Explore the vast range of titles available.

Reducing the spread of SARS-CoV-2 was the primary focus of the Saudi public health authorities during the unprecedented COVID-19 pandemic.3 The 2020 and 2021 Hajj pilgrimages were appropriately scaled down with strict implementation of infection control measures, and no COVID-19 outbreaks were reported.4 With the easing of COVID-19 travel restrictions globally, increasing numbers of people travelled for the 2023 Hajj, during which Saudi Arabia hosted 1 845 045 pilgrims (969 694 male and 875 351 female), including 1 660 915 international pilgrims.5 A further substantial increase in these numbers, many of whom will be older people with comorbidities, is anticipated for the forthcoming Hajj pilgrimage in June, 2024. Global surveillance data show that, in addition to SARS-CoV-2, other viral respiratory pathogens, such as influenza A (H1N1), influenza B, human rhinovirus, respiratory syncytial virus, non-MERS-CoV human coronaviruses (eg, CoV-229E, CoV-OC43, CoV-HKU1, and CoVNL63), human metapneumovirus, and measles virus, are circulating at much higher concentrations worldwide than before the COVID-19 pandemic.6 Additionally, there is the increasing threat that various bacterial respiratory pathogens will be imported into Saudi Arabia and spread globally by pilgrims from across the world.7 Such pathogens include multi-antibiotic-resistant Mycoplasma pneumoniae, Chlamydia pneumoniae, Streptococcus pneumoniae, Haemophilus influenzae, Mycobacterium tuberculosis, Klebsiella pneumoniae, Moraxella catarrhalis, Legionella pneumoniae, Bordetella pertussis, and Pseudomonas aeruginosa, which, over the past 5 years, have continued to evolve and acquire additional antibiotic-resistance genes and are spreading globally.7–9 Pathogen spread and infection outcomes depend on many factors, such as the vaccination status of pilgrims before travel, adherence to the recommended local public health measures, the prevalence of pathogens in the pilgrims’ home countries, asymptomatic nasopharyngeal carriage, innate and herd immunity, pathogen evolution and mutations, and host susceptibility factors including extremes of age and underlying comorbidities such as diabetes and immunosuppressive conditions. Approved vaccines Target group Target countries Mandatory vaccines Meningococcal meningitis Quadrivalent (ACYW) polysaccharide vaccine between 10 days and 3 years before arrival or quadrivalent (ACYW) conjugated vaccine between 10 days and 5 years before arrival; health authorities at the pilgrims'; country of origin should ensure their vaccination within the required validity period and ensure that the type of vaccine and its date is clearly shown on the vaccination certificate—if the vaccine type is not indicated, it will be considered valid for 3 years only All individuals aged ≥1 year arriving for Hajj or for seasonal work in Hajj zones All countries Poliomyelitis At least one dose of IPV or bivalent OPV All travellers Countries reporting cases of WPV1 strains (Afghanistan, Mozambique, and Pakistan) or cVDPV1 strains (Madagascar, Mozambique, Malawi, DR Congo, Yemen, and Republic of the Congo) Poliomyelitis At least one dose of IPV* or, if IPV is not available, at least one dose of OPV† is acceptable All travellers Countries reporting human samples positive for the cVDPV2 strain or cases of acute flaccid paralysis Yellow fever Yellow fever vaccine; the vaccination certificate is valid for life starting 10 days after vaccination All travellers aged >9 months Countries or areas at risk of yellow fever transmission Recommended vaccines COVID-19 Pfizer–BioNTech; Moderna; Oxford–AstraZeneca; Janssen; Covovax; Nuvaxovid; Sinopharm; Sinovac; Covaxin; Sputnik-V All travellers aged ≥12 years intending to perform or attend Hajj All countries Poliomyelitis At least one dose of IPV* or, if IPV is not available, at least one dose of OPV† is recommended All travellers Countries reporting samples positive for the cVDPV2 strain from environmental surveillance Seasonal influenza Seasonal influenza vaccine Travellers arriving to Hajj areas for Hajj or seasonal work; particularly pregnant women, children aged <5 years, adults aged ≥60 years, and individuals with chronic medical or immunosuppressive conditions (eg, malignancy and HIV/AIDS) who are receiving chemotherapy or steroids Table Mandatory and recommended vaccines for pilgrims travelling to Saudi Arabia for the June, 2024 Hajj10

To estimate and assess the prevalence and predictors of illness anxiety disorder among Saudi medical students in western Saudi Arabia. Methods: A cross-sectional study was conducted from November 2017 to March 2018 at King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia. A self-administered questionnaire was applied. The questionnaire is composed of demographic data, the short version of the Health Anxiety Inventory (SHAI), the Medical Student's Disease (MSD) perception and distress scale and history of a visit to a physician in the past 6 months. Results: Two hundred and seventy-one Saudi medical students participated; 71% were males and 53% were less than 22 years old. The participants represented all academic years, with 54% in their 4th, 5th, and 6th years. Illness anxiety disorder was identified in 17% of the participants. Younger students and those with a history of a physician's visit within the past 6 months were more likely to have illness anxiety disorder (OR=2.31, 95%  CI= 1.16, 4.60; OR=2.46, 95% CI=1.25, 4.84). Conclusions: The prevalence of illness anxiety disorder among Saudi medical students is comparable to similar recent studies. Student counseling programs highlighting coping techniques, especially during the early study years, should be implemented.

ObjectivesTo explore magnitude and factors associated with non-urgent visits to the emergency department (ED) in a tertiary care centre, western Saudi Arabia.DesignA cross-sectional study.SettingED of a tertiary care hospital in western Saudi Arabia.Participants400 patients, both men and women.InterventionsAn interview-based questionnaire was administered to a consecutive sample of patients who visited the ED during morning shifts, where primary healthcare centres (PHCs) and outpatient clinics were available.Primary outcome measureED visits classified as non-urgent versus urgent (excluding life-threatening conditions) based on the Canadian Triage and Acuity Scale (CTAS). Levels IV and V were classified as non-urgent.ResultsMajority of the cases were adult (97.3%) and half of them were women (54.8%). Non-urgent visits represented 78.5% among non-life-threatening cases. One-third of the patients (33.8%) had three visits or more to the ED during the past year. Main reasons for visiting the ED were perception that the condition was urgent (42.0%), easy access (25.5%) and limited resources and services at the PHCs (17.8%). Patients 40–50 years old were more likely to have non-urgent visits (OR=3.21, 95% CI 1.15 to 8.98). However, likelihood of non-urgent visits was significantly lower among patients with cancer (OR=0.37, 95% CI 0.19 to 0.72) and cardiovascular disease (OR=0.43, 95% CI 0.23 to 0.83), and those who live near the hospital (OR=0.49, 95% CI 0.28 to 0.88).ConclusionsThe current study reported overuse of the ED. Enhancement of the primary care services, in concordance with community awareness, is an important component to reduce burden due to non-urgent use of the ED.

Background: Assessing the effectiveness of antibiotics and communicating the problem of resistance is essential when devising antimicrobial stewardship programs in hospital settings. The drug resistance index (DRI) is a useful tool that combines antibiotic consumption and bacterial resistance into a single measure. In this study, we used the DRI to assess the impact of introducing a new antibiotic restriction form on antibiotic effectiveness for the treatment of gram-negative infections in the intensive care unit (ICU). Methods: We conducted a before-and-after intervention study from 2015 to 2017 at King Abdulaziz Medical City, a tertiary-care facility in Jeddah, Saudi Arabia. The antibiotic susceptibility of gram-negative bacteria and antibiotic prescribing rates for antibiotics indicated for gram-negative bacteria were assessed to evaluate the impact of a new antibiotic restriction form introduced in the ICU in July 2016. Changes in antibiotic effectiveness before and after the intervention were evaluated by calculating the DRI for 4 of the most common gram-negative pathogens and 8 commonly used antibiotic classes. Results: The overall DRI for the adult ICU (59.45) was higher than the hospital-wide DRI (47.96). A higher DRI was evident for carbapenems and antipseudomonal penicillins + β-lactamase inhibitors. A. baumannii had the highest DRI, followed by K. pneumoniae in both the adult ICU and hospital-wide. After implementation of antibiotic restriction in the adult ICU, the DRI for carbapenems was significantly lower in the postintervention phase, from 31.61 to 26.05 ( P = 0.031). Conclusions: DRI is a useful tool for tracking the effectiveness of antibiotics over time. The results highlight the importance of having effective antibiotic stewardship program in healthcare settings as well as regular feedback of antibiotic consumption data to the stakeholders to keep the antibiotic prescriptions in check, thereby ensuring their sustained effectiveness. Funding: None Disclosures: None

Background: Rejection, hesitancy and low uptake of the COVID-19 vaccine are major public health challenges in Saudi Arabia. Aims: To address COVID-19 vaccine hesitancy and rejection at the King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS) using evidence-based strategies. Methods: A questionnaire was administered electronically to participants at KSAU-HS to understand the reasons for vaccine hesitancy or rejection and develop an evidence-informed vaccination plan. Initial results from March 2021 showed that only 60% of respondents had taken at least 1 COVID-19 vaccine dose. Based on the results of the survey, KSAUHS designed a 6-month vaccination campaign to raise awareness about the vaccine and its importance and increase acceptability rates. Mass media, social media, and direct messaging as reminders were used to address the barriers identified and to help the university community overcome fears and misconceptions about the COVID-19 vaccine. Results: The evidence-based interventions helped achieve a significantly high vaccination rate in the university community, with 99.7% of individuals vaccinated by October 2021; one of the highest vaccination rates among public universities in Saudi Arabia. Conclusion: Evidence-based interventions targeted at specific populations can help address prevailing concerns about the COVID-19 vaccine and other similar public health issues.

ObjectivesThe present study was conducted to estimate the seroprevalence of antibody to pertussis toxin among adult populations in western Saudi Arabia.DesignA cross-sectional study.SettingKing Abdulaziz Medical City, Jeddah, western Saudi Arabia. A tertiary care teaching hospital.ParticipantsA total of 1200 participants (400 healthcare workers, 400 military recruits and 400 blood donors) were included. The majority were male (79.3%), and the mean (±SD) age was 27.2 (±6.7) years old.InterventionsThe study included the analysis of serum blood samples using commercial ELISA. A consecutive sampling technique was applied.Primary outcome measuresSeropositivity of antipertussis toxin immunoglobulin G (anti-PT IgG) ≥62.5 IU/mL.ResultsAntibody titres ≥62.5 IU/mL, indicating exposure to Bordetella pertussis infection within the last year, were identified in 12.0% (95% CI 10.2% to 14.0%) of the participants. Titres ≥125 IU/mL, suggesting recent infection, were detected in 3.5% (95% CI 2.5% to 4.7%). Seroprevalence of positive IgG antibody titres (≥62.5 IU/mL) was highest among the healthcare workers (HCWs) (14%), then the military recruits (13.5%) and blood donors (8.5%; p=0.03). The multivariate regression analysis showed association between participants group (HCWs and military), male gender and younger age (<25 years old) and higher antibody to pertussis toxin.ConclusionsHigh pertussis seropositivity was associated with participants’ occupation (ie, healthcare workers and military recruits), and anti-PT IgG titre was negatively correlated with age. A substantial deficiency in pertussis reporting in Saudi Arabia has been suggested, with potential increased risk to the most vulnerable populations (ie, infants and elderly). Enhancing the booster dose of pertussis vaccine for adolescents and adults is crucial to minimise the burden of pertussis.

HCV is a major etiological agent of liver disease with a high rate of chronic evolution. The virus possesses 6 genotypes with many subtypes. The rate of spontaneous clearance among HCV infected individuals denotes a genetic determinant factor. The current study was designed in order to estimate the rate of HCV infection and ratio of virus clearance among a group of infected patients in Saudi Arabia from 2008 to 2011. It was additionally designed to determine the genotypes of the HCV in persistently infected patients. HCV seroprevalence was conducted on a total of 15,323 individuals. Seropositive individuals were tested by Cobas AmpliPrep/Cobas TaqMan HCV assay to determine the ratio of persistently infected patients to those who showed spontaneous viral clearance. HCV genotyping on random samples from persistently infected patients were conducted based on the differences in the 5'untranslated region (5'UTR). Anti-HCV antibodies were detected in 7.3% of the totally examined sera. A high percentage of the HCV infected individuals experienced virus clearance (48.4%). HCV genotyping revealed the presence of genotypes 1 and 4, the latter represented 97.6% of the tested strains. Evidences of the widespread of the HCV genotype 4 and a high rate of HCV virus clearance were found in Saudi Arabia.

To determined the 5-year overall survival (OS) rates for adult patients with acute myeloid leukemia (AML) patients at King Abdulaziz Medical City, Jeddah, Saudi Arabia, based on cytogenetic and molecular abnormalities. Methods:  A retrospective cohort study reviewing adult AML patient files between 2011 and 2018. Sixty-three patients were excluded due to pediatric age and secondary AML. The remaining 87 adult patients with de novo AML were enrolled in this study. The most frequent cytogenetic abnormalities were t(15;17) (17.2%), followed by complex cytogenetic (13.8%) and t(8;21) (5.7%). The most frequent molecular abnormalities were promyelocytic leukemia/retinoic acid receptor alpha (PML-RARA) (16.1%) and Nucleophosmin 1 (NPM1) (11.5%). The highest OS rate was associated with t(15;17), PML-RARA, and NPM. However, complex cytogenetic was associated with the lowest OS rate; fms-like tyrosine kinase 3 (FLT3)-internal tandem duplication was independently correlated with low OS rate. Conclusion: The study describes cytogenetic and molecular abnormalities observed in adult AML patients and gives an overview of prognostic factors and determine the OS, with comparable results with recent published data by the WHO.

To investigate the epidemiological characteristics of cervical cancer cases reported at a tertiary care teaching hospital in western Saudi Arabia. A retrospective chart review was conducted on medical records of patients diagnosed with cervical cancer at King Abdulaziz Medical City, Jeddah, Saudi Arabia. Data were collected on demographic characteristics, histological types and stage, treatment modalities, and disease outcomes. Cervical cancer was diagnosed among 89 patients from 2002 to 2018. History of pap smear was reported among 31 cases (34.8%). Squamous cell carcinoma was the most common reported histopathological subtype. Almost one third (29.2%) of the patients were at stage III or IV at the time of diagnosis. The most frequent treatment regimen was combined radio/chemotherapy. Kaplan-Meier analysis showed an overall survival rate of 81.5%. The lack of an effective screening program for cervical cancer increases the likelihood of a late diagnosis and higher rates of complications and mortality. Public health programs should focus on cancer screening, screening, and reporting HPV infections, and supporting HPV vaccination activities.