Description of Candida auris Occurrence in a Tertiary Health Institution in Riyadh, Saudi Arabia.

BACKGROUND: Candida auris is an emerging multidrug-resistant fungal pathogen that represents a current serious threat to healthcare settings. OBJECTIVE: The objective was to determine the prevalence of C. auris in a Riyadh hospital since its initial detection in late 2019. METHODS: Using an adapted risk assessment tool, we reviewed the charts and medical files of all suspected and confirmed cases of C. auris infections reported at King Khalid University Hospital, Riyadh, between November 2019 and December 2022. Anonymized data were retrieved in a pre-established datasheet and analyzed to determine the epidemiological characteristics of C. auris infections in our facility. We analyzed prevalence by age, gender, risk factors, and according to sampling source. RESULTS: Of the 53 confirmed C. auris-positive cases during the study period, 33 (62%) were males. Their ages ranged between 15 and 98, with most positive cases occurring in those aged 50 and above. Only one of the confirmed cases was hospital-acquired. All patients had at least one risk factor, and urine samples yielded the greatest number of positive cases, while admission to healthcare facilities constituted the highest risk in our study. CONCLUSION: Establishing a local prevalence pattern could serve as a baseline/benchmark to compare with regional and international benchmarks.

Chemokine Levels among Patients with Middle East Respiratory Syndrome Coronavirus Infection.

Middle East respiratory syndrome coronavirus (MERS-CoV) is associated with significant morbidity and mortality due to intense pulmonary inflammation. Enhanced chemokine-mediated leukocyte infiltration in lungs has been linked with unfavorable outcomes with respect to the disease. This cross-sectional study assessed the levels of chemokines among 46 MERS-CoV-infected patients (19 asymptomatic and 27 symptomatic) and 52 healthy controls using a customized Luminex human chemokine magnetic multiplex panel. The plasma levels of interferon-inducible protein (IP)-10 (568.5 ± 114.7 vs. 55.19 ± 5.85 pg/mL; p < 0.0001), macrophage inflammatory protein (MIP)-1 alpha (MIP-1A) (30.78 ± 2.81 vs. 18.16 ± 0.91 pg/mL; p < 0.0001), MIP-1B (36.63 ± 4.25 vs. 25.26 ± 1.51 pg/mL; p < 0.003), monocyte chemoattractant protein (MCP)-1 (1267 ± 309.5 vs. 390.0 ± 35.51 pg/mL; p < 0.0002), and monokine-induced gamma interferon (MIG) (28.96 ± 3.93 vs. 16.29 ± 1.69 pg/mL; p < 0.001), interleukin (IL)-8 (147.9 ± 21.57 vs. 84.63 ± 10.62 pg/mL; p < 0.004) were significantly higher in symptomatic patients than healthy controls. Likewise, the levels of IP-10 (247.6 ± 80.09 vs. 55.19 ± 5.85 pg/mL; p < 0.0002) and MCP-1 (650.7 ± 149 pg/mL vs. 390 ± 35.51 pg/mL; p < 0.02) were also significantly higher in asymptomatic patients compared to healthy controls. However, no differences were observed in the plasma levels of MIP-1A, MIP-1B, MIG, and IL-8 between asymptomatic patients and uninfected controls. Conversely, the mean plasma levels of regulated on activation normal T cell expressed and secreted (RANTES) (3039 ± 301.0 vs. 4390 ± 223 pg/mL; p < 0.001) and eotaxin (176.9 ± 30.20 vs. 296.2 ± 28.11 pg/mL; p < 0.01) were significantly lower in symptomatic MERS-CoV-infected patients compared to healthy controls. Likewise, the levels of eotaxin (162.7 ± 21.60 vs. 296.2 ± 28.11 pg/mL; p < 0.01) were also significantly lower in asymptomatic patients. Interestingly, the level of MCP-1 (2139 ± 548.2 vs. 776.5 ± 165.3 pg/mL; p < 0.004) was significantly higher in deceased symptomatic patients compared to recovered symptomatic patients. MCP-1 was the only chemokine associated with a higher risk of mortality. Symptomatic MERS-CoV-infected patients had a significant elevation of plasma chemokines and elevated MCP-1 levels were found to be associated with fatal outcomes.

Exploring Determinants of COVID-19 Vaccine Acceptance, Uptake, and Hesitancy in the Pediatric Population: A Study of Parents and Caregivers in Saudi Arabia during the Initial Vaccination Phase.

OBJECTIVES: This study aims to assess COVID-19 vaccine acceptance, uptake, and hesitancy among parents and caregivers of children in Saudi Arabia during the initial rollout of pediatric COVID-19 vaccination. METHODS: An electronic survey was used to collect data from participants who visited a COVID-19 vaccine center. The survey included demographic data, COVID-19 vaccine status among participants and their children, and reasons for vaccine acceptance or rejection. The Vaccine Hesitancy Scale (VHS) tool was also employed to assess vaccine hesitancy and attitudes toward the COVID-19 vaccine and routine childhood vaccination. Multivariate binary regression analysis was used to identify predictors of actual COVID-19 vaccine uptake among children. RESULTS: Of the 873 respondents included in the analysis, 61.5% were parents and 38.5% were other caregivers. Of the participants, 96.9% had received the COVID-19 vaccine. Six hundred and ninety-four participants accepted the vaccine for their children, with the main reasons being an endorsement by the Saudi Ministry of Health (60%) and the importance of going back to school (55%). One hundred and seventy-nine participants would not vaccinate their children, with the most common reasons being fear of adverse effects (49%) and inadequate data about vaccine safety (48%). Factors such as age, COVID-19 vaccination status, self-rated family commitment level, attitudes toward routine children's vaccines, and participants' generalized anxiety disorder (GAD7) score did not significantly correlate with children's COVID-19 vaccination status. Parents were less likely to vaccinate their children compared to other caregivers, and participants with a higher socioeconomic status were more likely to vaccinate their children. CONCLUSION: Vaccine acceptance and uptake were high during the initial pediatric COVID-19 vaccination rollout in Saudi Arabia. Still, the ongoing endorsement of the Ministry of Health and healthcare authorities should continue to advocate for better vaccine uptake in children.

COVID-19: Factors Associated with the Psychological Distress, Fear and Resilient Coping Strategies among Community Members in Saudi Arabia.

(1) Background: COVID-19 caused the worst international public health crisis, accompanied by major global economic downturns and mass-scale job losses, which impacted the psychosocial wellbeing of the worldwide population, including Saudi Arabia. Evidence of the high-risk groups impacted by the pandemic has been non-existent in Saudi Arabia. Therefore, this study examined factors associated with psychosocial distress, fear of COVID-19 and coping strategies among the general population in Saudi Arabia. (2) Methods: A cross-sectional study was conducted in healthcare and community settings in the Saudi Arabia using an anonymous online questionnaire. The Kessler Psychological Distress Scale (K-10), Fear of COVID-19 Scale (FCV-19S) and Brief Resilient Coping Scale (BRCS) were used to assess psychological distress, fear and coping strategies, respectively. Multivariate logistic regressions were used, and an Adjusted Odds Ratio (AOR) with 95% Confidence Intervals (CIs) was reported. (3) Results: Among 803 participants, 70% (n = 556) were females, and the median age was 27 years; 35% (n = 278) were frontline or essential service workers; and 24% (n = 195) reported comorbid conditions including mental health illness. Of the respondents, 175 (21.8%) and 207 (25.8%) reported high and very high psychological distress, respectively. Factors associated with moderate to high levels of psychological distress were: youth, females, non-Saudi nationals, those experiencing a change in employment or a negative financial impact, having comorbidities, and current smoking. A high level of fear was reported by 89 participants (11.1%), and this was associated with being ex-smokers (3.72, 1.14-12.14, 0.029) and changes in employment (3.42, 1.91-6.11, 0.000). A high resilience was reported by 115 participants (14.3%), and 333 participants (41.5%) had medium resilience. Financial impact and contact with known/suspected cases (1.63, 1.12-2.38, 0.011) were associated with low, medium, to high resilient coping. (4) Conclusions: People in Saudi Arabia were at a higher risk of psychosocial distress along with medium-high resilience during the COVID-19 pandemic, warranting urgent attention from healthcare providers and policymakers to provide specific mental health support strategies for their current wellbeing and to avoid a post-pandemic mental health crisis.

Pattern of self-reported adverse events related to COVID-19 vaccines in Saudi Arabia: A nationwide study.

Background: Vaccination against coronavirus disease 2019 (COVID-19) is the most effective way to end the pandemic. Any development of adverse events (AEs) from various vaccines should be reported. We therefore aimed to explore major and minor AEs among vaccinated individuals in Saudi Arabia. Methods: This is a nationwide report based on the Saudi Arabian Ministry of Health (MOH) registry. It included those who received COVID-19 vaccines from 17th December 2020 to 31st December 2021. The study included spontaneous self-reported adverse effects to COVID-19 vaccines where the study participants used a governmental mobile app (Sehhaty) to report their AEs following vaccination using a checklist option that included a selection of side-effects. The primary outcome was to determine AEs reported within 14 days of vaccination which included injection site itching, pain, reaction, redness, swelling, anxiety, dizziness, fever, headache, hoarseness, itchiness, loss of consciousness, nausea, heartburn, sleep disruption, fatigue, seizures, anaphylaxis, shortness of breath, wheezing, swelling of lips, face, and throat, loss of consciousness, and admissions into the intensive care unit (ICU). Results: The study included a total number of 28,031 individuals who reported 71,480 adverse events (AEs); which were further classified into minor and major adverse events including ICU admissions post vaccination. Of the reported AEs, 38,309 (53. 6%) side-effects were reported following Pfizer-BioNTech, 32,223 (45%) following Oxford-AstraZeneca, and 948 (1.3%) following Moderna. The following reported AEs were statistically significant between the different vaccine types: shortness of breath\difficulty of breathing, dizziness, fever above 39°C, headache, hoarseness, injection site reactions, itchiness, nausea, sleep disruption, fatigue, wheezing, swelling of lips/face and\or throat, and loss of consciousness (p-value < 0.05). Fever and seizure were the only statistically significant AEs amongst the number of vaccine doses received (p-value < 0.05). Ten ICU admissions were reported in the 14 days observation period post-COVID-19 vaccination with the following diagnoses: acute myocardial infarction, pneumonia, atherosclerosis, acute respiratory failure, intracranial hemorrhage, grand mal seizure, Guillain-Barré syndrome, abnormal blood gas levels, and septic shock. Conclusion: This study demonstrated that the most prevalent SARS-CoV-2 vaccine side-effects among adults in Saudi Arabia were mild in nature. This information will help reduce vaccine hesitancy and encourage further mass vaccination to combat the COVID-19 pandemic, especially as booster doses are now available. Further studies are warranted to obtain a better understanding of the association between risk factors and the experiencing of side-effects post vaccination.

Impact of MERS-CoV and SARS-CoV-2 Viral Infection on Immunoglobulin-IgG Cross-Reactivity.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has posed a considerable threat to public health and global economies. SARS-CoV-2 has largely affected a vast world population and was declared a COVID-19 pandemic outbreak, with a substantial surge of SARS-CoV-2 infection affecting all aspects of the virus' natural course of infection and immunity. The cross-reactivity between the different coronaviruses is still a knowledge gap in the understanding of the SARS-CoV-2 virus. This study aimed to investigate the impact of MERS-CoV and SARS-CoV-2 viral infections on immunoglobulin-IgG cross-reactivity. Our retrospective cohort study hypothesized the possible reactivation of immunity in individuals with a history of infection to Middle East Respiratory Syndrome coronavirus (MERS-CoV) when infected with SARS-CoV-2. The total number of participants included was 34; among them, 22 (64.7%) were males, and 12 (35.29%) were females. The mean age of the participants was 40.3 ± 12.9 years. This study compared immunoglobulin (IgG) levels against SARS-CoV-2 and MERS-CoV across various groups with various histories of infection. The results showed that a reactive borderline IgG against both MERS-CoV and SARS-CoV-2 in participants with past infection to both viruses was 40% compared with 37.5% among those with past infection with MERS-CoV alone. Our study results establish that individuals infected with both SARS-CoV-2 and MERS-CoV showed higher MERS-CoV IgG levels compared with those of individuals infected previously with MERS-CoV alone and compared with those of individuals in the control. The results further highlight cross-adaptive immunity between MERS-CoV and SARS-CoV. Our study concludes that individuals with previous infections with both MERS-CoV and SARS-CoV-2 showed significantly higher MERS-CoV IgG levels compared with those of individuals infected only with MERS-CoV and compared with those of individuals in the control, suggesting cross-adaptive immunity between MERS-CoV and SARS-CoV.

Fatal Case of a Child Harboring Enterobius vermicularis.

Enterobius vermicularis is a threadlike parasite also known as "pinworms". It is the most common helminth infection, affecting the gastrointestinal tracts of children worldwide, although it seldom causes any fatalities. Enterobius vermicularis infections are usually asymptomatic and may only cause anal pruritis, with occasional reported cases of ectopic migration into the appendix or the female genital tract by adult pinworms. Here, we report a case of a 15-year-old girl who presented to the emergency department with high-grade fever, vomiting, and vague abdominal pain for three days. She was diagnosed with acute abdominal pain and underwent emergency ileocecectomy, but died the following day. Pathological examination of ileocecal junction showed intraluminal and intramural Enterobius vermicularis, which were attributed as the cause of her death in the absence of any other pathologies. Death due to Enterobius vermicularis is rare; this case calls for clinicians to be vigilant in exploring Enterobius vermicularis infections in patients with undiagnosed acute abdominal pain, since it could be a potential cause of death.

Assessment of Proinflammatory Cytokines Among Patients with Middle East Respiratory Syndrome Coronavirus Infection.

Middle East respiratory syndrome coronavirus (MERS-CoV) is associated with significant morbidity and mortality. This study was performed to assess the proinflammatory cytokines profile among MERS-CoV patients. A total of 46 MERS-CoV-infected patients (27 symptomatic and 19 asymptomatic) were assessed and compared with 52 normal healthy controls for plasma levels of interleukin (IL)-1ß, tumor necrosis factor (TNF)-α, IL-17, IL-7, IL-6, interferon (IFN)-α, and IL-15 using a customized luminex kit. Whereas asymptomatic MERS-CoV patients and controls were no different; the mean plasma levels among MERS-CoV symptomatic patients were significantly higher than the normal controls: IL-1ß (16.89 ± 1.23 vs. 12.80 ± 0.59 pg/mL; p < 0.001), TNF-α (14.04 ± 0.93 vs. 10.35 ± 0.29 pg/mL; p < 0.0001), IL-17 (14.3 ± 0.89 vs. 11.47 ± 0.61 pg/mL; p < 0.001), IL-7 (21.56 ± 1.00 vs. 16.31 ± 0.30 pg/mL; p < 0.0001), IL-6 (156.5 ± 37.90 vs. 18.60 ± 1.59 pg/mL; p < 0.0001), and IFN-α (68.73 ± 13.06 vs. 23.57 ± 1.05 pg/mL; p < 0.0001). The mean plasma levels of IL-7 (24.81 ± 1.63 vs. 19.79 ± 0.94 pg/mL; p < 0.01), IL-6 (312.7 ± 94.67 vs. 101.2 ± 25.67 pg/mL; p < 0.01), and IFN-α (89.00 ± 18.97 vs. 51.05 ± 8.68 pg/mL; p < 0.05) were significantly elevated among MERS-CoV symptomatic patients with fatal outcome compared with MERS-CoV symptomatic patients who survived. Only IL-7 was found to have a higher risk ratio of mortality (4.76, 95% confidence interval: 1.5-14.94; p < 0.01). No differences were observed in IL-15 levels among the groups. Significantly elevated proinflammatory cytokines among symptomatic MERS-CoV-infected patients may contribute to manifestations of cytokine storm frequently observed among critically ill MERS-CoV patients and IL-7 may serve as a marker for disease activity.

Mpox Perceptions and Vaccine Advocacy among the Healthcare Workers of Solid Organ Transplant Centers: A Multicenter, Cross-Sectional Survey in Saudi Arabia.

BACKGROUND: In response to the global Mpox outbreaks, this survey aimed to assess the knowledge, perceptions, and advocacy of Mpox vaccines among solid organ transplant healthcare workers (HCWs) in Saudi Arabia. METHODS: A cross-sectional survey was conducted among solid organ transplant HCWs in Saudi Arabia from 15 August to 5 September 2022. A total of 199 responses were received from participants primarily working in the kidney (54.8%) and liver (14.6%) transplant units. RESULTS: The survey found that most participants were aware of the 2022 Mpox outbreak, but the majority were more concerned about COVID-19 than Mpox. While the majority of participants thought laboratory personnel and HCWs in direct contact with Mpox patients should receive the vaccine, less than 60% believed that all HCWs should be vaccinated. Additionally, over half of the participants lacked knowledge of animal-human transmission of the virus. CONCLUSION: The results highlight the need for increased education on Mpox among transplant HCWs in Saudi Arabia, particularly regarding the virus's transmission dynamics and vaccines. This education is crucial to improve HCWs' understanding of this emerging disease, especially given their vulnerability during the COVID-19 pandemic.

Ethical uncertainty and COVID-19: exploring the lived experiences of senior physicians at a major medical centre.

Given the wide-reaching and detrimental impact of COVID-19, its strain on healthcare resources, and the urgent need for-sometimes forced-public health interventions, thorough examination of the ethical issues brought to light by the pandemic is especially warranted. This paper aims to identify some of the complex moral dilemmas faced by senior physicians at a major medical centre in Saudi Arabia, in an effort to gain a better understanding of how they navigated ethical uncertainty during a time of crisis. This qualitative study uses a semistructured interview approach and reports the findings of 16 interviews. The study finds that participants were motivated by a profession-based moral obligation to provide care during the toughest and most uncertain times of the pandemic. Although participants described significant moral dilemmas during their practice, very few identified challenges as ethical in nature, and in turn, none sought formal ethics support. Rather, participants took on the burden of resolving ethical challenges themselves-whenever possible-rationalising oft fraught decisions by likening their experiences to wartime action or by minimising attention to the moral. In capturing these accounts, this paper ultimately contemplates what moral lessons can, and must be, learnt from this experience.

Monkeypox Disease (MPOX) Perceptions among Healthcare Workers versus General Population during the First Month of the WHO Alert: Cross-Sectional Survey in Saudi Arabia.

Background: Monkeypox disease (MPOX) recently re-emerged in May 2022, causing international outbreaks in multiple non-endemic countries. This study demonstrates a novel comparison between the knowledge and perceptions of Saudi healthcare workers (HCWs) and the general public regarding MPOX. Methods: An online survey, conducted from 27 May to 5 June 2022, assessing participants' MPOX and monkeypox virus (MPV) knowledge in terms of transmission, vaccination, isolation precautions, and their attitudes toward seeking more information. Results: A total of 1546 members of the public and 1130 HCWs completed the survey. Briefly, 61.3% of the public and 74.2% of HCWs showed interest in seeking more information about MPOX. Both groups had average overall mean MPOX knowledge scores. Members of the public holding university degrees and those showing high levels of worry regarding MPOX had significantly higher knowledge scores. However, HCWs showed a poor vaccination knowledge score, while only 57% recognized that MPOX can present similarly to COVID-19 in the early stages. Female HCWs and those with high self-rated MPOX awareness had significantly high knowledge scores. HCWs in secondary and tertiary centers had significantly higher knowledge scores. Conclusion: Both groups showed a decent attitude in terms of seeking more MPOX knowledge, which correlated positively with their worry about and awareness of the disease. These observations are mostly as a consequence of the ongoing COVID-19 pandemic, which encouraged the public and HCW to acquire more information about any novel emerging disease. Policymakers should make the most of this attitude in their awareness campaigns to prevent the spread of the disease and encourage vaccination in cases where it is needed. The knowledge gaps among HCWs were most evident in terms of clinical presentation and vaccinations; this problem needs addressing if we are to avoid further emerging MPOX cases.

Differential expression of carcinoembryonic antigen-related cell adhesion molecule-5 (CEACAM5) and dipeptidyl peptidase-4 (DPP4) with detection of Middle East respiratory syndrome-coronavirus in peripheral blood.

BACKGROUND: Middle East respiratory syndrome-coronavirus (MERS-CoV) utilizes CD26 (dipeptidyl peptidase-4) and CD66e or CEACAM5 (carcinoembryonic antigen-related cell adhesion molecule 5) receptors for cell infection. Peripheral blood mononuclear cells (PBMCs) play a critical role in mounting adaptive immune response against the virus. This study was performed to assess the expression of CD26 and CD66e on PBMCs and their susceptibility to MERS-CoV infection. METHODS: Surface expression of CD26 and CD66e receptors on PBMCs from MERS-CoV patients (n = 20) and healthy controls (n = 20) was assessed by flow cytometry and the soluble forms were determined by enzyme-linked immunosorbent assay (ELISA). MERS-CoV UpE and Orf1a genes in PBMCs were detected by using Altona diagnostics reverse transcription polymerase chain reaction (RT-PCR) kit. RESULTS: Mean fluorescent intensity (MFI) of CD66e was significantly higher on CD4 + lymphocytes (462.4 ± 64.35 vs 325.1 ± 19.69; p < 0.05) and CD8 + lymphocytes (533.8 ± 55.32 vs 392.4 ± 37.73; p < 0.04) from patients with MERS-CoV infection compared to the normal controls. No difference in MFI for CD66e was observed on monocytes (381.8 ± 40.34 vs 266.8 ± 20.6; p = 0.3) between the patients and controls. Soluble form of CD66e among MERS-CoV patients was also higher than the normal controls (mean= 338.7 ± 58.75 vs 160.7 ± 29.49 ng/mL; p < 0.01). Surface expression of CD26 on PBMCs and its soluble form were no different between the groups. MERS-CoV was detected by RT-PCR in 16/20 (80%) patients from whole blood, among them 8 patients were tested in PBMCs, 4/8 (50%) patients were positive. CONCLUSION: Increased expression levels of CD66e (CEACAM5) may contribute to increased susceptibility of PBMCs to MERS-CoV infection and disease progression.

Parental perceptions and the 5C psychological antecedents of COVID-19 vaccination during the first month of omicron variant surge: A large-scale cross-sectional survey in Saudi Arabia.

Background: With the rapid surge of SARS-CoV-2 Omicron variant, we aimed to assess parents' perceptions of the COVID-19 vaccines and the psychological antecedents of vaccinations during the first month of the Omicron spread. Methods: A cross-sectional online survey in Saudi Arabia was conducted (December 20, 2021-January 7, 2022). Convenience sampling was used to invite participants through several social media platforms, including WhatsApp, Twitter, and email lists. We utilized the validated 5C Scale, which evaluates five psychological factors influencing vaccination intention and behavior: confidence, complacency, constraints, calculation, and collective responsibility. Results: Of the 1,340 respondents, 61.3% received two doses of the COVID-19 vaccine, while 35% received an additional booster dose. Fify four percentage were unwilling to vaccinate their children aged 5-11, and 57.2% were unwilling to give the additional booster vaccine to children aged 12-18. Respondents had higher scores on the construct of collective responsibility, followed by calculation, confidence, complacency, and finally constraints. Confidence in vaccines was associated with willingness to vaccinate children and positively correlated with collective responsibility (p < 0.010). Complacency about COVID-19 was associated with unwillingness to vaccinate older children (12-18 years) and with increased constraints and calculation scores (p < 0.010). While increasing constraints scores did not correlate with decreased willingness to vaccinate children (p = 0.140), they did correlate negatively with confidence and collective responsibility (p < 0.010). Conclusions: The findings demonstrate the relationship between the five antecedents of vaccination, the importance of confidence in vaccines, and a sense of collective responsibility in parents' intention to vaccinate their children. Campaigns addressing constraints and collective responsibility could help influence the public's vaccination behavior.

Not every skin rash in a returning adult male traveler is monkeypox.

In May 2022, several European countries including Spain reported cluster of monkeypox cases with no apparent travel to endemic areas. We report a suspected case of monkeypox in Saudi Arabia in a healthy 30-year-old man who returned from Spain and the Netherlands with fever and rash for six days duration during the same time period of the outbreak, he was suspected to have monkeypox but was ultimately diagnosed with chickenpox.

RT-PCR Ct values combined with age predicts invasive mechanical ventilation and mortality in hospitalized COVID-19 patients in a MERS-CoV-endemic country.

Background: Several risk factors have been used to predict severity of coronavirus disease 2019 (COVID-19), real-time reverse transcriptase polymerase chain reaction (RT-PCR) cycle threshold (Ct) values have not been included. Methods: A retrospective analysis of laboratory-confirmed COVID-19 patients who were hospitalized between March 2 and September 1, 2020, in an academic hospital in Riyadh that serves as a Middle East respiratory syndrome coronavirus (MERS-CoV) referral center was conducted. Nasopharyngeal (NP) and endotracheal (ET) samples were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by RT-PCR, and viral load (VL) was determined based on the Ct values of E genes. The Ct values were distributed into four groups, with group Ct1 (≤19) indicating the highest VL and Ct4 (≥31) indicating the lowest VL. Univariate logistic regression was used to analyze age, gender, and comorbidities in relation to Ct groups for a primary endpoint of either invasive mechanical ventilation (IMV) or mortality. Significant variables were further analyzed by multivariate logistic regression. Results: The analysis included 728 patients hospitalized with COVID-19 (38% female; median age = 53 years; 41.3% diabetic; 39.4% hypertensive). Overall, 13.6% of these patients required IMV, and the in-hospital mortality rate was 15.5%. The IMV rate was higher in the Ct1 and Ct2 groups (15.2% and 15.5%, respectively) than in the Ct4 group (6.4%; p = 0.01). The mortality rate was also higher in the Ct1 and Ct2 groups (19.4% and 18.9%, respectively) than in the Ct4 group (8.9%; p = 0.02). The univariate analysis showed that lower Ct values and increasing age were associated with an increased risk of IMV (OR: 1.03; 95% CI: 1.01, 1.04; P < 0.0001) and mortality (OR: 1.04; 95% CI: 1.03, 1.06; P < 0.0001). The multivariate analysis showed that Ct1 was associated with the highest risk of mortality (OR: 2.29; 95% CI: 1.16, 5.52; P = 0.016), while Ct2 was associated with the highest risk of IMV (OR: 3.1; 95% CI: 1.47, 6.53; P = 0.003). Conclusion: The SARS-CoV-2 RT-PCR Ct values of hospitalized COVID-19 patients can be used as predictors of IMV and mortality, and this effect increases when combined with age. Clinicians could use these predictors to triage older patients for risk stratification and allocate IMV.

Healthcare Workers' Worries and Monkeypox Vaccine Advocacy during the First Month of the WHO Monkeypox Alert: Cross-Sectional Survey in Saudi Arabia.

Background: Monkeypox virus re-surged in May 2022 as a new potential global health threat, with outbreaks bursting in multiple countries across different continents. This study was conducted in Saudi Arabia during the first month following the WHO announcement of the Monkeypox outbreak, to assess healthcare workers (HCWs) perceptions of, worries concerning, and vaccine acceptance for, Monkeypox, in light of the resolving COVID-19 pandemic. Methods: A national cross-sectional survey was conducted between 27 May and 10 June 2022, in Saudi Arabia. Data were collected on: HCWs' sociodemographic and job-related characteristics; COVID-19 infection status; and worries concerning Monkeypox, compared to COVID-19 and its sources; as well as their perceptions and awareness of, and advocacy for, supporting Monkeypox vaccination. Results: A total of 1130 HCWs completed the survey, of which 41.6% have already developed COVID-19. However, 56.5% were more concerned about COVID-19 compared to Monkeypox, while the rest were more worried about Monkeypox disease. The main cause for concern among 68.8% of the participants was the development of another worldwide pandemic, post-COVID-19, followed by their concern of either themselves or their families contracting the infection (49.6%). Most HCWs (60%) rated their level of self-awareness of Monkeypox disease as moderate to high. Males, and those who had previously developed COVID-19, were significantly less likely to worry about Monkeypox. The worry about Monkeypox developing into a pandemic, and the perception of Monkeypox being a severe disease, correlated significantly positively with the odds of high worry concerning the disease. The major predictors of participants' advocacy for vaccination against Monkeypox disease were: those who had developed COVID-19 previously; and those who supported tighter infection control measures (than those currently used) to combat the disease. A total of 74.2% of the surveyed HCWs perceived that they needed to read more about Monkeypox disease. Conclusions: Approximately half of the HCWs in this study were more concerned about Monkeypox disease than COVID-19, particularly regarding its possible progression into a new pandemic, during the first month following the WHO's Monkeypox international alert. In addition, the majority of participants were in favor of applying tighter infection prevention measures to combat the disease. The current study highlights areas requiring attention for healthcare administrators regarding HCWs' perceptions and preparedness for Monkeypox, especially in the event of a local or international pandemic.

Monkeypox caused less worry than COVID-19 among the general population during the first month of the WHO Monkeypox alert: Experience from Saudi Arabia.

BACKGROUND: Monkeypox re-emerged in May 2022 as another global health threat. This study assessed the public's perception, worries, and vaccine acceptance for Monkeypox and COVID-19 during the first month of WHO announcement. METHODS: A large-scale, cross-sectional survey was conducted between May 27 and June 5, 2022, in Saudi Arabia. Data were collected on sociodemographic characteristics, previous infection with COVID-19, worry levels regarding Monkeypox compared to COVID-19, awareness, and perceptions of Monkeypox, and vaccine acceptance. RESULTS: Among the 1546 participants, most respondents (62%) were more worried about COVID-19 than Monkeypox. Respondents aged 45 years and above and those with a university degree or higher had lower odds of agreement with Monkeypox vaccination (OR 0.871, p-value 0.006, OR 0.719, p-value <0.001), respectively. Respondents with moderate to a high level of self and family commitment to infection control precautionary measures and those who expressed self and family worry of Monkeypox infection had significantly higher odds of vaccination agreement (OR 1.089 p-value = 0.047, OR1.395 p-value = 0.003) respectively. On the other hand, respondents who previously developed COVID-19 were significantly more worried about the Monkeypox disease (1.30 times more, p-value = 0.020). CONCLUSION: Worry levels amongst the public are higher from COVID-19 than Monkeypox. Perception of Monkeypox as a dangerous and virulent disease, worry from contracting the disease, and high commitment to infection precautionary measures were predictors of agreement with Monkeypox vaccination. While advanced age and high education level are predictors of low agreement with vaccination.

SARS-CoV-2 variants and the global pandemic challenged by vaccine uptake during the emergence of the Delta variant: A national survey seeking vaccine hesitancy causes.

BACKGROUND: Herd immunity for COVID-19 is the ultimate goal to end the pandemic. Emergence of SARS-CoV-2 variants has been a subject of considerable debate regarding vaccines effectiveness. This ongoing discussion and other evolving variables contribute to the hesitancy toward vaccines and levels of vaccination acceptance among both the healthcare workers and the public. This study was conducted to assess COVID-19 vaccine uptake and hesitancy among the Saudi Arabian population during the emergence of SARS-CoV-2 Delta variant. METHODS: A national cross-sectional survey conducted between June 28 and July 5, 2021. The survey collected sociodemographic information, personal and family history of previous COVID-19 infection, adherence to precautionary measures, COVID-19 vaccination status, parental willingness to vaccinate their teenage children, and address variable associated with hesitancy to receive vaccination. RESULTS: Among the 4071 participants, 67 % were women, 86 % of the participants received COVID-19 vaccine, 70 % had very high or high commitment with COVID-19 precautionary measures. On multivariate analysis, vaccine hesitancy was less likely in men (OR 0.652, p-value < 0.001), those who had direct family members infected with COVID-19 (OR 0.455, p-value < 0.001), and those who reported using the Ministry of Health official channels as information sources (OR 0.522, p-value < 0.001), while those younger than 44 years had higher hesitancy to receive the vaccine (1.5-2.1 times). Of the participants, only 42 % showed willingness to vaccinate their teenage (12-18 years old) children. CONCLUSIONS: The participants in this study had high COVID-19 vaccination rate; however, hesitancy was reported more commonly among women. Their willingness to vaccinate their teenage children was much lower. Participants relying on social media platforms were highly hesitant to receive vaccination. Public health officials should scale up their efforts targeting females, young population, and parents by vaccination awareness campaigns, and refute misinformation spread on social media, especially with the emergence of variants and the news burst that coincide with them.