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To investigate a cluster of Middle East respiratory syndrome (MERS) cases in a women-only dormitory in Riyadh, Saudi Arabia, in October 2015, we collected epidemiologic information, nasopharyngeal/oropharyngeal swab samples, and blood samples from 828 residents during November 2015 and December 2015–January 2016. We found confirmed infection for 19 (8 by reverse transcription PCR and 11 by serologic testing). Infection attack rates varied (2.7%–32.3%) by dormitory building. No deaths occurred. Independent risk factors for infection were direct contact with a confirmed case-patient and sharing a room with a confirmed case-patient; a protective factor was having an air conditioner in the bedroom. For 9 women from whom a second serum sample was collected, antibodies remained detectable at titers >1:20 by pseudoparticle neutralization tests (n = 8) and 90% plaque-reduction neutralization tests (n = 2). In closed high-contact settings, MERS coronavirus was highly infectious and pathogenicity was relatively low.

The Zika virus (ZIKV) became the latest threat to global health security when WHO declared on 1t February 2016, that recently reported clusters of microcephaly and other neurological disorders in Brazil constitute a Public Health Emergency of International Concern (PHEIC). These clusters were reported concurrently with an outbreak of ZIKV, which has been ongoing in Brazil and other countries in the America region since 2015. A growing body of clinical and epidemiological data possibly leans towards a causal role for ZIKV as the occurrence of the clusters of microcephaly and other neurological disorders principally the Guillain-Barre' syndrome are associated in time and place with the ongoing ZIKV transmission in the America region. So far, Zika viral transmission has been documented in a total of 69 countries and territories with autochthonous transmission from 20I7 to 10 August 2016. The geographical range of ZIKV has been increasing steadily. Consid'ring the presence of competent vectors that transmit ZIKV in, some parts of the Gulf countries, and the close relationship with Brazil, a local transmission of the virus is plausible once the virus is introduced through travel. This review suggests the integration of epidemiologicalind entomological surveillance for monitoring and control of the vectors of ZIKV. The risks associated with ZIKV infection and the possible threat to the Gulf States was described. A strategic Zika response framework (SRF) for the Gulf States has been developed to meet'their,urgent need for a collaborative and coordinated response for prevention and spread of ZIKV infection. A coordinated response of all partners in the Gulf States across sectors and services at national, as well as, regional levels is required.

OBJECTIVE Our aim was to assess the potential relationships among happiness, physical activity, and smoking initiation among undergraduate medical students in Saudi Arabia. METHODS We performed a cross-sectional study of randomly selected first- to fifth-year undergraduate medical students. Smoking initiation was defined as "ever trying smoking a cigarette, waterpipe, cigar/cigarillo, or other type of tobacco, even one or 2 puffs." The short scale Oxford Happiness Questionnaire was used to assess each student's happiness. Multivariate logistic regression analysis was performed. RESULTS Of the 406 students surveyed (208 boys, 198 girls), 86 (21.1%) had initiated smoking. We found an interaction between physical activity (PA) and happiness on smoking initiation (p-interaction = .012). Among boys with low levels of PA, lower levels of happiness were associated with a greater likelihood of smoking initiation (OR = 5.8, 95%CI = 1.9 - 17.5). Also, high levels of PA increased the chance of smoking initiation among male students with high levels of happiness (OR = 5.6, 95%CI = 2.1 - 14.5). CONCLUSION Our results suggest that young men with low levels of happiness and low levels of PA, as well as high levels of PA and high levels of happiness, may be targeted as a priority population in tobacco control intervention programs.

To explore potential gender differences in the factors associated with asthma-specific quality of life (AQL).A cross-sectional study of consecutive series of adult patients attending primary care centers at three major hospitals in Riyadh, Saudi Arabia, was performed. AQL was measured using a standardized version of the AQL questionnaire (min = 1, max = 7), with higher scores indicating a better AQL. Multiple linear regression analysis was performed.The mean AQL was 4.3 (standard deviation [SD] = 1.5) for males and 4.0 (SD = 1.3) for females (p = 0.113). With each unit increase in asthma control, the AQL improved by 0.19 points (95% confidence interval [CI] = 0.14-0.23) in men and by 0.21 points (95% CI = 0.16-0.25) in women. Daily tobacco smoking was associated with a 0.72 point (95% CI = 0.14-1.30) decrease in the AQL among males. Women who had a household member who smoked inside the house had a significantly lower AQL (B = -0.59, 95% CI = -1.0 - -0.19). A monthly household income of 25,000 Saudi Riyals or more was associated with a better AQL among men (B = 0.51, 95% CI = 0.01-1.01), whereas being employed exhibited a protective effect in women (B = 0.48, 95% CI = 0.11-0.84). Higher levels of perceived asthma severity were associated with better AQL in women (B = 0.82, 95% CI = 0.36-1.28).Our findings revealed gender-specific differences in the correlates of AQL in Saudi Arabia, particularly in tobacco exposure, socio-economic factors and perceived asthma severity.

Introduction: Saudi Arabia was affected by an outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV). We aimed to determine the perception of risk and level of stress among nurses. Methodology: A questionnaire survey was administered to determine the perceptions of risk of MERS-CoV infection. Results: The majority of the participants were females (332; 86.0%), and there were 54 (14.0%) males. Of the 386 respondents, nurses constituted the majority of the respondents (293; 75.9%), and there were 34 doctors (8.8%). The percentage of exposure was found to be greater in those who were working in the intensive care unit (ICU) (89; 23%). There was a significant difference in the worry and fear scale of contracting the MERS-CoV infection between participants who worked in isolation areas, ICUs, and emergency rooms (mean: 3.01 ± 1.1) compared to participants who worked in areas that are less likely to admit and have MERS-CoV suspected or positive cases (mean: 2.77 ± 1.1; p = 0.031. Females were significantly more worried and fearful of contracting the virus compared to males (mean: 2.92 ± 1.1 versus 2.61 ± 1.0, respectively; p = 0.045). Conclusions: MERS-CoV caused a relatively significant level of distress among nurses. There was a difference in the worry and fear scale of contracting the MERS-CoV infection between participants who worked in areas likely to admit and have MERS-CoV suspected or positive cases. After the campaign, the level of confidence got higher and the participants were more adherent to the infection control precautions.

Dengue fever (DE) is commonest rapidly spreading Aedes-bome viral fever worldwide. In the last decade several confirmed dengue cases were reported in Jazan Province. The study assessed the knowledge, attitudes and preventive practices of dengue fever among the secondary schools students in Ja.zan. A cross-sectional study was conducted among students of six secondary schools in Jazan. Multistage stratified random sample method was used and seven hundred forty two (742) were taken as respondents in study. The data on the socio-demographic characteristics of the respondents about their knowledge, attitude and practice towards DF were collected by using a pre-structured and self-administered questionnaire. The results showed a poor DF knowledge arpong the students, regarding attitudes towards DF, prevention and control, the majority of the participants' had good attitudes and believed that DF could be controlled and prevented (93.2%), DF control was the responsibility of government and community (83.1%) and they themselves have an important role to play in DF prevention (78.5%).The most common practice to prevent mosquito breeding were found to be the disposing of water from breeding containers (85.5%) and covering of water containers (68.6%). A significant association between the practice of DE preventive and control measures and sex of the participants' was (P

The present study provided information on the susceptibility status of the adult and larvae of Aedes aegypti mosquitoes in Jazan region of Saudi Arabia. Bioassay tests were performed on adults and larvae by using WHO recommended concentrations and test kits. Adults of Ae. aegypti mosquitoes were exposed to test papers impregnated with Lambda-cyhalothrin (0.05%), Cyfluthrin (0.15%), Deltamethrin (0.05%), Permethrin (0.75%), Fenitrothion (1%), Bendiocarb (0.1%) and DDT (4%) insecticides. Ae. aegypti mosquitoes were found to be susceptible only to Cyfluthrin; (mortality rate was 100%), whereas variable resistances were observed from the rest of the other insecticides tested (mortality rates ranged between 93.6 and 17%). Larvae were subjected to different concentrations of Diflubenzuron, Methoprene (IGRs) and Temephos (Organophosphate). Adult emergence inhibition (IE₅₀ & IE₉₅) values for the IGRs and the (LC₅₀ & LC₉₅) for Temephos were determined by log-probit regression analysis. Ae. aegypti larvae were resistant to Temephos (LC₅₀ 61.8-LC₉₅ 35600.1 mg/l) and showed high susceptibility to Methoprene than Diflubenzuron (IE₅₀ 0.49-IE₉₅ 10.9 mg/l) and (IE₅₀ 0.86 and IE₉₅ 93.8 mg/l), respectively. Larvae were more susceptible to Methoprene than Diflubenzuron by 1.8 folds.

The present study was designed to provide information on the susceptibility status of the adult and larvae of Aedes aegypti mosquitoes in Jazan region of Saudi Arabia. Bioassay tests were performed on adults and larvae by using WHO recommended concentrations and test kits. Adults of Ae. aegypti mosquitoes were exposed to test papers impregnated with Lambda-cyhalothrin (0.05%), Cyfluthrin (0.15%), Deltamethrin (0.05%), Permethrin (0.75%), Fenitrothion (1%), Bendiocarb (0.1%) and DDT (4%) insecticides. Ae. aegypti mosquitoes were found to be susceptible only to Cyfluthrin; (mortality rate was 100 %), whereas variable resistances were observed from the rest of the other insecticides tested (mortality rates ranged between 93.6 and 17%). Larvae were subjected to different concentrations of Diflubenzuron, Methoprene (IGRs) and Temephos (Organophosphate). The inhibition of adult emergence (IE50 and IE95) values for the IGRs and the (LC50 and LC95) for Temephos have been determined by log-probit regression analysis. The Ae.aegypti larvae were resistant to Temephos (LC50 61.8 LC95 35600.1 mg/l) and showed high susceptibility to Methoprene than Diflubenzuron (IE50 0.49 IE95 10.9 mg/ l) and (IE50 0.86 and IE95 93.8 mg/l), respectively. The larvae were more susceptible to Methoprene than Diflubenzuron by 1.8 folds.

Dengue fever (DF) is the most rapidly spreading mosquito-borne viral disease worldwide. Several confirmed dengue cases occurred in Jazan region in the last decade. Current study aims to assess the knowledge, attitudes and preventive practices of dengue fever among students of secondary schools in Jazan, Kingdom of Saudi Arabia. A cross-sectional study was conducted among students of six secondary schools in Jazan. Multistage stratified random sample method was used and seven hundred forty two (742) were taken as respondents in study. We collected information on the socio-demographic characteristics of the respondents about their knowledge, attitude and practice towards DF using a prestructured and self administered questionnaire. findings illustrate a poor DF knowledge among the secondary school students in Jazan. As to attitudes towards DF prevention and control, the majority of the respondents were having good attitudes and believed that DF could be controlled and prevented (93.2%), DF control is the responsibility of government and community (83.1%) and they themselves have an important role to play in DF prevention (78.5%).The most common practice to prevent mosquito breeding were found to be the disposing of water from breeding containers (85.5%) and covering of water containers (68.6%). A significant association between the practice of DF preventive and control measures and the gender of the respondents was found (P

ObjectivesContamination of blood samples can lead to serious problems in patient management. The administration of unnecessary antibiotics, wastage of hospital resources, and risks to patient life are some of the known hazards. This study aimed to calculate the rate of blood culture contamination and associated factors at King Khalid University Hospital (KKUH), Riyadh, KSA.MethodsThis is a retrospective cross-sectional study. The total study population was calculated based on a review of all of the request sheets for blood cultures submitted to the microbiology laboratory from 1st of January to 31st of December, 2012, at KKUH, Riyadh, KSA.ResultsThe rate of blood culture contamination (false positive) was 1.9%, while 8.71% of the blood culture samples had true infections (true positive). Coagulase negative staphylococcus (CoNS) was the most predominant isolate (87%). The rate of blood culture contamination was significantly higher during the summer season of June (1.38%), July (3.97%) and August (3.72%) compared to other months of the year (p value

Objectives: To explore the determinants of uncontrolled asthma in Saudi Arabia. Methods: A consecutive series of adult asthma patients attending 3 pulmonary primary care clinics in Riyadh, Saudi Arabia for a scheduled appointment were interviewed. A multiple logistic regression analysis was used. Results: The proportion of patients with uncontrolled asthma was 68.1% (177/260). Daily tobacco smoking or monthly household income less than 15,000 Saudi Arabian Riyals were associated with a 4.6 (95% confidence interval [CI]=1.3-16.4) and 3.4 (95% CI=1.8-6.6) times increase in the odds of having uncontrolled asthma. Patients with less than a graduate degree (odds ratio [OR]=3.1; 95% CI=1.0-9.5) or patients who were unemployed, disabled, or too ill to work (OR=3.1; 95% CI=1.4-6.9) had poorer asthma control. Having heartburn during the past 4 weeks decreased the odds of asthma control by 2.5 (95% CI=1.3-4.9), and having chronic sinusitis during the past 4 weeks decreased the odds of asthma control by 2.0 (95% CI=1.0-4.0) times. Being female (OR=2.0; 95% CI=1.0-4.0) or ≥35 years of age (OR=2.0; 95% CI=1.0-3.9) was also associated with having uncontrolled asthma. Conclusion: Our findings suggest that most respondents had uncontrolled asthma. Less modifiable socio-demographic factors (for example, income, education, occupation, gender, and age) significantly increased the odds of having uncontrolled asthma. However, modifiable risk factors such as tobacco smoking and clinical factors such as heartburn and chronic sinusitis could also be targeted for intervention. Saudi Med J 2015; Vol. 36 (5): 599-604 doi: 10.15537/smj.2015.5.10929

Middle East respiratory syndrome coronavirus (MERS-CoV) is a zoonotic virus originating in camels that has been causing significant mortality and morbidity in humans in the Arabian Peninsula. The epidemiology of the virus remains poorly understood, with hospital outbreaks, isolated cases with known exposure to camels and apparent community transmission occurring simultaneously. While traditional and seroepidemiological studies have been employed extensively throughout the epidemic, viral sequence data have not been utilised to their full potential in understanding transmission patterns within the outbreak. Here we use existing MERS-CoV sequence data to explore the phylodynamics of the virus in two of its known major hosts, humans and camels. We employ structured coalescent models to show that long-term MERS-CoV evolution occurs exclusively in camels, whereas humans act as a transient, and ultimately terminal host. By analysing the distribution of human outbreak cluster sizes and zoonotic introduction times we show that human outbreaks in the Arabian peninsula are driven by seasonally varying zoonotic transfer of viruses from camels. Without heretofore unseen evolution of host tropism, MERS-CoV is unlikely to become endemic in humans.

The objective of this study was to examine caregiver responses to individual questions of the asthma knowledge questionnaire and to compare the prevalence of uncontrolled asthma among children according to caregiver responses (correct vs. incorrect).We conducted an analytical cross-sectional study among 158 children with asthma aged 4-11 who were attending the pediatric primary care clinic of the King Khalid University Hospital in Riyadh, Saudi Arabia. The asthma knowledge questionnaire for use with parents or guardians of children with asthma was used to measure the knowledge of caregivers. Asthma control in the children was measured using an Arabic version of the childhood asthma control test. Pearson's chi-square or Fisher's exact tests were used to compare the prevalence of uncontrolled asthma according to the caregivers' responses.This study showed substantial gaps in knowledge among caregivers of children with asthma. The answer to only one of 17 questions was well known (86.1%); this question involved the harm of smoking near a child with asthma. Answers on 11 of 17 questions were significantly (p0.05) associated with asthma control in children. Among the key questions explored, the prevalence of uncontrolled asthma was 3.0 (1.8-4.9), 2.5 (95% confidence interval = 1.7-3.9) and 1.8 (1.3-2.5) times higher among children of caregivers who did not disagree with the statements that it is not good for children to use an inhaler for too long, that inhalers can affect or damage the heart, and that children with asthma should use asthma medications only when they have symptoms.Although innovations are needed to help patients improve their adherence to treatment and to effectively utilize the benefits of contemporary asthma medications, we observe substantial knowledge-related problems in the asthma management of children in Saudi Arabia.

Background Hand hygiene (HH) is single most effective preventive measure for health care–associated infection, but compliance rates remain low. This study estimated HH compliance among health care workers (HCWs) and examined factors associated with noncompliance. Methods An observational study design was carried out in 5 intensive care units (ICUs) at the University Hospital in Riyadh, Saudi Arabia. Among 242 HCWs, a total of 3,940 HH opportunities were observed by 6 trained medical interns and students. The World Health Organization's “Five Moments for Hand Hygiene” procedure was used as a basis for the observations. Results The overall observed noncompliance rate was 58%. The factors associated with noncompliance were HCW job title (physicians, odds ratio [OR], 2.8; 95% confidence interval [CI], 1.8-4.2; allied health professionals, OR, 2.9, 95% CI, 1.9-4.6); working the a.m. shift (OR, 1.5; 95% CI, 1.3-1.8), working in a pediatric ICU (OR, 1.8; 95% CI, 1.5-2.2), and performance of HH before patient contact (OR, 4.5; 95% CI, 2.6-7.8). Conclusions Overall HH noncompliance was high in ICUs of this hospital. The demanding ICU work setting was an important factor associated with noncompliance. HH compliance was highest among therapists and technicians because of fewer patient interactions and thus fewer HH noncompliance opportunities per person. Further studies on the relationship between work environment demands and HH compliance rates are needed.

Background The objective of this retrospective cohort study was to assess the impact of implementation of different levels of infection prevention and control (IPC) measures during an outbreak of Middle East respiratory syndrome (MERS) in a large tertiary hospital in Saudi Arabia. The setting was an emergency room (ER) in a large tertiary hospital and included primary and secondary MERS patients. Methods Rapid response teams conducted repeated assessments of IPC and monitored implementation of corrective measures using a detailed structured checklist. We ascertained the epidemiologic link between patients and calculated the secondary attack rate per 10,000 patients visiting the ER (SAR/10,000) in 3 phases of the outbreak. Results In phase I, 6 primary cases gave rise to 48 secondary cases over 4 generations, including a case that resulted in 9 cases in the first generation of secondary cases and 21 cases over a chain of 4 generations. During the second and third phases, the number of secondary cases sharply dropped to 18 cases and 1 case, respectively, from a comparable number of primary cases. The SAR/10,000 dropped from 75 (95% confidence interval [CI], 55-99) in phase I to 29 (95% CI, 17-46) and 3 (95% CI, 0-17) in phases II and III, respectively. Conclusions The study demonstrated salient evidence that proper institution of IPC measures during management of an outbreak of MERS could remarkably change the course of the outbreak.

Considering the high prevalence of sexually transmitted infections (STIs) and other associated health problems among young people globally, it is important to identify sexual practices that could potentially compromise health. This study explored the sexual practices of young men in Riyadh city, the Kingdom of Saudi Arabia (KSA). Materials and methodology A cross-sectional study among young, male students was conducted using a pre-tested, structured, self-administered questionnaire. Descriptive analysis and adjusted odds ratio (OR) were calculated.Among 225 study participants, 31% had engaged in premarital sexual activity at least once and 61% viewed pornographic movies/materials. Only 51% knew that condom use could prevent STIs, 20% were not aware that HIV could be transmitted through both homosexual and heterosexual contacts. Premarital sexual activity was associated with the use of illegal drugs (OR: 2.51), viewing of pornographic movies (OR: 6.79) and traveling alone abroad (OR: 3.10).and recommendations Our study was the first to report the existence of premarital sexual practices among young educated men in KSA. There is a need to identify in detail the risks and the knowledge gaps, and base sexual health awareness among youth on such knowledge in order to prevent the spread of STIs and HIV.

Please cite this paper as: Mohamed et al. (2011) Communicability of H1N1 and seasonal influenza among household contacts of cases in large families. Influenza and Other Respiratory Viruses 6(3), e25–e29. Background Quantitative knowledge of the transmissibility of influenza is crucial to its prevention and control. Objectives To quantify the transmission of influenza A (H1N1) and seasonal influenza in household contacts of patients with influenza diagnosed in a large university hospital. Patients/Methods A prospective study was conducted between September and October 2009 in which all confirmed cases of influenza diagnosed at King Khalid University Hospital were included. All household contacts were followed by telephone calls every other day for 12 days. They were asked about the development of influenza symptoms in addition to their age and nationality. Results Overall, 432 household contacts of 69 influenza A (H1N1) cases and 417 contacts of 91 seasonal influenza cases were included. Suspected influenza was diagnosed in 16·9% and 14·4% of household contacts of H1N1 and seasonal influenza patients, respectively. Household reproduction numbers were 1·06 (0·84–1·28) for H1N1 and 0·66 (0·51–0·81) for seasonal influenza. Children in households were more susceptible than were adults (22·2% versus 13·7%, respectively). Evidence of coughing in the index case tripled the risk of infection in households afflicted with the H1N1 influenza [relative risk (RR) = 3·28, CI = 1·24–8·69], while evidence of a runny nose doubled it (RR = 1·89, CI = 1·19–2·92). Conclusions Communicability of influenza in households in Riyadh is comparable to that in other countries. Children are more susceptible to influenza infection. The presence of a cough or runny nose in the index cases increases the risk of infection.

BACKGROUND AND OBJECTIVES: The satisfaction of the family is essential to the success of home care support services. This study aimed to assess home caregivers’ satisfaction with support services and to identify potential factors affecting their satisfaction. DESIGN AND SETTINGS: The study was conducted in the Family and Community Medicine Department at Riyadh Military Hospital using cross-sectional design over a period of six months. PATIENTS AND METHODS: Two hundred forty participants were recruited by systematic random sampling from the division registry. Data were collected through telephone calls using a designed structured interview form. All research ethics principles were followed. RESULTS: The response rate was 76.25%. Most caregivers were patients’ sons or daughters. The duration of patients’ disabling illnesses varied from less than 1 year to up to 40 years. The majority of caregivers agreed that a home care services team provided the proper healthcare-related support to the patients and improved caregivers’ self-confidence in caring for their patients. Overall, on a scale of 100%, the median level of satisfaction was 90%, and 73.2% of caregivers had a satisfaction score of 75% or higher. Increased age, female gender, and more frequent home visits were positive independent factors associated with caregivers’ satisfaction scores. CONCLUSION: Although most caregivers are satisfied with the services provided by a home care support program, there are still areas of deficiency, particularly in physiotherapy, vocational therapy, and social services. The implications are that caregivers need to be educated and trained in caring for their patients and need to gain self-confidence in their skills. The program's administration should improve physiotherapy, vocational therapy, social services, and procedures for hospital referral.

BACKGROUND AND OBJECTIVES: A new test (Dr. KSU H1N1 RT-PCR kit) was recently developed to provide a less expensive alternative to real-time reverse transcriptase-polymerase chain reaction (RT-PCR). We report the findings of a validation study designed to assess the diagnostic accuracy, including sensitivity and specificity, of the new kit, as compared to real-time RT-PCR. DESIGN AND SETTING: Cross-sectional validation study conducted from 18-22 November 2009 at a primary care clinic for H1N1 at a tertiary care teaching hospital in Riyadh. PATIENTS AND METHODS: Nasopharyngeal swab samples and data on socio-demographic characteristics and symptoms were collected from 186 patients. Swab samples were sent to the laboratory for testing with both real-time RT-PCR and the new Dr. KSU H1N1 RT-PCR kit. We measured the sensitivity and specificity of the new test across the entire sample size and investigated how these values were affected by patient socio-demographic characteristics and symptoms. RESULTS: The outcomes of the two tests were highly correlated (kappa=0.85; P

The main objectives of this paper were to estimate the consumption patterns of tobacco use among King Saud University (KSU) undergraduate students; and investigate different risk factors which may contribute to tobacco use among female students.A representative sample (n = 7550) of the total KSU undergraduate student population of 69,498 (males and females) was selected, stratified according to college and gender. A modified version of the WHO/CDC Global Youth Tobacco Survey (GYTS) questionnaire was used for data collection.Overall smoking prevalence among KSU students was estimated at 14.5%, prevalence among male students (32.7%), and females (5.9%). Independent risk factors for smoking among males were found to be: age, father's smoking habits, and “friends’ smoking habits”; while among females were: sister's smoking habits and “friends’ smoking habits.”The findings of this study re-emphasize the significance of peer pressure on smoking among university students of both sexes; influence of family members, usually of same sex. We need to foster gender-sensitive tobacco prevention intervention programs, to prevent youngsters of both sexes from taking up such habit. We also need to raise awareness of girls and young women, of the consequences of smoking in general, water-pipe in specific, on their own health, that of their spouses, families, and off-springs, many of whom could develop chronic respiratory disorders, as passive smokers in the beginning/potential smokers themselves, later on. All such efforts should be backed and supported by strong governmental commitment, to ensure success of their implementation accordingly. Keywords: Smoking, Undergraduate university students, Riyadh, Saudi Arabia

BACKGROUND AND OBJECTIVES: A national plan of management for flu-like illnesses was developed by the Saudi Ministry of Health after the first outbreak in Saudi Arabia in June. We describe the clinical presentation of the H1N1 cases attending King Khalid University Hospital (KKUH) between July through September 2009 and identify the high-risk age groups. METHODS: All patients presenting with influenza-like illnesses (ILI) in the H1N1 clinics during the specified period were clinically examined and tested using reverse transcription polymerase chain reaction (RT-PCR). Those who were clinically diagnosed and confirmed positive for novel influenza A (H1N1) were included in the study. RESULTS: Over a 6-week period, 117 cases of laboratory-confirmed cases were reported in KKUH with a mean (SD) age of 19.6 (16.7) years, of whom 72 (62.1%) were males. Most reported cases were Saudis (n=99, 85.3%); 94 (81%) had no travel history outside the country; 100 (86.2%) had had no contact with an H1N1-identified patient; 33% were aged 5-14 years and 28.4% were aged 15-29 years. The most commonly reported symptoms were fever in 99 (85.3%), cough in 9 (81%), runny nose (33.6%) and sore throat (21.3%). All 117 cases were confirmed positive using real time RT-PCR testing. Thirty-one cases (26%) were admitted and 22 of those (71%) recovered after receiving oseltamivir. Two deaths were attributed to the 2009 pandemic. One patient died of chronic pulmonary disease. The other cause of death was unknown. CONCLUSION: These findings indicate indigenous influenza A (H1N1) transmission, and confirm the urgent need for prevention strategies which specifically target children and young adults, who appear to have a higher risk of infection and hospitalization. Such measures include immunization, improved personal hygiene, and increased ventilation in habitations.

Background The draft Global Technical Strategy for malaria aims to eliminate malaria from at least 10 countries by 2020. Yemen and Saudi Arabia remain the last two countries on the Arabian Peninsula yet to achieve elimination. Over the last 50 years, systematic efforts to control malaria in the Kingdom of Saudi Arabia has successfully reduced malaria cases to a point where malaria is now constrained largely to Jazan Province, the most south-western area along the Red Sea. The progress toward elimination in this province is reviewed between 2000 and 2014. Methods Data were obtained from the Ministry of Health case-reporting systems, activity reports, unpublished consultants reports, and relevant scientific published papers. Sub-provincial population data were obtained the national household censuses undertaken in 2004 and 2010. Rainfall data were obtained from the Meteorological Department in Jazan. Results Between 2000 and 2014 there were 5522 locally acquired cases of malaria and 9936 cases of imported malaria. A significant reduction in locally acquired malaria cases was observed from 2000 to 2014, resulting in an average annual incidence (2010–2014) of 0.3 cases per 10,000 population. Conversely imported cases, since 2000, remain consistent and higher than locally acquired cases, averaging between 250 and 830 cases per year. The incidence of locally acquired cases is heterogeneous across the Province, with only a few health districts contributing the majority of the cases. The overall decline in malaria case incidence can be attributed to coincidental expansion of control efforts and periods of exceptionally low rainfall. Conclusions Jazan province is poised to achieve malaria elimination. There is a need to change from a policy of passive case detection to reactively and proactively detecting infectious reservoirs that require new approaches to surveillance. These should be combined with advanced epidemiological tools to improve the definitions of epidemiological receptive and hotspot malaria risk mapping. The single largest threat currently remains the risks posed by imported infections from Yemen.

To evaluate the role of the rapid influenza diagnostic test (RIDT) and clinical decision in the diagnosis of H1N1.In November 2009, 290 suspected influenza patients were examined for H1N1 during an outbreak in Riyadh, Saudi Arabia. Nasopharyngeal swabs were analyzed using Directigen EZ Flu A+B kit. Monoclonal anti-human influenza A/B and reverse transcription- polymerase chain reaction (RT-PCR) were used. Positive and negative controls were used in each run of specimens. Validity indices were calculated for RIDT and clinical diagnostic criteria.The sensitivity and specificity of RIDT were 40.5% (95% confidence interval [CI]: 33.0-48.5), and 94.5% (95% CI: 88.6-97.6). The sensitivity of clinical decision was 66.3% (95% CI: 58.4-73.4), and the specificity was 65.4% (95% CI: 56.3-73.4). The sensitivity of clinical decision was higher in early presenters (79.2%; 95% CI: 57.3-92.1). The RIDT sensitivity was higher in younger patients (48.4%; 95% CI: 35.7-61.3). The positive predictive value (PPV) was 90.4% (95% CI: 80.7-95.7) for RIDT, and 71.1% (95% CI: 63.1-78.0) for clinical decision. The PPV for RIDT was greater for older (94.7%; 95% CI: 80.9-99.1) and late (90.7%; 95% CI: 76.9-97.0) presenters. The adjusted odds ratio for clinical decision was significant for cough, headache, and fatigue.The RIDT can be useful in epidemics and high prevalence areas, whereas clinical decision, and RT-PCR complement the diagnosis of H1N1 in any setting.

This study aimed at studying tobacco consumption patterns among male school children in Riyadh. Methods: A cross-sectional survey was carried out on 5961 male school children, using a modified WHO-GYTS questionnaire. Results: Smoking data was available for 4693(83%) children, among whom 483(10.3%; 95% CI:9.4-11.2%) reported being “current smokers”. Logistic regression reflected independent risk factors for tobacco use to include: educational stage (OR=3.1-4.4 for high school), school type (OR=6.2 for governmental-general compared to private schools), smoking household member (father / mother / brother / friends) (OR=1.5–25.7). Recommendations: Raising awareness of children is important for saving them from taking up the habit and assisting smokers to quit. The school health team should be playing important dual roles: directly for children and indirectly through empowering their teachers in combating tobacco use campaigns. Male school children are mostly affected by their peers, fathers and brothers. Thus, parents and siblings should be role models for their children / siblings, respectively, by not smoking themselves.

Asthma is the most common chronic disease among children. Uncontrolled asthma may considerably decrease the quality of life for patients and their families. Our objective was to identify possible risk factors for poor asthma control in children.A cross-sectional study was conducted among children with asthma aged 4-11 years who attended a pediatric clinic for follow-up visits at one of the major teaching hospitals in Riyadh, Saudi Arabia. Asthma control status was measured by the childhood asthma control test. Multiple logistic regression analysis was performed to explore the relationships between the outcome and exposure variables.Uncontrolled asthma was present in 89 out of 158 children (59.3%). Asthma control improved with the number of siblings. Control improved by 69% with two or three siblings (OR = 0.31, 95% CI = 0.10-0.96) and by 87% with four or more siblings (OR = 0.13, 95% CI = 0.04-0.48). Similarly, asthma control improved with an increased asthma knowledge of the caregiver (OR = 0.87, 95% CI = 0.81-0.93). Household incomes less than SAR 15 000 and sharing a bedroom increased the odds of having uncontrolled asthma by 2.30 (95% CI = 1.02-5.21) and 3.33 (95% CI = 1.33-8.35), respectively.In addition to knowledge, socioeconomic factors, such as family income, household crowding, and the number of siblings are associated with asthma control among children in Saudi Arabia. Further research is needed to investigate the role of these factors.

Background Extended-spectrum β-lactamase (ESBL)-producing Klebsiella species cause worldwide problems in neonatal intensive care units (NICUs). This study aimed to determine possible risk factors for infection or colonization with ESBL-producing Klebsiella pneumoniae (ESBLKp) during an outbreak in the NICU. Methods A retrospective cohort study was conducted among neonates admitted to the NICU of a teaching hospital in Riyadh, Saudi Arabia, during an outbreak of ESBLKp from April to July 2008. The incidence density ratio was calculated to determine possible predictors of ESBLKp colonization or infection. Results During 2,265 person-days of follow-up of 118 neonates, 4 became infected, and 8 were colonized with ESBLKp. Univariate analyzes revealed that, among 14 neonates who were treated with vancomycin, 9 (64.3%) developed infection or colonization with ESBLKp, whereas, among 104 neonates who were not treated with vancomycin, 3 (2.9%) were affected, with an incidence density ratio of 4.22 (95% confidence interval: 1.47-5.15). Parenteral feeding and mechanical ventilation were found to be marginally significant risk factors. Conclusion Treatment with vancomycin appears to be a risk factor for infection or colonization with ESBLKp in the NICU setting.

To measure the prevalence of obesity among military personnel in the Kingdom of Saudi Arabia (KSA), and to identify its risk factors.This nationwide cross-sectional study covered all 5 military regions of KSA. It included a multistage stratified random sample of 10,500 active military personnel. The World Health Organization STEP wise approach to chronic disease risk factor surveillance (STEPS) was used in the design of the data collection tool. The project lasted from January 2009 to February 2011.The response rate was 97.4%; 40.9% of the participants were overweight, 29% obese, and 42.4% had central obesity. Multivariate analysis revealed age, education years, and family history of diabetes or hypertension as statistically significant positive predictors of body mass index, while higher military rank, smoking, eating fruits more than twice per week, and heavy physical activities were negative predictors.Obesity is a major health problem among military personnel in this survey especially among soldiers, and is associated with unhealthy dietary and physical activity habits. Prompt action must be taken by the military medical services department in terms of intervention programs primarily directed to soldiers and overweight personnel to control obesity and mitigate its consequences. Review of the anthropometric standards for recruitment, continuation, and promotion in military service is recommended.

To determine the meningitis and influenza vaccination coverage rates among Saudi military personnel in Riyadh (Central Military Region [CMR]), Kingdom of Saudi Arabia, (KSA) and the socio-demographic factors that influence vaccination.This cross-sectional descriptive study was carried out on a sample of 2286 military personnel from different army forces and different military ranks in CMR in KSA selected by a 2-stage stratified random sampling technique. A self-administered questionnaire designed for the National Military Health Survey was used with a section added for assessment of vaccination status. Data collection was carried out from May to August 2009.The response rate was 97.6%. The vaccination coverage was higher for meningitis (51.7%) compared with influenza (17.8%). A high percentage lacked awareness of their vaccination status. Vaccination rates were higher in the Land Forces, and increased with more years of education, and lower crowding index.The proportion of vaccination coverage among military personnel in CMR of KSA is low, especially for influenza, along with their awareness of their vaccination status. A vaccination program that includes awareness promotion of vaccine-preventable diseases is recommended, with changes in the policies to mandate vaccination against meningitis and influenza.

The prevalence of obstructive sleep apnea OSA has not been assessed in Saudi Arabia. We aimed to assess the prevalence of individuals who were at risk of OSA in a sample of middle-aged Saudi males, using the Berlin questionnaire at primary care settings.The study was conducted at King Khalid University and King Fahd National Guard primary health care clinics in Riyadh, Kingdom of Saudi Arabia between December 2005 and March 2006. Berlin Questionnaire was administered by trained medical students to consecutive Saudi male patients in the age group 30-65 years attending the primary health care clinics, after explaining the procedure of the study. Based on the data collected and defined criteria, patients were stratified into high risk and low risk according to responses.Five hundred and seventy-eight middle-aged Saudi males with a mean age of 45.02 +/- 9.3 year were surveyed in this study. Snoring was present in 52.3%, and breathing pauses more than once per week was noticed in 11.3%. Based on the Berlin questionnaire stratification for risk of OSA, 33.3% were considered as high risk patients for OSA. The occurrence of daytime tirednessonce/week was reported by 35.5%. The prevalence of snoring and risk for OSA is similar to that reported in the US.In primary care setting, one in 3 middle-aged Saudi males is at risk for OSA.

Aim: This study aimed at assessing prevailing patterns and risk factors of tobacco consumption among clients, food handlers and employers of food facilities, in Riyadh, Saudi Arabia. Methods: A cross-sectional approach to a representative sample of food facilities in Riyadh was used. A sample of 3000 participants included clients (75%); food handlers/hospitality workers (20 %) and employers (5 %). Participants were reached at restaurants, food courts or cafes. A modified version of the WHO-CDC-Global Youth Tobacco Survey questionnaire was used for data collection. Results: The prevalence of tobacco use at food facilities was found to be 40.3 %, of which 74% were customers, 18.8% were food handlers and 7.2% were managers. The consumption of tobacco was higher at restaurants (39.9%), but lowest at food courts of shopping malls. Water pipe (55.3%) was the main consumption type, followed by cigarettes (42.6%) and chewing tobacco (2.1%). Multivariate analysis showed that gender (male), marital status (single), and type of food facility (Estaraha and café/coffee shop) were independent risk factors associated with tobacco use at food facilities. Conclusion: Tobacco use is very common in food facilities in Riyadh as reflected by results of our study, especially among single males Saudis. We should build on success encountered in banning smoking in airports, airplanes, shopping malls, market places, educational institutions and healthcare facilities, extending the ban to include food facilities as well. This is important for the health of non-smokers as well as smokers themselves.

Helicobacter pylori (H. pylori) is one of the most common infections that affects humans. Although H. pylori was only identified in 1983,[1] numerous studies reveal that it is encountered worldwide. It is estimated that half or more of the world's population is infected.[2] Substantial differences in the prevalence of H. pylori infection have been observed between countries.[2,3] These differences conform to two major patterns that differ in developed and developing countries. The general trend of H. pylori prevalence in developed countries is slow increases during childhood, which continue through adolescence and early adulthood, with an abrupt increase around 50–60 years of age.[4] In the nonindustrialized countries, H. pylori prevalence increases more rapidly during childhood and most adolescents and adults are infected. Thus, differences in H. pylori prevalence between industrialized and nonindustrialized countries are greater at younger ages and get smaller at older ages.[2,3,5] Although the overall prevalence is generally lower in the Western world, high prevalence, approaching that of the nonindustrialized nations, have been observed within some subgroups in the industrialized nations. Differences in prevalence within populations are due to a variety of factors primarily relating to socioeconomic status and geographic origin. In this issue of this Journal, a report about H. pylori prevalence and its association with recurrent abdominal pain is published.[6] The authors of this publication have surveyed a group of school children for H. pylori using the 14C urea breath test. They further tried to establish a relationship between H. pylori and recurrent abdominal pain. In spite of the importance of this report, it has potential methodological problems. Using a radioactive material as a tool of diagnosis in the young agegroup is questionable, especially with the lack of credible evidence that supports that decision. Even in the presence of some references that probably mention its safety to be used in older children,[7] conducting a research on healthy people requires the use of the safest procedure ever, especially with the presence of better alternatives that can be used.[8,9] Other limitations of the report are the lack of very important information on demographic and socioeconomic factors that may explain some of the conflicting findings. These problems are not limited to this paper. Research from the region in this field is limited and most of the published papers that emanated from this region have had inherent problems related to their design and sample size. The issue requires further in-depth investigation in order to address various regional questions of epidemiological importance. A PubMed® search, using H. pylori as a keyword, shows a great interest in research of this infection. This interest is reflected by the exponential increase in the number of papers published on the subject from a total of 14 in 1984 to over 500 in 1990 and over 26,000 in 2007, making it one of the most active areas of research in the medical field. The Saudi contribution to this enormous literature is very minimal, with less than 70 publications. In contrast, publications from Australia, with a similar population but a lower prevalence of H. pylori, exceeded 500 articles. In conclusion, the strong effort and commitment of several medical disciplines with a large and proper collection of scientific data from Saudi population/subgroups will give significant support to this field of research.

Summary Background Since hepatitis A virus (HAV) is acquired primarily through the fecal–oral pathway, several investigators have used HAV seropositivity as a proxy for exposure to this pathway. This paper is a critical review of the evidence relevant to the association between seropositivity to HAV and Helicobacter pylori, and considers the validity of comparisons for testing the hypothesis that H. pylori spreads by the fecal–oral route. Materials and methods : A Medline search identified reports of all types published in the English language literature that were linked to the keywords ‘Campylobacter pylori’, ‘hepatitis A’, or ‘Helicobacter pylori’, cross-referenced with ‘seroepidemiology’, ‘seroprevalence’, or ‘seropositivity’. Studies identified by the search were included in the review if they used specific IgG antibodies to classify the serostatus of subjects for both HAV and H. pylori infection and provided an estimate of the magnitude of the association between HAV and H. pylori or information that permitted calculation of an odds ratio (OR). Results Out of the 21 studies identified, 15 met the inclusion criteria. The studies showed ORs for an association of HAV and H. pylori that ranged from 0.81 to 8.4. After adjustment for potential confounders, ORs shifted toward the null. They also showed that HAV seroprevalence is lower than H. pylori seroprevalence in early life and then becomes higher in later life. Thus in most populations, the trends cross over at some point. Conclusion The observed associations between the two infections are generally overestimated by the confounding effects of age and socio-economic status-related factors, and when these factors are controlled, the association becomes weak. Moreover, HAV infection elicits a long-term antibody response, while H. pylori infection does not. Consequently, serostatus comparison does not constitute a convincing test of the fecal–oral transmission hypothesis for H. pylori.

Background During the Hajj season 2014, several public health measures were applied by the Ministry of Health at Prince Mohammed International Airport in Almedinah. However, several operational defects affected the provision of preventive health services for passengers and airport workers. This study aims to evaluate the applied public health emergency system at the airport, detect any potential gaps and to provide appropriate operational solutions. Methods This is a qualitative case study conducted at Prince Mohammed International Airport in Almedinah during the 2014 Hajj season, September 2014. Data were collected via semi-structured interviews, focus groups and policy document reviews. Interviews were conducted with the 14 individuals of the airport’s decision makers and relevant health practitioners. Data were recorded via taking notes during interviews and data coding was performed to produce the main themes and subthemes of the study. Results The main findings of the study revealed three main defects affecting the applied public health emergency system at the airport. The main themes were mainly related to shortage in logistics related to public health emergency systems, shortage in proper documentation of policies and lack of documented protocols of communications among airport stakeholders. Conclusions The study highlighted the main factors hindering the application of public health emergency measures at the airport. A Public Health Emergency Contingency Plan was proposed as a method to regulate the process of providing logistics for public health preventive services, the method of producing documented policies and methods of producing Memoranda of Understandings as communication regulators.