excellence in Biotechnology Research, King Saud University, Riyadh, Saudi Arabia
| | - Hayssam M. Ali
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed E. El-Zaidy
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia
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Seroprevalence Survey of Varicella, Measles, Rubella, and Hepatitis A and B Viruses in a Multinational Healthcare Workforce in Saudi Arabia. Infect Control Hosp Epidemiol 2016. [DOI: 10.1017/s0899823x00196795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective.To determine the prevalence of the vaccine-preventable diseases caused by varicella, measles, rubella, and hepatitis A and B viruses in a multinational healthcare workforce.Design.Prospective cohort study.Setting.A 750-bed tertiary care center located in Riyadh, Saudi Arabia.Methods.In compliance with hospital policy, newly recruited healthcare workers (HCWs) were enrolled in the study from September 2001 to March 2005. Serum samples were collected from all HCWs during the initial hiring process and tested for IgG antibodies against each of the 5 viral agents. Nonimmune HCWs were subsequently vaccinated at the earliest opportunity.Results.A total of 4,006 newly hired (international and local) employees were included in the study. All underwent serologic testing for IgG antibodies against varicella, measles, rubella, hepatitis A, and hepatitis B viruses. Of the total, 63% were female and 37% were male. Middle Eastern employees comprised 47% of the total, followed by employees from the Far East (35%), the West (10%), and Africa (8%). Forty-two percent were nurses, 27% were in administration, 18% were medical technicians, and 13% were physicians. Among the 4,006 newly hired HCWs, 14% had negative IgG antibody test results for varicella virus, 13% for measles virus, 10% for rubella virus, 33% for hepatitis A virus, and 43% for hepatitis B virus. More women than men were susceptible to hepatitis A (40% vs. 24%; P< .001), whereas more men were susceptible to hepatitis B (55% vs. 35%; P< .001). Varicella susceptibility was more common among HCWs from the Far East (19%), whereas susceptibility to measles, rubella, hepatitis A, and hepatitis B was highest among HCWs from the Middle East. Both relative youth and male sex were associated with lack of antibodies against hepatitis B virus and rubella virus. In contrast, female sex and younger age were associated with lack of antibodies against hepatitis A virus (P< .001).Conclusion.Seroprevalence surveys of vaccine-preventable diseases among HCWs, although labor intensive, are invaluable in caring for a multinational workforce.
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Al Humayed SM. Seroprevalence of HBsAg among adolescents and adults in the Muhayil Aseer region of KSA: 25 years after the introduction of national vaccination. J Taibah Univ Med Sci 2016. [DOI: 10.1016/j.jtumed.2015.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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15
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Ghomraoui FA, Alfaqeeh FA, Algadheeb AS, Al-Alsheikh AS, Al-Hamoudi WK, Alswat KA. Medical students' awareness of and compliance with the hepatitis B vaccine in a tertiary care academic hospital: An epidemiological study. J Infect Public Health 2015; 9:60-5. [PMID: 26185014 DOI: 10.1016/j.jiph.2015.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/11/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The hepatitis B virus (HBV) poses a health risk to healthcare workers who are in close proximity to infected individuals. Medical students are a particularly high-risk group due to the lack of an obligatory vaccination program and a post-vaccination screening program to determine immunity status, which results in a lack of awareness of and compliance with the HBV vaccine. METHODS This cross-sectional survey was conducted in King Khalid University Hospital (KKUH), a tertiary care academic hospital in Riyadh, Saudi Arabia, from November 2013 to March 2014. Medical students in their second to fifth years (n=444; 213 men and 231 women) completed a self-administered questionnaire regarding awareness of HBV and compliance with the HBV vaccination program in KKUH. RESULTS Medium to low knowledge levels were present in 53.5% of the participants, and 44.3% reported that they were not compliant with the vaccination program provided by KKUH. While 93.9% received the HBV vaccine upon entry to medical school, only 59.5% received all 3 doses, citing forgetfulness and a busy schedule as common reasons for the low compliance. There was no association between the knowledge and awareness of the participants and their compliance (p=0.988). CONCLUSION Medical students had a low level of compliance with the HBV vaccination program, regardless of their knowledge and awareness of the disease and vaccination. We recommend that programs and campaigns be developed to increase the overall awareness of this disease. We also suggest that a mandatory HBV vaccination program should be implemented to improve the compliance rate among medical students.
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Affiliation(s)
- Firas A Ghomraoui
- Department of Medicine, College of Medicine, King Saud University, Saudi Arabia
| | - Faisal A Alfaqeeh
- Department of Medicine, College of Medicine, King Saud University, Saudi Arabia
| | | | | | - Waleed K Al-Hamoudi
- Department of Medicine, College of Medicine, Liver Disease Research Center, King Saud University, Saudi Arabia
| | - Khalid A Alswat
- Department of Medicine, College of Medicine, Liver Disease Research Center, King Saud University, Saudi Arabia.
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Alqahtani JM, Abu-Eshy SA, Mahfouz AA, El-Mekki AA, Asaad AM. Seroprevalence of hepatitis B and C virus infections among health students and health care workers in the Najran region, southwestern Saudi Arabia: the need for national guidelines for health students. BMC Public Health 2014; 14:577. [PMID: 24912684 PMCID: PMC4059075 DOI: 10.1186/1471-2458-14-577] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 05/28/2014] [Indexed: 12/11/2022] Open
Abstract
Background The objectives of the study were to study the seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among health college students (HS) and health care workers (HCWs) in the Najran Region of south-western Saudi Arabia and to study the students’ knowledge of occupational exposure to blood-borne viral infections. Methods A cross-sectional study of a representative sample of 300 HS and 300 HCWs was conducted. Results An overall seroprevalence of HBV of 1.7% and 8.7% was found among HS and HCWs, respectively. Two-thirds of HS (66.7%, 200) and 23.3% (70) of HCWs lack anti-HBs and are susceptible to HBV infection. An overall seroprevalence of HCV of 0% and 0.3% was found among the HS and HCWs, respectively. The present study indicates poor knowledge among HS and moderate knowledge among HCWs regarding occupationally transmitted blood-borne diseases, safe injection practices, and standard precautions to prevent occupationally transmitted blood-borne infections. Conclusion It is mandatory to develop a structured program to raise awareness among HS, and current health colleges’ curricula should be upgraded to address these issues early. The HS should be considered new recruits to health services in terms of their initial screening for blood-borne infections and vaccination against HBV. The development of a novel continuing medical education and pre-employment awareness program for HCWs is recommended to address the following: blood-borne diseases transmitted occupationally, standard precautions to prevent occupationally transmitted blood borne infections, and safe injection practices.
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Affiliation(s)
| | | | - Ahmed A Mahfouz
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, P,O, Box 641, Saudi Arabia.
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Kurdi M, Abughararah M, Mulike M, Yamani O, Bugdady M, Noor M. Molecular detection of hepatitis B virus (HBV) among voluntary ELISA positive blood donors in Almadinah Almunawwarah. J Taibah Univ Med Sci 2014. [DOI: 10.1016/j.jtumed.2014.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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18
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Al Ghamdi SS, Fallatah HI, Fetyani DM, Al-Mughales JA, Gelaidan AT. Long-term efficacy of the hepatitis B vaccine in a high-risk group. J Med Virol 2014; 85:1518-22. [PMID: 23852676 DOI: 10.1002/jmv.23658] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2013] [Indexed: 12/26/2022]
Abstract
Chronic infection with hepatitis B virus (HBV) is a global health problem. In an attempt to control infection, worldwide HBV vaccination programs have been established. Saudi Arabia, an endemic area for HBV infection, established an HBV immunization program in 1989. This cross-sectional study evaluates the long-term protection of HBV vaccination 14-24 years after primary immunization in a high-risk group (clinical year medical students) at King Abdulaziz University Hospital in Jeddah, Saudi Arabia. All participants had complete HBV immunization at birth or in early childhood. Hepatitis B surface antibody (anti-HBs) levels were obtained. An anti-HBs titer of <10 mIU/ml indicated no protection, while a titer of >10 mIU/ml was considered to represent protective immune status. A total of 238 students were included; they were predominantly females (n = 182, 76.5%). Mean age was 22.2 ± 1.1 years. Duration since primary vaccination was 19.8 ± 2.3 years. Female students were more likely to maintain long-term protection compared to males (62.1% and 58.8%, respectively). Anti-HBs levels were significantly low in many students after primary immunization. Testing medical students for anti-HBs levels may be warranted as they represent a high-risk population. The higher rate of vaccine failure in males than females requires further investigation as it may explain the higher prevalence of HBV in the male population.
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Affiliation(s)
- Sarah S Al Ghamdi
- Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
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19
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Agha A, Chakik R, Abdulhadi Ali MM, Alsaudi D, Sammito G, Giannini EG. Peg-interfon alpha-2a and low-dose ribavirin for treatment of hepatitis C virus infection in patients with sickle-cell anemia in Saudi Arabia. Ann Saudi Med 2013; 33:610-3. [PMID: 24413867 PMCID: PMC6074907 DOI: 10.5144/0256-4947.2013.610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Data regarding the safety and efficacy of antiviral therapy with pegylated interferon (PEG-IFN) and ribavirin (RBV) in patients with sickle-cell disease (SCD) and hepatitis C virus (HCV) infection are scanty. In this study, our aim was to evaluate the safety and efficacy of antiviral therapy with PEG-IFN and low-dose RBV in patients with SCD and chronic HCV infection receiving hydroxyurea in Saudi Arabia. DESIGN AND SETTINGS This was a prospective interventional study conducted between January 2009 and September 2012 at the outpatient departments of Haematology and Hepatology/Gastroenterology of a tertiary care hospital in Saudi Arabia. PATIENTS AND METHODS We studied 8 treatment-naive patients (5 males, 63%) with chronic hepatitis C and SCD receiving hydroxyurea who were treated with PEG-IFN alpha-2a (180 micro g weekly) and low-dose RBV (200 mg daily). Early virological response (EVR) and sustained virological response (SVR) rates were assessed in all patients. RESULTS All patients were infected with HCV genotype 1 (n=6.8%) or 4 (n=22%). EVR was obtained in 3 patients (38%) and SVR in 6 patients (7%). During the study, there was no increase in the number of blood units transfused and emergency visits due to painful crises. CONCLUSION in Saudi Arabian patients with SCD and chronic HCV infection on hydroxyurea, PEG-IFN and low-dose RBV treatment proved to be efficacious and safe.
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Affiliation(s)
| | | | | | | | | | - Edoardo Giovanni Giannini
- Prof. Edoardo Giovanni Giannini, Department of Internal Medicine,, Gastroenterology Unit,, Viale Benedetto XV,, No. 6, Genova 16146,, Italy ., T: +390103537950, F: +390103538638,
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C MA, J M RT, A CR, M BN, M DG, S L MR. Prevalence of hepatitis A antibodies in Eastern Bolivia: a population-based study. J Med Virol 2013; 85:1692-7. [PMID: 23861034 DOI: 10.1002/jmv.23671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2013] [Indexed: 11/12/2022]
Abstract
The seroprevalence of hepatitis A virus (HAV) is changing from high to intermediate endemicity in several Latin American countries, but the pattern in the Andean Latin American countries is unknown. A seroepidemiological survey (n = 436) of HAV in schoolchildren living in the Cochabamba region of Bolivia was conducted in 2010. A questionnaire was completed by parents to obtain demographic, socio-economic, and housing data, and blood samples were collected. The overall prevalence of HAV IgG was 95.4% (95% CI 93.5-97.4). The prevalence was higher in children aged 5-10 years (97%) and pre-adolescents aged 10-13 years (97.9%). The prevalence was also higher in subjects whose parents had a low level of education (99.4-99.5%), who lived in rural areas (98.7%), lived in municipalities with low urban development (99.1-100%), had water delivered at home from a tanker (99.4%), and spoke Quechua at home (99.5%). The descriptive and bivariate analysis suggested that no change in HAV epidemiology has occurred in Cochabamba.
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Affiliation(s)
- Masuet-Aumatell C
- Preventive Medicine Department, Bellvitge Biomedical Research Institute (IDIBELL), International Health Centre and Travel Medicine Clinic, University Hospital of Bellvitge, Catalonia, Spain.
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Alfaleh FZ, Alswat K, Helmy A, Al-hamoudi W, El-sharkawy M, Omar M, Shalaby A, Bedewi MA, Hadad Q, Ali SM, Alfaleh A, Abdo AA. The natural history and long-term outcomes in patients with chronic hepatitis C genotype 4 after interferon-based therapy. Liver Int 2013; 33:871-83. [PMID: 23490034 DOI: 10.1111/liv.12127] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 01/16/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Hepatitis C virus (HCV) genotype 4 (G4) infection is common in the Middle East. Post-treatment long-term outcomes have not been reported in these patients. This study evaluates these outcomes in patients after interferon-based therapy. PATIENTS AND METHODS A total of 157 patients were followed from June 2001 to February 2012. Descriptive and analytical statistics, cumulative outcomes and the independent predictors of disease progression were calculated. RESULTS The overall age was 48.0 ± 11.8 years, 75 (47.8%) were males and 53 (70.7%) of 75 who were genotyped had G4. The follow-up period was 63.8 ± 32.8 months. Sustained virological response (SVR) was achieved in 62 (39.5%) and 24 (45.3%) patients in the whole group and the G4 subgroup respectively. Among the whole cohort and the G4 subgroup, disease progressed in 59 (37.6%) and 21 (39.6%), respectively, with less progression in the SVR groups; 15/62 (24.2%) and 3/24 (12.5%) compared with non-responders; 44 (46.3%) and 18 (62.1%) with P = 0.01 and 0.001 respectively. Multivariate logistic regression analysis showed that having diabetes mellitus (P = 0.03), higher baseline APRI score (P = 0.00) and non-SVR (P = 0.00) were independent predictors of disease progression. G4 patients showed similar results, but 'non-SVR' (P = 0.00) was the only independent predictor of progression. Eight patients died and four developed HCC all among the non-SVR group only. CONCLUSIONS This study describes, for the first time, the natural history and demonstrates the beneficial long-term effects of interferon-based therapy in HCV G4 patients.
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Affiliation(s)
- Faleh Z Alfaleh
- Gastroenterology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Alswat KA, Sanai FM, Altuwaijri M, Albenmousa A, Almadi M, Al-Hamoudi WK, Abdo AA. Clinical characteristics of patients with hepatocellular carcinoma in a middle eastern population. HEPATITIS MONTHLY 2013; 13:e7612. [PMID: 23922558 PMCID: PMC3732662 DOI: 10.5812/hepatmon.7612] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 12/02/2012] [Accepted: 01/19/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is one of the leading causes of death in Saudi male patients. Local clinical and demographic data of this disease are scarce. OBJECTIVES We sought to describe the clinical characteristics and outcomes of patients from two tertiary care centers in Saudi Arabia. PATIENTS AND METHODS Data were collected for all patients diagnosed to have hepatocellular carcinoma between June 2003 and July 2008 who had been registered in a special research database (the Saudi Observatory Liver Disease Registry (SOLID)). Data were extracted from SOLID for clinical, biochemical, radiologic parameters and outcome. RESULTS Data was available for 363 patients, the mean age of diagnosis was 66 years, 74% of patients were males, and Hepatitis C was the underlying cause of liver disease in 48%, while Hepatitis B in 29%. Most of the patients were diagnosed at an advanced stage, 53 % of patients had a CLIP score of 4 to 6 (advanced stage), 55% had large multi-nodular tumors and 16% had vascular invasion or extra-hepatic spread at the time of diagnosis. Most of the patients had decompensated cirrhosis; with child-pogh score B in 44% and C in 26% with presence of portal hypertension in 55%. Forty eight percent died during the study period. Predictors of poor survival in the univariate analysis were; presence of portal vein thrombosis (P = 0.03), portal hypertension (P < 0.0001), presence of ascites (P = 0.022), hepatic encephalopathy (P < 0.0001), advanced child-pough score (P < 0.0001), bilirubin > 22 (P < 0.0001) and INR > 1.2 (P = 0.02). On multivariate analysis, only the presence of portal hypertension, bilirubin > 22 and severe hepatic encephalopathy were significant with adjusted hazard ratio of 1.6 (95% CI; 1.04-2.47), 1.76 (95% CI; 1.12-2.8), and 3.18 (95% CI; 1.42-7.14) respectively. CONCLUSIONS The data from this cohort indicates that most of patients diagnosed with HCC present at late tumor and liver disease stages, when prognosis is usually dismal. Regular cancer surveillance in cirrhotic patients might change the outcomes. Further studies with results of treatment outcomes in this community are needed.
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Affiliation(s)
- Khalid A. Alswat
- Department of Medicine, Liver Disease Research Center, King Saud University, Riyadh, Saudi Arabia
- Corresponding author: Khalid A. Alswat, Department of Medicine, Liver Disease Research Center, King Saud University, Riyadh, Saudi Arabia. Tel: +966-14679167, Fax: +966-14671217, E-mail:
| | - Faisal M. Sanai
- Department of Hepatobiliary Science and Liver Transplantation, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mansour Altuwaijri
- Department of Medicine, Liver Disease Research Center, King Saud University, Riyadh, Saudi Arabia
| | - Ali Albenmousa
- Department of Gastroenterology, Riyadh Military Hospital, Riyadh, Saudi Arabia
| | - Majid Almadi
- Department of Medicine, Liver Disease Research Center, King Saud University, Riyadh, Saudi Arabia
| | - Waleed K. Al-Hamoudi
- Department of Medicine, Liver Disease Research Center, King Saud University, Riyadh, Saudi Arabia
| | - Ayman A. Abdo
- Department of Medicine, Liver Disease Research Center, King Saud University, Riyadh, Saudi Arabia
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Al-Thaqafy MS, Balkhy HH, Memish Z, Makhdom YM, Ibrahim A, Al-Amri A, Al-Thaqafi A. Hepatitis B virus among Saudi National Guard personnel: seroprevalence and risk of exposure. J Infect Public Health 2013; 6:237-45. [PMID: 23806697 DOI: 10.1016/j.jiph.2012.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 12/28/2012] [Accepted: 12/29/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Data on HBV prevalence among active military personnel in Saudi Arabia (SA) are lacking. In addition, the work-related risk of exposure is unclear. The objective of this study was to estimate the seroprevalence of HBV and the risk of HBV exposure among SA National Guard (SANG) soldiers. METHODS A cross-sectional study was performed and included 400 male SANG soldiers working in Jeddah during January 2009. All soldiers completed a questionnaire to assess their risk of exposure and gave a blood sample to test for hepatitis serology markers. RESULTS A total of 16 (4.0%) soldiers were positive for HbsAg, 53 (13.2%) were positive for anti-HBc, and 230 (57.5%) were positive for anti-HBs. None of the soldiers had acute HBV infection, but 15 (3.8%) were chronic HBV carriers. A total of 152 (38.0%) soldiers were susceptible to HBV infection, and 230 (57.5%) were immune to HBV infection, primarily (84.3%) due to HBV vaccination. Compared with those who were negative for anti-HBc (never exposed), soldiers who were positive for anti-HBc were more likely to be older, have a lower education level, have a higher income, have a longer service duration, have a household member with HBV disease, have undergone surgery, or have undergone endoscopy. In the multivariate logistic regression model, older age, presence of a household member with HBV disease and previous endoscopy were independent predictors of HBV exposure. CONCLUSION We report a 4% prevalence of HBsAg in the Saudi military population. This HBV prevalence was higher than those in the general Saudi population and military populations from Western countries. Both work-related and community-related risk factors for exposure are suggested.
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Affiliation(s)
- Majid S Al-Thaqafy
- Infection Prevention and Control, King Abdulaziz Medical City, Jeddah, Saudi Arabia
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Akbar HO, Al Ghamdi A, Qattan F, Fallatah HI, Al Rumani M. Chronic hepatitis C in saudi arabia: three years local experience in a university hospital. HEPATITIS MONTHLY 2012; 12:e6178. [PMID: 23087760 PMCID: PMC3475025 DOI: 10.5812/hepatmon.6178] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 07/16/2012] [Accepted: 07/28/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chronic hepatitis C (CHC) is a global infection. In Saudi Arabia, the prevalence of CHC is declining due to the implementation of a blood screening program. However, CHC still remains a leading cause of liver cirrhosis and hepatocellular carcinoma. OBJECTIVES This is a retrospective study of CHC patients at the King Abdul Aziz University Hospital, Jeddah, Saudi Arabia. PATIENTS AND METHODS Out of a total of 291 CHC patients from the hepatology clinic at King Abdul Aziz University hospital, Jeddah, 279 patients were included in the present study. They were primarily male (152, 54.5%), with a mean age of 50.41 ± 1.72 years. The majority of patients were either Saudi (108, 38.7%) or Egyptian (60, 21.5%). A total of 61 patients received combination treatment with pegylated interferon and ribavirin, and one patient with sickle-cell anemia received pegylated INF monotherapy. Demographic, clinical and laboratory features of the CHC patients, and their responses to treatment were studied. RESULTS Decompensated cirrhosis was documented in 60 patients (21.5%), and hepatocellular carcinoma in 14 (5%). The mean level of serum alanine aminotransferase was 83.6 ± 231 u/L. The predominant genotype among the 70 patients tested, was genotype 4, followed by genotype 1 (39 and 18 patients, respectively). The sustained viral response (SVR) rate was 82.99%. The main predictive factors for SVR were baseline HCV viral load and rapid virologic response (RVR). The mean duration of follow-up was 4.2 ± .85 years. There were 24 patients who had liver disease-related mortality. CONCLUSIONS our data showed that 22% of CHC patients progress to cirrhosis and another 22% had treatment. Liver related mortality was more common in patients with advanced cirrhosis.
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Affiliation(s)
- Hisham O Akbar
- Department of Internal Medicine, King Abdul Aziz University Hospital, Jeddah, Saudi Arabia
- Corresponding author: Hisham O Akbar, Department of Internal Medicine, King Abdul Aziz University Hospital, P. O. Box: 80215 Jeddah 21589, Jeddah, Saudi Arabia. Tel.: +96-626408435, Fax: +96-626408315, E-mail:
| | - Ahmad Al Ghamdi
- Molecular Biology Department, King Abdul Aziz University Hospital, Jeddah, Saudi Arabia
| | - Faten Qattan
- Molecular Biology Department, King Abdul Aziz University Hospital, Jeddah, Saudi Arabia
| | - Hind I Fallatah
- Department of Internal Medicine, King Abdul Aziz University Hospital, Jeddah, Saudi Arabia
| | - Maha Al Rumani
- Molecular Biology Department, King Abdul Aziz University Hospital, Jeddah, Saudi Arabia
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Alghamdi AS, Sanai FM, Ismail M, Alghamdi H, Alswat K, Alqutub A, Altraif I, Shah H, Alfaleh FZ. SASLT practice guidelines: management of hepatitis C virus infection. Saudi J Gastroenterol 2012; 18 Suppl:S1-32. [PMID: 23006491 PMCID: PMC3713589 DOI: 10.4103/1319-3767.101155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Abdullah S. Alghamdi
- Department of Medicine, Gastroenterology Unit, King Fahad General Hospital, Jeddah, Saudi Arabia,Address for correspondence: Dr. Abdullah Saeed Alghamdi, Department of Medicine, King Fahad General Hospital, PO BOX 50505 (450), Jeddah, Saudi Arabia. E-mail:
| | - Faisal M. Sanai
- Hepatobiliary Sciences and Liver Transplantation, King Abdulaziz Medical City, and King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs,Liver Disease Research Center, National Plan for Science and Technology, King Saud University, Riyadh, Saudi Arabia
| | - Mona Ismail
- Department of Medicine, Division of Gastroenterology, King Fahad Hospital of the University, College of Medicine, University of Dammam, Dammam, Saudi Arabia
| | - Hamdan Alghamdi
- Hepatobiliary Sciences and Liver Transplantation, King Abdulaziz Medical City, and King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs
| | - Khalid Alswat
- Liver Disease Research Center, National Plan for Science and Technology, King Saud University, Riyadh, Saudi Arabia,Department of Medicine, Gastroenterology unit, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Adel Alqutub
- Department of Medicine, Gastroenterology Unit, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ibrahim Altraif
- Hepatobiliary Sciences and Liver Transplantation, King Abdulaziz Medical City, and King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs
| | - Hemant Shah
- Division of Gastroenterology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Faleh Z. Alfaleh
- Liver Disease Research Center, National Plan for Science and Technology, King Saud University, Riyadh, Saudi Arabia,Department of Medicine, Gastroenterology unit, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Abstract
Some 400 million people worldwide are currently infected with the hepatitis B virus (HBV), and the infection is common in the Middle East. Another 170 million people around the globe presently live with chronic hepatitis C virus (HCV) infection. Both HBV and HCV represent a worldwide epidemic. Despite significant decline in the prevalence of HBV and HCV infection in Saudi Arabia, these viral diseases cause significant morbidity and mortality, and impose a great burden on the country's healthcare system. On the other hand, Saudi epidemiology studies have shown that the hepatitis A virus seroprevalence in the country has reduced considerably over the past two decades. The progress in mapping the epidemiological pattern of viral hepatitis in Saudi Arabia has not only aided our understanding of the disease, but has also exposed the small but relevant gaps in our identification of the intricate details concerning the disease's clinical expression. In this review, we aim to document the timeline of viral hepatitis epidemiology in Saudi Arabia, while summarizing the relevant published literature on the subject.
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Affiliation(s)
- Ayman A. Abdo
- Department of Medicine, Gastroenterology Unit, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia,Liver Disease Research Center, King Saud University, Riyadh, Saudi Arabia,Address for correspondence: Dr. Ayman A. Abdo, Gastroenterology Unit, Department of Medicine, King Khalid University Hospital, College of Medicine, King Saud University, PO Box 2925 (59), Riyadh - 11461, Saudi Arabia. E-mail:
| | - Faisal M. Sanai
- Liver Disease Research Center, King Saud University, Riyadh, Saudi Arabia,Hepatobiliary Sciences and Liver Transplantation, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Faleh Z. Al-Faleh
- Department of Medicine, Gastroenterology Unit, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia,Liver Disease Research Center, King Saud University, Riyadh, Saudi Arabia
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Balkhy HH, El Beltagy KE, El-Saed A, Sallah M, Jagger J. Benchmarking of percutaneous injuries at a teaching tertiary care center in Saudi Arabia relative to United States hospitals participating in the Exposure Prevention Information Network. Am J Infect Control 2011; 39:560-5. [PMID: 21636172 DOI: 10.1016/j.ajic.2010.10.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 10/12/2010] [Accepted: 10/18/2010] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite recent improvements in policies, practices, and device design, percutaneous injuries (PIs) from needles and sharp instruments continue to expose health care workers to the risk of bloodborne pathogens. METHODS Prospective surveillance was instituted to study the epidemiologic characteristics of PIs at King Abdulaziz Medical City, Riyadh, Saudi Arabia (KAMC-R) from 2004 through 2008 and to benchmark these characteristics relative to those of a network of US hospitals participating in the Exposure Prevention Information Network (EPINet) research group (2004-2007). RESULTS The mean PIs rate per 100 daily occupied beds in KAMC-R was significantly lower than that reported by teaching and nonteaching US EPINet hospitals. Similar to US EPINet hospitals, nurses at KAMC-R reported more PIs than physicians. Compared with US EPINet hospitals, nurses at KAMC-R experienced more PIs (52.8% vs 38.1%, respectively), whereas physicians experienced fewer PIs (18.4% vs 28.6%, respectively). The majority of PIs happened in patient wards (50.6%) in KAMC-R and operating rooms (34.1%) in US EPINet hospitals. Suturing, which was involved in only 10% of PIs at KAMC-R, was the most frequent PIs mechanism in US EPINet hospitals (23.3%). In both KAMC-R and US EPINet hospitals, disposable syringes were the most frequent devices involved, the left hand was the most common site of injury, and the source patient was largely identifiable. CONCLUSION We have lower rates of PIs at KAMC-R relative to US EPINet hospitals. Whereas it is difficult to fully explain such differences, this could be due to variations in health care systems, underreporting, or the impact of the PIs prevention activities.
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Affiliation(s)
- Hanan H Balkhy
- Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
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Khattab MA, Ferenci P, Hadziyannis SJ, Colombo M, Manns MP, Almasio PL, Esteban R, Abdo AA, Harrison SA, Ibrahim N, Cacoub P, Eslam M, Lee SS. Management of hepatitis C virus genotype 4: recommendations of an international expert panel. J Hepatol 2011; 54:1250-62. [PMID: 21316497 DOI: 10.1016/j.jhep.2010.11.016] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 11/17/2010] [Accepted: 11/23/2010] [Indexed: 02/06/2023]
Abstract
HCV has been classified into no fewer than six major genotypes and a series of subtypes. Each HCV genotype is unique with respect to its nucleotide sequence, geographic distribution, and response to therapy. Genotypes 1, 2, and 3 are common throughout North America and Europe. HCV genotype 4 (HCV-4) is common in the Middle East and in Africa, where it is responsible for more than 80% of HCV infections. It has recently spread to several European countries. HCV-4 is considered a major cause of chronic hepatitis, cirrhosis, hepatocellular carcinoma, and liver transplantation in these regions. Although HCV-4 is the cause of approximately 20% of the 170 million cases of chronic hepatitis C in the world, it has not been the subject of widespread research. Therefore, this document, drafted by a panel of international experts, aimed to review current knowledge on the epidemiology, natural history, clinical, histological features, and treatment of HCV-4 infections.
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Al Faleh FZ, Ali S, Aljebreen AM, Alhammad E, Abdo AA. Seroprevalence rates of Helicobacter pylori and viral hepatitis A among adolescents in three regions of the Kingdom of Saudi Arabia: is there any correlation? Helicobacter 2010; 15:532-7. [PMID: 21073610 DOI: 10.1111/j.1523-5378.2010.00800.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The seroprevalence rate of Helicobacter pylori in the Kingdom of Saudi Arabia (KSA) was reported to be in the range of 50-80% among mostly symptomatic patients in non-community-based studies. However, the seroprevalence of viral hepatitis A (HAV) underwent a marked decline in the last two decades from over 50% in 1989 to 25% in 1997 among Saudi children under the age of 12 years. The aim of this paper was to study seroprevalence rates of H. pylori and HAV among the adolescent population in three regions of KSA and to determine whether there was any correlation between them. MATERIALS AND METHODS We randomly selected 1200 16-18-year-old students from three regions around KSA. Demographic data, including socioeconomic status (SES), were recorded, and each student was tested for the presence of H. pylori-IgG antibodies and anti-HAV-IgG. RESULTS The results indicate a high H. pylori infection rate (47%) among this age group. Boys had a higher prevalence than girls (p = .03), and the Al-Qaseem region had the highest prevalence (51%, p = .002). SES did not contribute to the high prevalence rates (p = .83). A cross-tabulation of data showed that 88 (8%) of the teenagers were seropositive and that 512 (44%) were negative for both H. pylori and HAV antibodies (χ(2) = 0.03, OR = 0.97, CI = 0.70-1.34). The agreement between H. pylori and HAV seropositivity was lower than would be predicted by chance (κ = -0.03). The variables that were independently associated with seropositivity to H. pylori were being female (OR = 0.75, 95% CI = 0.60-0.95) and living in the Madinah region (OR = 0.72, 95% CI = 0.55-0.94). CONCLUSION The prevalence of H. pylori in this group of adolescents was high. However, there was no correlation between H. pylori and HAV infection rates. Hence, factors contributing to the transmission source and route seem to be different.
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Affiliation(s)
- Faleh Z Al Faleh
- Department of Medicine (Gastroenterology Unit), College of Medicine, Liver Disease Research Center, King Saud University, Riyadh, Saudi Arabia.
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Jacobsen KH, Wiersma ST. Hepatitis A virus seroprevalence by age and world region, 1990 and 2005. Vaccine 2010; 28:6653-7. [PMID: 20723630 DOI: 10.1016/j.vaccine.2010.08.037] [Citation(s) in RCA: 370] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 07/27/2010] [Accepted: 08/03/2010] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To estimate current age-specific rates of immunity to hepatitis A virus (HAV) in world regions by conducting a systematic review and meta-analysis of published data. The estimation of the global burden of hepatitis A and policies for public health control are dependent on an understanding of the changing epidemiology of this viral infection. METHODS Age-specific IgG anti-HAV seroprevalence data from more than 500 published articles were pooled and used to fit estimated age-seroprevalence curves in 1990 and 2005 for each of 21 world regions (as defined by the Global Burden of Disease 2010 Study). FINDINGS High-income regions (Western Europe, Australia, New Zealand, Canada, the United States, Japan, the Republic of Korea, and Singapore) have very low HAV endemicity levels and a high proportion of susceptible adults, low-income regions (sub-Saharan Africa and parts of South Asia) have high endemicity levels and almost no susceptible adolescents and adults, and most middle-income regions have a mix of intermediate and low endemicity levels. CONCLUSION Anti-HAV prevalence estimates in this analysis suggest that middle-income regions in Asia, Latin America, Eastern Europe, and the Middle East currently have an intermediate or low level of endemicity. The countries in these regions may have an increasing burden of disease from hepatitis A, and may benefit from new or expanded vaccination programs.
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Affiliation(s)
- Kathryn H Jacobsen
- Department of Global & Community Health, George Mason University, 4400 University Drive MS 5B7, Fairfax, VA 22030, USA.
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Alzahrani AJ, Dela Cruz DM, Obeid OE, Bukhari HA, Al-Qahtani AA, Al-Ahdal MN. Molecular detection of hepatitis B, hepatitis C, and torque teno viruses in drug users in Saudi Arabia. J Med Virol 2009; 81:1343-7. [PMID: 19551834 DOI: 10.1002/jmv.21487] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Injecting drug users are at increased risk of infection with hepatitis viruses and blood-borne pathogens. The aim of this study was to examine HBV, HCV, HDV, and TTV infections in Saudi drug users (N = 344). Extraction of nucleic acid from serum, reverse-transcription, amplification of viral nucleic acids, and HBV and HCV genotyping were done using established techniques. Of the analyzed samples, 41 (12%) contained detectable HBV DNA, 131 (38%) contained detectable HCV RNA, and 174 (51%) had detectable TTV DNA. The predominant HBV genotype was found to be genotype D and the predominant HCV genotype was found to be genotype 1b. All the samples were negative for HDV. Twelve samples (3.5%) were found to contain mixed HBV and HCV genomes, 24 samples (7%) were found to contain mixed HBV and TTV genomes, 82 samples (24%) were found to contain mixed HCV and TTV genomes, and 9 samples (2.6%) were found to contain mixed HBV, HCV, and TTV genomes. Identification of various infections in drug users will help the control of these infections in this group as well as in the community.
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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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Memish ZA, Knawy BA, El-Saed A. Incidence trends of viral hepatitis A, B, and C seropositivity over eight years of surveillance in Saudi Arabia. Int J Infect Dis 2009; 14:e115-20. [PMID: 19540786 DOI: 10.1016/j.ijid.2009.03.027] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Revised: 03/25/2009] [Accepted: 03/29/2009] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES In Saudi Arabia, viral hepatitis ranked the second most common reportable viral disease in 2007, with almost 9000 new cases diagnosed in that year. The objective of this study was to determine the incidence trends of viral hepatitis seropositivity among the population served by the National Guard Health Affairs (NGHA) hospitals in the central, eastern, and western Saudi Arabia regions. METHODS The surveillance system at King Abdulaziz Medical City in Riyadh receives weekly reports of laboratory confirmed hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis C virus (HCV) cases from all NGHA-served regions. In this study the viral hepatitis surveillance data for the period from January 2000 through December 2007 were analyzed. RESULTS Between 2000 and 2007, a total of 14 224 seropositive cases of viral hepatitis were reported to the surveillance system. The average annual incidence of seropositivity per 100 000 served population was highest for HBV (104.6), followed by HCV (78.4), and lowest for HAV (13.6). Saudis had higher HBV and HAV incidence, but lower HCV incidence compared to non-Saudis. Over the eight years (2000-2007), the incidence of all three viral hepatitis types showed a 20-30% declining trend. Only HAV incidence followed a clear seasonal cyclic pattern. CONCLUSIONS Despite the declining trend over the eight-year period, viral hepatitis, especially that caused by HBV and HCV, remains a major public health problem in Saudi Arabia, and has probably been underestimated in previous reports. There is a need for more comprehensive prevention strategies.
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Affiliation(s)
- Ziad A Memish
- Department of Infection Prevention and Control, King Abdulaziz Medical City, PO Box 22490, Riyadh 11426, Saudi Arabia.
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Faleh FA, Shehri SA, Ansari SA, Jeffri MA, Mazrou YA, Shaffi A, Abdo AA. Changing patterns of hepatitis A prevalence within the Saudi population over the last 18 years. World J Gastroenterol 2008; 14:7371-5. [PMID: 19109871 PMCID: PMC2778121 DOI: 10.3748/wjg.14.7371] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the seroprevalence of Hepatitis A (HAV) amongst Saudi children and compare it with previously reported prevalence data from the same population.
METHODS: A total of 1357 students were randomly selected between the ages of 16 and 18 years (689 males and 668 females) from three different regions of Saudi Arabia (Madinah, Al-Qaseem, and Aseer) and tested for anti-HAV-IgG.
RESULTS: The overall prevalence of anti-HAV-IgG among the study population was 18.6%. There was no difference between males and females but there was a significant difference in the seroprevalence (P = 0.0001) between the three different regions, with Madinah region showing the highest prevalence (27.4%). When classified according to socioeconomic status, lower class students had a prevalence of 36.6%, lower middle class 16.6%, upper middle class 9.6%, and upper class 5.9% (P = 0.0001). Comparing the current study results with those of previous studies in 1989 and 1997 involving the same population, there was a marked reduction in the overall prevalence of HAV from 52% in 1989, to 25% in 1997, to 18.6% in 2008 (P < 0.0001).
CONCLUSION: Over the last 18 years, there has been a marked decline in the prevalence of HAV in Saudi children and adolescents. The current low prevalence rates call for strict adherence to vaccination policies in high-risk patients and raises the question of a universal HAV vaccination program.
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Alfaleh F, Alshehri S, Alansari S, Aljeffri M, Almazrou Y, Shaffi A, Abdo AA. Long-term protection of hepatitis B vaccine 18 years after vaccination. J Infect 2008; 57:404-9. [PMID: 18829116 DOI: 10.1016/j.jinf.2008.08.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2008] [Accepted: 08/22/2008] [Indexed: 12/17/2022]
Abstract
INTRODUCTION This is the third evaluation study of the hepatitis B virus (HBV) vaccination program, initiated in 1989 in Saudi Arabia. AIMS This study sought to assess the efficacy and long-term protection of the hepatitis B vaccine among Saudi adolescents. METHODS School students between the ages of 16 and 18 years were randomly chosen from high endemic (Aseer), intermediate endemic (Madinah), and low endemic (Al-Qaseem) areas of the country. Hepatitis B surface antigen (HBsAg), hepatitis B core IgG antibody (anti-HBc), and hepatitis B surface antibody (anti-HBs) were measured using standard techniques. RESULTS A total of 1355 students (689 males and 666 females) were selected randomly from the three areas. No cases of positive HBsAg or anti-HBc were detected among the study population. Five hundred and ten students (38%) showed protective anti-HBs titers (>/= 10mIU/ml), while 528 (39%) students had undetectable anti-HBs titers (<1 mIU/ml). CONCLUSIONS This study shows the excellent efficacy of the HBV vaccination program in Saudi Arabia 18 years after its launch. Based on this study and others, a booster dose for the adult population appears to be unnecessary.
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Affiliation(s)
- Faleh Alfaleh
- Department of Medicine, College of Medicine, King Saud University, P.O. Box 2925(59), Riyadh 11461, Saudi Arabia
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Abstract
Hepatitis C virus (HCV) infection is a significant health problem, as it can lead to chronic active hepatitis, liver cirrhosis, and hepatic carcinoma. Patients undergoing hemodialysis treatment are at increased risk of contracting HCV and other viral infections. This is primarily due to their impaired cellular immunity, underlying diseases, and blood exposure for a prolonged period. Transmission of viral hepatitis, and in particular HCV in dialysis units, has been showing a progressive increase worldwide, ranging between 5% in some western countries and up to 70% in some developing countries. The annual rate of HCV seroconversion in Saudi Arabia is 7% to 9%, while its prevalence is variable between 15% and 80%. This prevalence remained at almost 50% in recent years, despite the further increase in number of patients with end-stage renal disease and the expansion of dialysis services. The most prevalent genotypes in Saudi Arabia are genotype 4 followed by genotypes 1a and 1b, whereas genotypes 2a/2b, 3, 5, and 6 are rare. Genotypes 1 and 4 were associated with different histological grades of liver disease. Mixed infections with more than one genotype were observed in some studies. Isolation of dialysis machines and infected patients, together with strict application of infection-control policies and procedures and continuous education and training of nursing staff, remain the cornerstone in prevention and control of the spread of HCV infection in dialysis units. Interferon (INF)-alpha or pegylated INF, alone or in combination with ribavirin, have shown great promise in the treatment of chronic HCV in dialysis patients.
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MESH Headings
- Antiviral Agents/therapeutic use
- Education, Nursing, Continuing
- Genotype
- Hepacivirus/genetics
- Hepacivirus/immunology
- Hepatitis C, Chronic/drug therapy
- Hepatitis C, Chronic/epidemiology
- Hepatitis C, Chronic/genetics
- Hepatitis C, Chronic/immunology
- Hepatitis C, Chronic/prevention & control
- Humans
- Infection Control
- Interferon-alpha/therapeutic use
- Kidney Failure, Chronic/blood
- Kidney Failure, Chronic/complications
- Kidney Failure, Chronic/immunology
- Kidney Failure, Chronic/therapy
- Kidney Failure, Chronic/virology
- Prevalence
- Renal Dialysis/adverse effects
- Ribavirin/therapeutic use
- Saudi Arabia
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Affiliation(s)
- Ayman Karkar
- Department of Nephrology, Kanoo Kidney Centre, Dammam Central Hospital, Dammam, Saudi Arabia.
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Almuneef MA, Memish ZA, Balkhy HH, Otaibi B, Helmi M. Seroprevalence survey of varicella, measles, rubella, and hepatitis A and B viruses in a multinational healthcare workforce in Saudi Arabia. Infect Control Hosp Epidemiol 2006; 27:1178-83. [PMID: 17080374 DOI: 10.1086/508826] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Accepted: 08/29/2005] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the prevalence of the vaccine-preventable diseases caused by varicella, measles, rubella, and hepatitis A and B viruses in a multinational healthcare workforce. DESIGN Prospective cohort study. SETTING A 750-bed tertiary care center located in Riyadh, Saudi Arabia. METHODS In compliance with hospital policy, newly recruited healthcare workers (HCWs) were enrolled in the study from September 2001 to March 2005. Serum samples were collected from all HCWs during the initial hiring process and tested for IgG antibodies against each of the 5 viral agents. Nonimmune HCWs were subsequently vaccinated at the earliest opportunity. RESULTS A total of 4,006 newly hired (international and local) employees were included in the study. All underwent serologic testing for IgG antibodies against varicella, measles, rubella, hepatitis A, and hepatitis B viruses. Of the total, 63% were female and 37% were male. Middle Eastern employees comprised 47% of the total, followed by employees from the Far East (35%), the West (10%), and Africa (8%). Forty-two percent were nurses, 27% were in administration, 18% were medical technicians, and 13% were physicians. Among the 4,006 newly hired HCWs, 14% had negative IgG antibody test results for varicella virus, 13% for measles virus, 10% for rubella virus, 33% for hepatitis A virus, and 43% for hepatitis B virus. More women than men were susceptible to hepatitis A (40% vs. 24%; P<.001), whereas more men were susceptible to hepatitis B (55% vs. 35%; P<.001). Varicella susceptibility was more common among HCWs from the Far East (19%), whereas susceptibility to measles, rubella, hepatitis A, and hepatitis B was highest among HCWs from the Middle East. Both relative youth and male sex were associated with lack of antibodies against hepatitis B virus and rubella virus. In contrast, female sex and younger age were associated with lack of antibodies against hepatitis A virus (P<.001). CONCLUSION Seroprevalence surveys of vaccine-preventable diseases among HCWs, although labor intensive, are invaluable in caring for a multinational workforce.
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Affiliation(s)
- M A Almuneef
- Department of Infection Prevention and Control, National Guard Health Affairs, King Abdulaziz Medical City-King Fahad National Guard Hospital, Riyadh, Saudi Arabia
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Almuneef MA, Memish ZA, Balkhy HH, Qahtani M, Alotaibi B, Hajeer A, Qasim L, Al Knawy B. Epidemiologic shift in the prevalence of Hepatitis A virus in Saudi Arabia: A case for routine Hepatitis A vaccination. Vaccine 2006; 24:5599-603. [PMID: 16757065 DOI: 10.1016/j.vaccine.2006.04.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2006] [Revised: 04/15/2006] [Accepted: 04/17/2006] [Indexed: 11/24/2022]
Abstract
This study aims to determine the seroprevalence of Hepatitis A among a selected group of Saudi children and thus, identify the best immunization strategy. A school-based seroprevalence study in children 4-18 years of age attending the National Guard schools was done. Of the 25,531 children attending the National Guard schools, 2399 (10%) were randomly selected through a stratified one-stage cluster survey. The overall prevalence of HAV-IgG was 28.9%. The prevalence was almost the same in male and female (28.2% versus 29.5%, respectively). There was a gradual increase in the HAV-IgG with 7% in children (< 8 years), 14% (8-11 years), 30% (12-15 years), and 52% (> 16 years) of age. Since a substantial proportion of this pediatric population confirms a continuing decrease in anti-HAV seroconversion rates, we recommend including Hepatitis A in the schedule of routine childhood vaccinations.
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Affiliation(s)
- M A Almuneef
- Department of Infection Prevention and Control, King Abdulaziz Medical City-King Fahad National Guard Hospital, Riyadh, Saudi Arabia
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Alfaleh FZ, Hadad Q, Khuroo MS, Aljumah A, Algamedi A, Alashgar H, Al-Ahdal MN, Mayet I, Khan MQ, Kessie G. Peginterferon alpha-2b plus ribavirin compared with interferon alpha-2b plus ribavirin for initial treatment of chronic hepatitis C in Saudi patients commonly infected with genotype 4. Liver Int 2004; 24:568-74. [PMID: 15566506 DOI: 10.1111/j.1478-3231.2004.0976.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
AIM Comparing the efficacy of peginterferon alpha-2b plus ribavirin with interferon alpha -2b plus ribavirin in Saudi patients with chronic hepatitis C virus (HCV) commonly infected with genotype 4. METHODS A total of 96 patients with chronic HCV infection were randomly assigned to two treatment groups. Forty-eight patients received once weekly 100 microg of peginterferon alpha-2b plus ribavirin given orally 800 mg/day (peginterferon group). Another 48 patients received thrice weekly 3 million units of interferon alpha-2b plus ribavirin 800 mg/day (interferon group). At the end of treatment (48 weeks) and sustained (72 weeks) biochemical and virologic responses were determined. RESULTS In the peginterferon group, 70.8% (34/48) patients attained both biochemical and virologic responses at the end of the treatment as against 52.1% (25/48) patients in the interferon group. (P=0.09 for both). Similarly, sustained biochemical and virologic responses in the peginterferon group were attained in 52.1% (25/48) and 43.8% (21/48) patients as against 43.8% (21/48) and 29.2% (14/48) patients in the interferon group, respectively (P=0.54 and 0.20, respectively). The sustained virologic response rates in patients with genotype 4 were 42.9% (12/28) in the peginterferon group and 32.3% (10/31) in the interferon group (P=0.43). Patients in peginterferon group had higher, although statistically not significant adverse reactions. CONCLUSIONS Saudi patients with chronic HCV attained a higher, although statistically not significant sustained virologic response with pegylated interferon plus ribavirin compared with interferon plus ribavirin.
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Affiliation(s)
- F Z Alfaleh
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
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