Adverse drug reactions from two COVID-19 vaccines reported in Saudi Arabia.

Background: Several reports have been published about the impact of coronavirus disease 2019 (COVID-19) vaccines on human health, and each vaccine has a different safety and efficacy profile. The aim of this study was to reveal the nature and classification of reported adverse drug reactions (ADRs) of the two COVID-19 vaccines (tozinameran and ChAdOx1) among citizens and residents living in Saudi Arabia, and show possible differences between the two vaccines and the differences between each batch on the health of populations. Methods: A cross-sectional study was conducted in Saudi Arabia between December 2020 and March 2021. Saudi citizens and residents aged ≥ 16 years who had at least one dose of any batch of either of the two approved COVID-19 vaccines (tozinameran and ChAdOx1) and who reported at least one ADR from the vaccines were included. The study excluded people who reported ADRs after receiving tozinameran or ChAdOx1 vaccines but no information was provided about the vaccine's batch number. Results: During the study period, 12,868 vaccinated people, including a high-risk group (i.e., those with chronic illness or pregnant women), reported COVID-19 vaccine ADRs that had been documented in the General Directorate of Medical Consultations, Saudi Ministry of Health. The study reported several ADRs associated with COVID-19 vaccines, with the most common (> 25%) being fever/chills, general pain/weakness, headache, and injection site reactions. Among healthy and high-risk people, the median onset of all reported ADRs for tozinameran and ChAdOx1 vaccine batches were 1.96 and 1.64 days, respectively (p < 0.01). Furthermore, significant differences (p < 0.05) were recorded between the two studied vaccines in regard to fever/chills, gastrointestinal symptoms, headache, general pain/weakness, and neurological symptoms, with higher incidence rates of these ADRs observed with the ChAdOx1 vaccine than the tozinameran vaccine. However, the tozinameran vaccine was found to cause significantly (p < 0.05) more palpitation, blood pressure variations, upper respiratory tract symptoms, lymph node swelling, and other unspecified ADRs than the ChAdOx1 vaccine. Among patients vaccinated with seven different batches of the tozinameran vaccine, people vaccinated with the T4 and T5 batches reported the most ADRs. Conclusion: There were significant differences regarding most of the reported ADRs and their onset among tozinameran and ChAdOx1 vaccines on both healthy people and high-risk individuals living in Saudi Arabia. Moreover, the study found that the frequencies of most listed ADRs were statistically different when seven batches of tozinameran vaccine were compared.

Analysis of patients' complaints in primary healthcare centres through the Mawid appl in Riyadh, Saudi Arabia; a cross-sectional study.

Introduction: The Saudi Ministry of Health launched a central appointment mobile application system (Mawid) that is linked to all primary healthcare (PHC) centres in the kingdom. The application allows patients to evaluate the healthcare services they receive. This study aimed to determine the frequency and nature of the complaints of patients visiting PHC centres through the Mawid application. Method: This cross-sectional study was conducted using 3-month secondary data from the Mawid application. The study included 3134 comments from 380,493 patients who visited 38 PHC centres in Riyadh and responded to the Mawid application evaluation questionnaire. Data were analysed using SPSS version 21. Results: Approximately 59.1% of the patients' comments were negative (patients' complaints); only 19%, positive; 8.40%, mixed; and 13.6%, unrelated. The patients' complaints (n=2969) were obtained from 380,493 patients within 3 months, yielding a complaint rate of 2.6 per 1000 attendances per month. The majority of the complaints (79.3%) were from patients visiting nonspecialised PHC centres. Approximately 59.1% of the complaints fell under the management domain; 23.6%, patient-staff relationship domain; and only 17.2%, clinical domain. Conclusion: Management and interpersonal problems constituted the main patients' complaints in the PHC centres in Saudi Arabia. Therefore, future studies must clarify the reasons contributing to these complaints. Increasing the number of physicians, providing staff training and continuous auditing are mandatory to improve patients' experiences in PHC centres.

The effectiveness of single and two-dose Pfizer-BioNTech vaccine against SARS-COV-2: A real-world evidence from Saudi Arabia.

BACKGROUND: Several studies proved the effectiveness of Severe Acute Respiratory Syndrome Corona Virus (SARS-CoV-2) vaccines; however, the number of doses and the period between doses that warrant the highest protection remain unclear. This study aims to assess the effectiveness of the Pfizer-BioNTech vaccine and to evaluate the effectiveness of early and delayed second-dose administration of the vaccine. METHODS: This is a retrospective cohort study that was conducted using the data from March 1st, 2021, to August 31st, 2021. Data regarding vaccination coverage and confirmed SARS-CoV-2 infection were obtained using academic hospitals databases and Health Electronic Surveillance Network (HESN) platform. The vaccination status of the participants were categorized as: unvaccinated, vaccinated 1st dose, and vaccinated 2nd dose of Pfizer-BioNTech vaccine. The outcome of interest was positive polymerase chain reaction test for SARS-CoV-2. Generalized linear model with a Poisson distribution was used to estimate the incidence of the infection. FINDINGS: Among 66,775 participants included, 2615 SARS-CoV-2 infections were observed. The sample was relatively young with median age of 22 years and 43% female. A single dose of Pfizer-BioNTech vaccine had 40 % effectiveness. The effectiveness of the vaccine was doubled after the second dose of Pfizer-BioNTech (80 %). The time between the first and the second dose appears to be crucial after observing 75 %, 90 % and 85 % effectiveness with early vaccination, on-time vaccination, and delayed vaccination, respectively. CONCLUSION: For Pfizer-BioNTech vaccine recipients in Saudi Arabia, particularly among a predominantly young population, higher effectiveness against SARS-CoV-2 was observed with two doses of the vaccine. The timing of the second dose appears crucial for the extent of protection against SARS-CoV-2. However, potential residual confounding cannot be discounted, and further studies are needed to validate these findings and improve generalizability.

Post-COVID-19 syndrome: nature of symptoms and associated factors.

Aim: Post-COVID-19 syndrome is defined as continuous symptoms related to SARS-CoV-2 infection, which can persist for several weeks or months. Previous studies identified risk factors associated with post-COVID-19 syndrome, including female sex, hypertension, and allergic respiratory diseases. This study aims to investigate the frequency of this syndrome among Arabic patients. Subject and methods: A cross-sectional study was conducted from March to August 2022. The study included 520 Arabic patients with confirmed COVID-19 diagnosis, who were asked about possible symptoms persisting for ≥28 days. Results: Twenty-five percent (25%) of the included patients developed post-COVID-19 syndrome. The most common recorded symptoms were cough (32%), anosmia (32%), fatigue (28%), headache (19%), muscle pain (19%), and shortness of breath (17%). It was found that female sex, hospitalization due to initial COVID-19 infection, and the presence of chronic diseases were significant risk factors for developing post-COVID-19 syndrome. Conclusion: The study recorded post-COVID-19 syndrome among 25% of Arabic participants. Initial COVID-19 hospitalization, initial symptomatic COVID-19, and female sex were significant risk factors for developing post-COVID-19 syndrome. Supplementary Information: The online version contains supplementary material available at 10.1007/s10389-022-01802-3.

Quality of life among schoolchildren with type 1 diabetes mellitus and the satisfaction of their guardians towards school health care in Saudi Arabia.

AIMS: This study aimed to assess the quality of life of schoolchildren with type 1 diabetes mellitus (T1DM) and determine their guardians' satisfaction of diabetes health care in Saudi Arabian schools. METHODS: A cross-section multicenter study was conducted from February to July 2022 among Schoolchildren with T1DM in Saudi Arabia. The study included T1DM school children aged 6-18 years. The patients' health-related quality of life (HRQoL) data were collected and determined using a modified version of the PedsQL 3.0 Diabetes Module. RESULTS: The grand total median PedQL-DM score among the included participants (N = 283) was 64.7, while items related to diabetes symptoms and diabetes management were 61.1 and 68.7, respectively. Schoolchildren who have lower HbA1c levels and take care of regular monitoring of their blood glucose showed significantly better quality of life concerning diabetes symptoms. A significant number of guardians claimed they were not satisfied with the current status of diabetes management at schools. CONCLUSIONS: The overall HRQoL among schoolchildren with T1DM was average and acceptable to some extent. The PedsQL-DM median score was higher among those who received health care during school time. The guardians' satisfaction of diabetes health care was low, emphasizing the role of health clinics in schools.

Does ChAdOx1-S and BNT162b2 heterologous prime-boost vaccination trigger higher rates of vaccine-related adverse events?

Background: There has been significant international interest in heterologous prime-boost COVID-19 vaccination. However, it is linked with different intensity and frequency of adverse events. This study aimed to assess the safety of ChAdOx1-S and BNT162b2 vaccines when given as heterologous prime-boost vaccination in Saudi Arabia. Methods: A cross-sectional study was conducted during the period October 2021 to March 2022. The study included two groups of people based on the type of vaccination regimen. The first group (heterologous) was subjected to different prime-boost vaccination schedules irrespective of the prime and boost vaccine types. The second group included people vaccinated with the same type of COVID-19 vaccine (homologous). Results: The overall sample included 334 participants. Those included in the heterologous group were at about 1.5 fold -increased risk for developing local and systemic adverse events compared to the homologous group. Fever, headache, and vomiting were significantly more frequent among the heterologous group compared to the homologous group (p-value<0.05). In both groups, more than half of the recorded adverse events were mild/moderate in severity. Conclusion: Heterologous prime-post vaccination is associated with a slightly increased risk for the development of local and systemic adverse events compared to the homologous regimen. However, most of these adverse events are mild/moderate in nature and recede within two days with no serious adverse events documented.

The role of telemedicine services in changing users' intentions for presenting to the emergency departments in Saudi Arabia.

Background: Emergency department (ED) overcrowding is described as one of the main issues in any hospital. In Saudi Arabia, the ministry of health applied new telemedicine technology to serve patients by using the mobile application, including the Sehha application and 937 medical call center. The main aim of this study is to determine the role of different telemedicine services in changing the intention users' intentions for visiting the emergency departments in Saudi Arabia. Methods: A cross-sectional study was conducted during August 2020 to May 2021 among 319 patients using two telemedicine services in Saudi Arabia, including the medical call center and Sehha smartphone application. The primary endpoint of this study was to determine the number of patients intended to visit ER before and after contacting one of the two telemedicine services and the frequency of people who changed their opinion to visit an ED. Results: This study analyzed the data from 319 patients who completed the survey provided by the Saudi Ministry of Health concerning information related to their health status and ED visits. Among patients that had the intention to visit the ED (N = 159), 53 of them did not go to EDs after using telemedicine services (p < 0.01). Regarding the medical call center and Sehha application, 9.6% and 24.4%, respectively, of the patients who used these telemedicine services changed their minds concerning visiting ED after taking the medical advice (p < 0.01). Conclusions: The implemented telemedicine services in Saudi Arabia, namely the Sehha application and medical call center, could reduce those intended to visit ED and consequently reduce the overload of EDs by providing medical advice to patients concerning their minor medical issues.

Adverse events following administration of COVID-19 vaccines in Saudi Arabia.

Previous studies investigated the frequency of different adverse events of COVID-19 vaccines. However, this study compares these adverse events between the two main COVID-19 vaccines used in Saudi Arabia (Pfizer-BioNTech and Oxford-AstraZeneca) using telemedicine technology. A cross-sectional study was conducted among 958 individuals, 7 days after receiving either Pfizer-BioNTech or Oxford-AstraZeneca vaccines during June 2021. Immediate adverse events were reported by 1.04% and 2.09% for Pfizer-BioNTech and Oxford-AstraZeneca vaccines, respectively, with no serious events. Recipients of Pfizer-BioNTech vaccine had a higher percentage of local adverse events (24.8% versus 9.8% in AstraZeneca vaccine). The most common reported systemic adverse events in both vaccines respectively were general fatigue (23.1% and 25.1%), fever (18.5% and 27.2%), myalgia (20.6% and 20.3%), and headache (15.2% and 17.2%). No significant difference was recorded between both vaccines regarding overall systemic adverse events; however, they were more frequent following the first dose of AstraZeneca vaccine compared to Pfizer-BioNTech vaccine, while the reverse was observed for the second dose. Adverse events were more frequent in females and younger age groups for both vaccines. Most of systemic and local adverse events were mild in nature. Further cohort studies are recommended to investigate the long-term adverse events of COVID-19 vaccines.

COVID-19 vaccine acceptance: knowledge and beliefs.

Backgrounds: Vaccine acceptance varies across countries, generations, and the perceived personality of individuals. Investigating the knowledge, beliefs, and acceptability of COVID-19 vaccines among individuals is vital to ensuring adequate health system capacity and procedures and promoting the uptake of the vaccines. Results: A cross-sectional study was conducted from August 2021 to January 2022 in Saudi Arabia. The study included 281 residents to estimate their acceptance to receive COVID-19 vaccination. Around 70% of the included participants had a moderate to high COVID-19 vaccine acceptance rate during the data collection period. The risk increases to about two folds among undergraduates [OR 1.846 (1.034-3.296), p value = 0.036)] and increases to four folds among non-employed [OR 3.944 (2.310-6.737), p value = 0.001]. About 78% of participants with high and 44% with low COVID-19 vaccine acceptance (p value = 0.001) believed the vaccines were safe and effective. The belief that COVID-19 disease will be controlled within two years increased the risk for low vaccine acceptance by about two folds [OR 1.730 (1.035-2.891), p value = 0.035]. Good knowledge about COVID-19 vaccination significantly affected the acceptance rate (p value = 0.001). Conclusions: Several factors affect the intention of individuals to receive vaccines. Therefore, building good knowledge and health literacy through educational intervention programs, especially vaccine safety and effectiveness, is important for successful vaccination campaigns among the general population and ensuring control of the COVID-19 pandemic.

Protective Duration of ChAdOx1 and BNT162b2 Vaccines Against SARS-CoV-2 Infection.

BACKGROUND AND OBJECTIVE: A limited number of studies have addressed the protective duration of coronavirus disease 2019 (COVID-19) vaccines following primary and booster doses in Saudi Arabia. Therefore, this study aimed to evaluate the protective duration of primary and booster doses of BNT162b2 and ChAdOx1 COVID-19 vaccine batches in Saudi Arabia. METHODS: A cross-sectional study was conducted from 1 January to 31 December, 2021. The study included 53,354 people infected with severe acute respiratory syndrome coronavirus-2 2 weeks or more after receiving at least a primary vaccination of either the ChAdOx1 or BNT162b2 vaccine. RESULTS: The total median protective duration of both primary COVID-19 vaccinations was 134 days. Heterologous primary vaccination (ChAdOx1 followed by BNT162b2) showed a significantly higher median protective duration of 142 days. The results show that the total median protective duration of the first booster doses of COVID-19 vaccines was 57 days. ChAdOx1 batch code C1 was found to have the most extended protective duration of 173 days (range 163-192 days). CONCLUSIONS: The current study revealed that the median protective duration of ChAdOx1 and BNT162b2 COVID-19 primary vaccination regimens administered in Saudi Arabia in 2021 was 134 days and that heterologous primary vaccination (ChAdOx1→BNT162b2) exhibited a significantly higher protective duration than other vaccination regimens.

Community-Based Seroprevelance of SARS-CoV-2 in Saudi Arabia.

Introduction  The new coronavirus disease 2019 (COVID-19) is a major global concern. Due to the number of asymptomatic cases that go untested, the actual proportion of those who have been infected is likely to be higher than the reported prevalence. Thus, investigating the exact proportion of those who developed antibodies against the virus through serological surveys is crucial to identify the immune status of the population and direct public health decisions accordingly. Objectives The aim of this study is to estimate the seroprevalence of SARS-CoV-2 in the community and to describe the epidemiological characteristics of the discovered cases. Methods Between July and October 2020, a cross-sectional sero-survey was conducted including a total of 15,873 serum samples collected from seven regions within the kingdom. Using a multistage convenient sampling, people were invited to participate in an interviewer-administrated questionnaire. Afterward, blood samples were collected and seroprevalence was determined using the SARS-CoV-2 virus IgG/IgM antibody detection kits (ELISA). A p-value of <0.05 and 95% CI were used to report the significance. Results The overall seroprevalence of SARS-CoV-2 in the sample was 17.0%, and Makkah region constituted the highest number of reactive cases (33.3%). There was a significant association between all comorbidities and having symptoms except for diabetes. In addition, age, education, nationality, and region were all significant predeterminants of sero-result. Also, contact with a confirmed or suspected case increased the risk of being seropositive by nearly 1.5 times. Conclusion This study estimated the national seroprevalence of SARS-CoV-2 in Saudi Arabia to be 17%. At the time of this study, most of the population did not have the SARS-CoV-2 specific antibodies. This suggests that the population is still below the threshold of herd immunity and emphasizes the importance of mass vaccination programs and abiding by recommended prevention precautions.

Demographic Characteristics and Status of Vaccinated Individuals with a History of COVID-19 Infection Pre- or Post-Vaccination: A Descriptive Study of a Nationally Representative Sample in Saudi Arabia.

BACKGROUND: Saudi Arabia expedited the approval of some COVID-19 vaccines and launched mass vaccination campaigns. The aim of this study was to describe the demographics of vaccinated COVID-19 cases and compare the mortality rates of COVID-19 cases who were infected post-vaccination in Saudi Arabia. METHODS: This was a retrospective cohort study. We retrieved data for COVID-19 cases who were infected pre- or post-vaccination and had received at least one injection of the Oxford-AstraZeneca or Pfizer-BioNTech vaccine from 4 December 2020 to 15 October 2021. RESULTS: The number of patients who were infected and had received at least one dose of a COVID-19 vaccine was 281,744. Approximately 45% of subjects were infected post-vaccination, and 75% of subjects had received the Pfizer-BioNTech vaccine. Only 0.342% of the patients who were infected post-vaccination died, and 447 patients were admitted to ICUs. Most of the patients who were infected with COVID-19 post-vaccination and were admitted to ICUs (69.84%) had received only one dose of the vaccine (p < 0.0001). The mean time to infection for patients who had received one and two doses of the Oxford-AstraZeneca vaccine were 27 and 8 days longer than their counterparts who had received one and two doses of Pfizer-BioNTech vaccine, respectively. No difference in the odds of mortality between the Pfizer-BioNTech and Oxford-AstraZeneca vaccines was found (OR = 1.121, 95% CI = [0.907-1.386], p-value = 0.291). Patients who had received two doses of the vaccine had significantly lower odds of mortality compared to those who had received one dose (p < 0.0001). CONCLUSIONS: Vaccines are vital in combating the COVID-19 pandemic. The results of this study show no difference between the Pfizer-BioNTech and Oxford-AstraZeneca vaccines in the rate of mortality. However, the number of vaccine doses was significantly associated with a lower risk of mortality. Future studies should examine the effectiveness of different COVID-19 vaccines using real-world data and more robust designs.

Efficacy of favipiravir in adults with mild COVID-19: a randomized, double-blind, multicentre, placebo-controlled clinical trial.

OBJECTIVE: To evaluate whether favipiravir reduces the time to viral clearance as documented by negative RT-PCR results for severe acute respiratory syndrome coronavirus 2 in mild cases of coronavirus disease 2019 (COVID-19) compared to placebo. METHODS: In this randomized, double-blinded, multicentre, and placebo-controlled trial, adults with PCR-confirmed mild COVID-19 were recruited in an outpatient setting at seven medical facilities across Saudi Arabia. Participants were randomized in a 1:1 ratio to receive either favipiravir 1800 mg by mouth twice daily on day 1 followed by 800 mg twice daily (n = 112) or a matching placebo (n = 119) for a total of 5 to 7 days. The primary outcome was the effect of favipiravir on reducing the time to viral clearance (by PCR test) within 15 days of starting the treatment compared to the placebo group. The trial included the following secondary outcomes: symptom resolution, hospitalization, intensive care unit admissions, adverse events, and 28-day mortality. RESULTS: Two hundred thirty-one patients were randomized and began the study (median age, 37 years; interquartile range (IQR): 32-44 years; 155 [67%] male), and 112 (48.5%) were assigned to the treatment group and 119 (51.5%) into the placebo group. The data and safety monitoring board recommended stopping enrolment because of futility at the interim analysis. The median time to viral clearance was 10 days (IQR: 6-12 days) in the favipiravir group and 8 days (IQR: 6-12 days) in the placebo group, with a hazard ratio of 0.87 for the favipiravir group (95% CI 0.571-1.326; p = 0.51). The median time to clinical recovery was 7 days (IQR: 4-11 days) in the favipiravir group and 7 days (IQR: 5-10 days) in the placebo group. There was no difference between the two groups in the secondary outcome of hospital admission. There were no drug-related severe adverse events. CONCLUSION: In this clinical trial, favipiravir therapy in mild COVID-19 patients did not reduce the time to viral clearance within 15 days of starting the treatment.

Factors Affecting COVID-19 Vaccination among the General Population in Saudi Arabia.

Vaccine refusal or hesitancy is one of the significant issues that can have an adverse impact on people's health and their countries' economy. Additionally, vaccine acceptance or refusal could have a decisive role in controlling the COVID-19 pandemic. This study aims to investigate the factors affecting COVID-19 vaccine refusal and hesitancy among the general population in Saudi Arabia. The method is a cross-sectional survey using an online questionnaire, and data were collected from 1935 participants between 18 February 2021 and 1 April 2021. Out of 1935 participants aged ≥18 years and residing in Saudi Arabia, 46.9% reported their intention to receive the COVID-19 vaccine, 22.4% had received the vaccine, 9.5% did not intend to receive the vaccine, and 21.2% had not made their decision. In the multinomial logistic regression models, vaccine refusal was associated with age (OR: 0.961), nationality (OR: 0.182), monthly income of more than SAR 18,000 (OR: 2.325), chronic diseases (OR: 0.521), knowledge about the vaccine (OR: 0.937), and concerns about the vaccine (OR: 1.5). The hesitancy was associated with age (OR: 0.977), nationality (OR: 0.231), monthly income between SAR 6000 to 12,000 (OR: 0.607), chronic diseases (OR: 0.640), knowledge about the vaccine (OR: 0.907), and concerns about the vaccine (OR: 1.3). The main concerns about the vaccine were "COVID-19 vaccines are not tested enough on people", "drug companies are interested in COVID-19 vaccine sales only", and "COVID-19 vaccines have serious adverse effects". Awareness programs and vaccination campaigns should consider people's concerns and correct their misinformation.

Knowledge, beliefs, and acceptability of people toward new COVID-19 vaccines: a pilot study.

A cross-section pilot study was done to determine the knowledge and belief toward new COVID-19 vaccines among a small sample size group of people. A new Vaccine Acceptability Questionnaire (VAQ) consists of 31 questions that were concerned about three elements: underlying factors, knowledge, and beliefs. The study included 96 people from the different regions of Saudi Arabia who had accepted to participate in this pilot study. Around 31% of the included people had low to very low acceptability toward COVID-19 vaccines; however, the other 69% had moderate to high acceptability. The new simple designed questionnaire (VAQ) could be effective in assessing knowledge, beliefs, and acceptability toward COVID-19 vaccination among a specific group of population.

Onsite Versus Remote Working: The Impact on Satisfaction, Productivity, and Performance of Medical Call Center Workers.

Job satisfaction is determined as the measure to know the individuals' feelings toward their work. The working conditions that can affect satisfaction and performance of the call center agents have received particular concern. This study aimed to determine the role of remote call center working on agents' satisfaction compared to onsite workers. A cross-section study was conducted between December 2020 and April 2021 that include 124 agents working in a governmental medical call center in Saudi Arabia. Each agent was receiving a questionnaire that investigates his/her satisfaction with the job nature, supervisor support, job autonomy, job productivity, and performance. Seventy-seven physicians working onsite were compared to forty-seven physicians remotely working in the medical call center. The mean age of the physicians included was 43.17 ± 8.4 years, and most of them were male (>70%), married (>85%), and family medicine specialists (>50%). The mean years of experience in the medical field of the physicians included was 16.87 ± 8.07 years, and the mean years of experience in the medical call center was 1.44 ± .97 years. Onsite agents were more satisfied concerning job nature, supervisor support, productivity, and performance compared to remote agents (70.82 vs 53.47%, 63.38 vs 55.05%, and 66.51 vs 56.03%, respectively). However, onsite agents were less satisfied regarding job autonomy than remote physicians (46.81 vs 53.19%, P-value = .128). Overall, general satisfaction was more seen in physicians working onsite as opposed to remote workers in the medical call center in Saudi Arabia (64.90 vs 54.25%, P-value < .01).

Prevalence of Health Problems Targeted by the National School-Based Screening Program among Primary School Students in Saudi Arabia, 2019.

The Saudi Ministry of Health (MOH) established a National School-Based Screening Program (NSBSP) for health screening of schoolchildren. Students from specific grades were systematically screened for several health problems, including obesity, visual and auditory problems, dental cavities, scoliosis, and attention-deficit/hyperactivity disorder (ADHD). This cross-sectional study aimed to determine the prevalence of these health problems among primary school students based on secondary data obtained from the NSBSP. We included 444,259 screened school children from the first and fourth grades of 50% of the selected schools (both private and public) across the Kingdom of Saudi Arabia (KSA) during the academic year 2018-2019. Among them, the most prevalent health problems identified were dental cavities (38.7%), eye refractory errors (10.9%), and overweight and obesity (10.5%); the less prevalent problems included ADHD (2.81%), auditory problems (0.6%), and scoliosis (0.48%). A greater prevalence of most health problems was observed in girls more than boys. The NSBSP successfully aided the detection of health conditions with high and low prevalence among primary school students in the KSA, and thus, the identification of health problems of specific concern. Implementation of effective school health services for the prevention, early detection, diagnosis, and treatment of these health problems are imperative.

Hydroxychloroquine Safety Outcome within Approved Therapeutic Protocol for COVID-19 Outpatients in Saudi Arabia.

BACKGROUND: Global healthcare is challenged following the COVID-19 pandemic, since late 2019. Multiple approaches have been performed to relieve the pressure and support existing healthcare. The Saudi Arabian Ministry of Health (MOH) launched an initiative to support the National Healthcare System. Since the 5th of June 2020, 238 outpatient fever clinics were established nationwide. This study aimed to assess the safety outcome and reported adverse events from hydroxychloroquine use among suspected COVID-19 patients. METHOD: A cross-sectional study included 2,733 patients subjected to MOH treatment protocol (hydroxychloroquine) and followed-up within 3-7 days after initiation. Data was collected through an electronic link and cross-checked with the national database (Health Electronic Surveillance Network, HESN) and reports from the MOH Morbidity and Mortality (M&M) Committee. RESULTS: 240 patients (8.8%) discontinued treatment because of side effects (4.1%) and for non-clinical reasons in the remaining (4.7%). Adverse effects were reported among (6.7%) of all studied participants, including mainly cardiovascular (2.5%, 0.15% with QTc prolongation), and gastrointestinal (2.4%). No Intensive Care Unit admission or death were reported among these patients. CONCLUSION: Our results show that hydroxychloroquine for COVID-19 patients in mild to moderate cases in an outpatient setting, within the protocol recommendation and inclusion/exclusion criteria, is safe, highly tolerable, and with minimum side effects.

Seroprevalence of antibodies to SARS-CoV-2 among blood donors in the early months of the pandemic in Saudi Arabia.

BACKGROUND: Serologic testing provides better understanding of SARS-CoV-2 prevalence and its transmission. This study was an investigation of the prevalence of antibodies to SARS-CoV-2 among blood donors in Saudi Arabia. OBJECTIVE: To estimate the seroprevalence of anti-SARS-CoV-2 antibodies among blood donors in Saudi Arabia during the early phase of the COVID-19 pandemic. METHODS: Serology results and epidemiological data were analyzed for 837 adult blood donors, with no confirmed SARS-CoV-2 infection, in Saudi Arabia from 20th to 25th May 2020. Seroprevalence was determined using electrochemical immunoassay to detect anti-SARS-CoV-2 antibodies. RESULTS: The overall seroprevalence of anti-SARS-CoV-2 antibodies was 1.4% (12/837). Non-citizens had higher seroprevalence compared with citizens (OR 13.6, p = 0.001). Secondary education was significantly associated with higher seroprevalence compared with higher education (OR 6.8, p = 0.005). The data showed that the highest seroprevalence was in Makkah (8.1%). Uisng Makkah seroprevalence as the reference, the seroprevalence in other areas was: Madinah 4.1% (OR 0.48, 95% CI 0.12-1.94), Jeddah 2.3% (OR 0.27, 95% CI 0.31-2.25), and Qassim 2.9 % (OR 0.34, 95% CI 0.04-2.89) and these were not statistically different from seroprevalence in the Makkah region. CONCLUSIONS: At the early months of the COVID-19 pandemic in Saudi Arabia, the seroprevalence of antibodies to SARS-CoV-2 among blood donors was low, but was higher among non-citizens. These findings may indicate that non-citizens and less educated individuals may be less attentive to preventive measures. Monitoring seroprevalence trends over time require repeated sampling.

Comorbidities and severity of coronavirus disease 2019 patients.

OBJECTIVES: To determine the association between comorbidities and the severity of the disease among COVID-19 patients. METHODS: We searched the Cochrane, Medline, Trip, and EMBASE databases from 2019. The review included all available studies of COVID-19 patients published in the English language and studied the clinical characteristics, comorbidities, and disease outcomes from the beginning of the pandemic.  Two authors extracted studies characteristics and the risk of bias. Odds ratio (OR) was used to analyze the data with 95% confidence interval (CI). RESULTS: The review included 1,885 COVID-19 patients from 7 observational studies with some degree of bias risk and substantial heterogeneity. A significant association was recorded between COVID-19 severity and the following variables: male (OR= 1.60, 95%CI= 1.05 - 2.43); current smoker (OR=2.06, 95%CI= 1.08 - 3.94); and the presence of comorbidities including hypertension (OR=2.05, 95%CI= 1.56 - 2.70), diabetes (OR=2.46, 95%CI= 1.53 - 3.96), coronary heart disease (OR=4.10, 95%CI= 2.36 - 7.12), chronic kidney disease (OR=4.06, 95%CI= 1.45 - 11.35), and cancer (OR=2.28, 95%CI= 1.08 - 4.81). CONCLUSIONS: Comorbidities among COVID-19 patients may contribute to increasing their susceptibility to severe illness. The identification of these potential risk factors could help reduce mortality by identifying patients with poor prognosis at an early stage.