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BACKGROUND : More than 60 million persons have been infected since AIDS was described in 1981. By the end of 2003, an estimated 40 million individuals were living with HIV globally. The surveillance of HIV/AIDS still faces challenges in Saudi Arabia. This study describes the pattern and characteristics of HIV/AIDS cases in Saudi Arabia. METHODS : This descriptive analytic study describes the reported HIV/AIDS data for all notifiable cases during the period 1984 to 2003 in the Kingdom of Saudi Arabia. Case definitions based on ELISA and Western Blot tests were used. Age, sex and regional distribution were studied in addition to survival rates. RESULTS : As of 2003, 1743 Saudi nationals and 6064 non-Saudi HIV cases were reported. Among Saudis, 872 were AIDS cases. Males accounted for 1329 HIV infections, comprising 77%, with a male-to-female ratio of about 3:1. Adults 15-49 years constituted 78% of cases, including 46% of cases infected through sexual activity, while 33% of reported HIV seropositive cases had already died. Most cases (67%) were registered in Jeddah, Riyadh and Dammam. Infection through blood transfusion declined with no reported cases since 2001. CONCLUSION : The number of reported HIV infections in KSA has increased in the last few years. Using the coverage rate estimating method, the number of Saudi HIV infections since the emergence of the epidemic was estimated to be 2640 cases as of the beginning of the year 2004. The estimated number of HIV infections is almost one and one-half times the reported number, indicating that a problem of underreporting of HIV/AIDS cases still exists.

Background: Saudi Arabia used to be hyperendemic for HBV infection. Most of infection occurs in early life. HBV vaccine was, therefore, introduced in 1989 as the seventh primary immunogen of the EPI Program. This study is conducted to evaluate the efficacy of this program in Riyadh and Hail Regions. Method and Patients: A cohort follow-up study of children from Riyadh and Hail, who had been vaccinated in 1989, evaluated in 1991 and tested for HBV markers six years later. Results: The files of 303 children from Riyadh and Hail, who were investigated in 1991 retrieved and only 119, were available for testing. Fifty percent of the children have still a protective anti-HBs tittre. One vaccinated child was found to be positive for HBsAg. According to this study, the efficacy rate against HBsAg carriage is 88%. Conclusion: This study demonstrates the tremendous effect of HB vaccine on the HBV infection of Saudi children in these two regions

Abstract Background data on HIV epidemiology and preventive measures in Islamic countries is limited. This study describes the results of 18-year of HIV surveillance in Saudi Arabia (SA) and the preventive measures implemented from an Islamic perspective. Methods surveillance for HIV has been underway in SA since 1984. Indications for HIV testing include clinical suspicion, screening of contacts of HIV-infected patients, and routine screening of blood and organ donors, prisoners, intravenous drug users, patients with other sexually transmitted infections, and expatriates pre-employment. This is a case series descriptive study of all confirmed HIV infections diagnosed in SA from 1984 through 2001. Results a total of 6046 HIV infections were diagnosed, of which 1285 (21.3%) cases were Saudi citizens. Over the 18-year surveillance period the number of HIV infections diagnosed annually among Saudi citizens gradually increased and, over the period 1997–2001, it reached to 84 to 142 cases per year. The number of cases per 100,000 population varied widely between regions with a maximum of 74 cases and a minimum of 2 cases. The infection was most common in the age group 20–40 years (74.6%) and predominantly affected men (71.6%). The modes of transmission among Saudi citizens and expatriates, respectively, were as follows: heterosexual contact, 487 (37.9%) and 1352 (28.4%) cases; blood transfusion, 322 (25.0%) and 186 (3.9%) cases; perinatal transmission, 83 (6.5%) and 19 (0.4%) cases; homosexual contact, 32 (2.5%) and 38 (0.8%) cases; intravenous drug use, 17 (1.3%) and 33 (0.7%) cases; bisexual contact, 10 (0.8%) and 14 (0.3%) cases; unknown, 334 (26.0%) and 3119 (65.5%) cases. The number of HIV infections transmitted by blood or blood products transfusion declined to zero by year 2001 and all such infections occurred due to transfusions administered before 1986. At HIV diagnosis, 4502/6046 (74.5%) patients had no symptoms, 787 (13.0%) patients had non-AIDS defining manifestations, and 757 (12.5%) patients had AIDS. A total of 514/1285 (40%) Saudi patients died by year 2001. Conclusions the number of HIV cases in SA is limited with heterosexual contact being the main mode of transmission. From an Islamic perspective, preventive strategies include prevention of non-marital sex and intravenous drug use with encouragement of "safe sex" through legal marriage.

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.

In 1990, Saudi Arabia began vaccinating all children at school entry against hepatitis B. We evaluated hepatitis B surface antigen (HBsAg) prevalence rate among pregnant Saudi women 12 years later in 5 regions of the country. Using multistage sampling, 2664 pregnant Saudi women were recruited. Blood samples were tested for HBsAg; positive samples were also tested for hepatitis Be antigen (HBeAg). In all 2.44% were positive for HBsAg and 4 (0.15%) were also positive for HBeAg. HBsAg prevalence was highest in Gizan (4.2%) and lowest in Tabuk (1.4%). Positivity for women < or = 20 years of age was 0.5% compared with 2.6% for older women (P = 0.049). The overall HBsAg prevalence rate was lower than previously reported.

An outbreak of serogroup W-135 meningococcal disease occurred during the 2000 Hajj in Saudi Arabia. Disease was reported worldwide in Hajj pilgrims and their close contacts; however, most cases were identified in Saudi Arabia. Trends in Saudi meningococcal disease were evaluated and the epidemiology of Saudi cases from this outbreak described. Saudi national meningococcal disease incidence data for 1990 to 2000 were reviewed; cases from January 24 to June 5, 2000, were retrospectively reviewed. The 2000 Hajj outbreak consisted of distinct serogroup A and serogroup W-135 outbreaks. Of 253 identified cases in Saudi Arabia, 161 (64%) had serogroup identification; serogroups W-135 and A caused 93 (37%) and 60 (24%) cases with attack rates of 9 and 6 cases per 100,000 population, respectively. The 2000 Hajj outbreak was the first large serogroup W-135 meningococcal disease outbreak identified worldwide. Enhanced surveillance for serogroup W-135, especially in Africa, is essential to control this emerging epidemic disease.

Monitoring of adverse events following the administration of MMR vaccine containing the Urabe mumps virus vaccine strain, to over 2 million schoolchildren (aged 6-13 years) revealed that the incidence of vaccine-associated aseptic meningitis was one case per 295 000 doses given. About 92 per cent of these children had had their primary immunization against MMR at 12 months of age and, therefore, were probably not immunologically naïve. It appears from our data that the use of the Urabe-based mumps vaccine in the booster-dose format induces much less adverse effects than usually observed following the primary immunization with it. Further studies are needed to prove this conclusively.

This paper describes the measles immunization programme in Saudi Arabia and the change from the single-dose schedule with the Schwartz vaccine to the double-dose schedule with the Edmonston-Zagreb vaccine. The recent measles-mumps-rubella school campaign is also described.

Background: Saudi children vaccinated with a primary series of Hib vaccine (HbOC) at six weeks, three and five months have shown higher antibody titers compared to recent data from the U.S. The aim of this study was to evaluate the persistence of antibodies and to measure the immunogenicity of a booster dose of Haemophilus influenzae type b (Hib) vaccine in Saudi children., Patients and Methods: In the first phase of the trial, 210 children were divided into three groups. Group 1 received HbOC, DPT and the WHO formula of oral poliovirus vaccine (OPV); group 2 received HbOC, DPT and the FDA formula of OPV; and group 3 (control) received DPT and the WHO formula of OPV, without HbOC. Haemophilus influenzae geometric mean antibody levels after primary immunization were reported previously. In this study, blood samples were collected at 18 months (before the booster dose) and one month later to measure antibody levels against Haemophilus influenzae polysaccharide., Results: Following the booster doses, there was an increase in the geometric mean titers (GMTs) from 2.57 microg/mL to 39.4 microg/mL in group 1, and from 1.2 microg/mL to 48.9 microg/mL in group 2. In group 3, the GMT remained at 0.3 microg/mL. There was no significant difference in Hib GMTs after the booster dose between children given Hib vaccine with the FDA formula of DPT and OPV and those given the WHO formula., Conclusion: Based on the high immunogenicity of the Hib vaccine in Saudi children, a booster dose is not necessary at the initial stages of immunization, and should instead be given to children in the second year of life. This option, however, needs further evaluation and close monitoring.

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Background: The aim of this report was to study the immunogenicity of three doses of DTP in six-week-old Saudi infants when given either as World Health Organization (WHO) DTP or Federal Drug Administration (FDA) DTP formula., Methods: As part of the Haemophilus influenzae type b immunization research protocol, six-week-old infants were randomized into three groups to receive three doses of HbOC and WHO DTP formula, HbOC and FDA DTP formula, or in a control group to receive the usual vaccines without HbOC, at six weeks, three months and five months. Antibody levels for PRP, tetanus, diphtheria and pertussis were measured after the third dose. The results of diphtheria, pertussis and tetanus are presented in this paper., Results: After three doses, no difference was found between anti-PRP when given with either FDA DTP or WHO DTP formula. Also anti-tetanus and anti-diphtheria antibodies were significantly higher in the group vaccinated with HbOC and FDA DTP formula, compared to children vaccinated with WHO DTP formula. No negative interactions with other vaccines were observed after the third dose. Conclusion. Although diphtheria and tetanus antigens in the FDA formula are half the concentration in the WHO formula, they are more antigenic. There is a need for methods of potency assay to be re-evaluated.

Full text is available as a scanned copy of the original print version.

Full text is available as a scanned copy of the original print version.

Objectives: On October 1 1989, a programme was begun in Saudi Arabia in which the HBV vaccine was added as the 'seventh' primary immunogen of the Extended Programme of Immunization (EPI). In 1990, another programme was launched by the Ministry of Health to vaccinate all school children. Eight years after this mass vaccination programme, the efficacy of HBV vaccine was evaluated in a community-based study., Methods: A community-based study was carried out in Saudi children in urban and rural areas, covering all the regions of Saudi Arabia. After informed consent, blood samples were obtained and tested for HBV markers., Results: Among 4791 vaccinated Saudi children aged 1-12 years, only 15 were found to be HbsAg-positive (0.31%). HbsAg-positivity was 0.16% in children vaccinated at birth compared with 0.7% in those vaccinated at school entry. The overall HbsAg carrier rate dropped from 6.7% in 1989 to 0.3% in 1997 (P<0.00001). Similarly, there was a significant reduction in the prevalence of anti-HBc from 4.2% in 1989 to 0.46% in 1997 (P<0.00001). The overall seroconversion rate to HB vaccine among 4087 Saudi children up to 12 years of age was about 77%. Seroconversion rate in those vaccinated at birth was 77% compared with 71% in those vaccinated at school entry. After 8 years of receiving the third vaccine dose, close to 65% of the children had an anti-HBs titre of more than 10 IU/l compared with about 28% who had an anti-HBs titre of more than 100 IU/l after the same period., Conclusion: The result of this study demonstrates the tremendous impact of the mass HB vaccination programme on the seroepidemiology of HBV infection in Saudi Arabia. The ultimate goal of preventing HBV-related chronic liver disease and hepatocellular carcinoma in Saudi Arabia is foreseeable in the near future.

The prevalence of anti-HAV antibody in children was tested in subjects presenting at clinics in Riyadh, Saudi Arabia. A blood sample was taken to test for the presence of IgG (indicating past infection) and a questionnaire concerning personal and epidemiological data relating to hepatitis A was completed. In total, 592 children aged 6 months to 15 years were suitable for the analysis. There were 179 subjects who were positive for HAV (30.2%). The proportions of subjects positive for HAV varied significantly with age (P=0.001); 32%-49% in the 7-15 age range were positive compared with 13-20% aged 6 and below. There was a significant association between a positive HAV test and social level (P=0.044), with a higher proportion positive in the low social level. Children with jaundice, personal history of jaundice or travel abroad were significantly more likely to be HAV positive (P=0.001, P=0.006, P=0.021, respectively). There was also a significant association with nationality (P=0.022), where the lowest proportion of HAV positive children were Saudi Arabian (28%). Compared to previous studies, there is a significant decrease in the HAV exposure in Saudi children with shift from high to intermediate pattern. National strategy for prevention should be evaluated.

This is a national seroprevalence study conducted in Saudi Arabai in 1991G to determine postvaccination poliovirus antibody. Two hundred and nine children vaccinated with three oral polio vaccines at three, four, and five months of age were included in the study representing the five main regions in Saudi Arabia. Blood samples were collected at the age of nine months. Cytopathic effect (CPE) neutralization was used to determine the level of polio antibody. A dilution of 1/8th or more was defined as positive. Seventy-nine percent, 88% and 65% of the children were positive for Type 1, Type 2, and Type 3, respetively. Development of a new strategy of polio vaccination is needed.

The potential role of 3 species of Bulinus in the transmission of Schistosoma haematobium in Saudi Arabia was assessed on the basis of their susceptibility to experimental infection, their geographical distribution and numbers, and the type of habitats in which they were found. B. truncatus, distributed mainly in the mid- and south-western regions, showed extremely low susceptibility to strains of S. haematobium from Yemen, Egypt and Sudan. The same species from one area in the north-west was refractory to a strain of the parasite from Yemen. In contrast, B. wrighti was very susceptible to infection but is found only in a few habitats far from human settlements, thus probably playing little part in the transmission of the disease. As B. beccarii is highly susceptible to the infection and is distributed widely, this snail is probably the main intermediate host of schistosomiasis in Saudi Arabia.