Knowledge and attitude towards the Middle East respiratory syndrome coronavirus among healthcare personnel in the southern region of Saudi Arabia.

INTRODUCTION: Middle East respiratory syndrome coronavirus (MERS-CoV) belongs to the family Coronaviridae, and is named for the crown-like spikes on its surface. The clinical presentation of MERS-CoV infection ranges from asymptomatic to very severe disease, and the classical presentation includes fever, cough chills, sore throat, myalgia, and arthralgia. METHODS: A cross-sectional study of 339 healthcare personnel was conducted over an 8-month period in the Aseer region of Saudi Arabia using a structured survey that included demographic information and questions testing participant's knowledge. RESULTS: Approximately two-thirds of the respondents properly identified the causative agent of MERS-CoV as an RNA virus (66.4%, n=225) that is enveloped (68.1%, n=231). On the other hand, few respondents identified the proper number of strains or the genus (16.5% and 17.4%, respectively). More than half of the study sample identified the disease as zoonotic (57.2%, n=194). Similarly, 89.1% (n=302) identified that camels and bats are prone to infection with coronaviruses. Only 23.9% (n=81) properly identified March through May as the season with the highest transmission rate. There was a massive lack of adequate knowledge regarding prevalence of antibodies. Only 18.3% (n=62) of respondents identified PCR as the proper diagnostic confirmatory test for MERS-CoV infection. Regarding MERS-CoV clinical features, 76.4% (n=259) recognized the presence of sub-clinical infection, 64.7% (n=218) indicated that cases should be immediately isolated, and 46.9% (n=159) identified the main cause of mortality as respiratory failure. CONCLUSIONS: There is limited microbiological and virological knowledge of MERS-CoV infection among healthcare personnel in the southern region of Saudi Arabia, although the clinical aspects are known.

Hepatitis C virus infection in southwestern Saudi Arabia: Are we still in the plateau phase?

The aim was to study the seroprevalence of Hepatitis C virus (HCV) infection and related risk factors in Aseer region in southwestern Saudi Arabia, the region known to be of the highest endemicity of viral hepatitis. In a cross-sectional study, all participants were interviewed using structured questionnaire. HCV infection was diagnosed using fourth-generation ELISA. All positive and equivocal HCV serology results were further confirmed by using a qualitative confirmatory RT-PCR. The study enrolled 10,234 participants. A seroprevalence of 2.2% (95%CI: 1.9-2.5%) was found. In multivariate logistic regression analysis, the study showed that males had significantly more risk to become seropositive for HCV (aOR = 1.437, 95%CI: 1.071-1.927) compared to females. Similarly, participants having history of blood transfusion had more than two times the risk of becoming seropositive for HCV (aOR = 2.079, 95%CI: 1.037-4.149). HCV infection in the study area is still high in the plateau phase. It is recommended to have an active educational and media campaign about the risks of HCV infections. Workshops and training of qualified laboratory staff related to blood banking seem mandatory. J. Med. Virol. 89:867-871, 2017. © 2016 Wiley Periodicals, Inc.

Seroprevalence of hepatitis B and C virus infections among health students and health care workers in the Najran region, southwestern Saudi Arabia: the need for national guidelines for health students.

BACKGROUND: The objectives of the study were to study the seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among health college students (HS) and health care workers (HCWs) in the Najran Region of south-western Saudi Arabia and to study the students' knowledge of occupational exposure to blood-borne viral infections. METHODS: A cross-sectional study of a representative sample of 300 HS and 300 HCWs was conducted. RESULTS: An overall seroprevalence of HBV of 1.7% and 8.7% was found among HS and HCWs, respectively. Two-thirds of HS (66.7%, 200) and 23.3% (70) of HCWs lack anti-HBs and are susceptible to HBV infection. An overall seroprevalence of HCV of 0% and 0.3% was found among the HS and HCWs, respectively. The present study indicates poor knowledge among HS and moderate knowledge among HCWs regarding occupationally transmitted blood-borne diseases, safe injection practices, and standard precautions to prevent occupationally transmitted blood-borne infections. CONCLUSION: It is mandatory to develop a structured program to raise awareness among HS, and current health colleges' curricula should be upgraded to address these issues early. The HS should be considered new recruits to health services in terms of their initial screening for blood-borne infections and vaccination against HBV. The development of a novel continuing medical education and pre-employment awareness program for HCWs is recommended to address the following: blood-borne diseases transmitted occupationally, standard precautions to prevent occupationally transmitted blood borne infections, and safe injection practices.

Rift Valley fever among children and adolescents in southwestern Saudi Arabia.

PURPOSE: Rift Valley fever (RVF) virus has expanded its geographical range, reaching Asia in 2000. This work investigated RVF seroprevalence among children born after the 2000-2001 outbreak in Saudi Arabia and compared it with the seroprevalence of adolescents born before the outbreak. DESIGN: In a seroepidemiological study in southwestern Saudi Arabia (Jazan, Aseer, and Al-Qunfuda), a random sample of 389 children and adolescents was investigated. Data were collected regarding the subjects' sociodemographic status, housing conditions, and animal contact. Blood samples were collected and tested for RVF-specific IgG and IgM. RESULTS: None of the study samples were found to be seropositive for anti-RVF virus IgM. None of the study subjects aged 1-8 years (born after the outbreak) were positive for RVF-specific IgG. In contrast, 14 subjects (4.8%) aged 9-19 years (born before the outbreak) were positive for RVF-specific IgG. Among adolescents in our study, 4.9% were positive for anti-RVF IgG. This study showed that among adolescents, a history of contact with aborted animals (aOR=13.361, 95% CI=5.091-35.072) and transporting aborted animals (aOR=18.861, 95% CI=11.125-31.622) were significant risk factors. CONCLUSIONS: Despite the low virus activity recently reported among animals, neither clinically apparent RVF infections nor outbreaks among humans have been documented, indicating that the control measures taken by the Ministry of Agriculture and Ministry of Health are effective.

Seroprevalence of dengue virus infection in Aseer and Jizan regions, Southwestern Saudi Arabia.

BACKGROUND: The objectives were to measure seroprevalence of dengue virus (DENV) infection in Southwestern regions of Saudi Arabia and the potential risk factors. METHODS: Two areas in Jizan region and four areas in Aseer region were randomly selected. A random sample of patients attending the outpatients' clinics of the relevant hospitals was included. Blood samples were taken and tested for DENV-specific IgG antibodies. RESULTS: The study included 965 persons. A seroprevalence of 31.7 % (306/965) for DENV specific IgG was found. In logistic regression analysis, the following significant risk factors were identified: age ≥20 years, being male, lack of electricity and having water basins in the house. CONCLUSION: The study reported the first and the largest seroprevalence study of DENV infection in south-western Saudi Arabia. The relatively high seroprevalence of DENV infection in the study area indicates that it is endemic in the region. Strong and effective health education programs in the study region will help to control DENV infection and public should be discouraged from having indoor water basins. Furthermore, the public should be encouraged to protect themselves from mosquito bites.

Rift Valley Fever in Southwestern Saudi Arabia: a sero-epidemiological study seven years after the outbreak of 2000-2001.

The objective of the present study was to measure seroepidemiology of Rift Valley Fever virus infection in the Southwestern regions of Saudi Arabia and to determine the potential risk factors leading to Rift Valley Fever virus infection. Through a series of field trips to the study area (Jizan, Aseer and Al-Qunfuda), a random sample of the general population (patients and their relatives) attending the outpatients' clinics for any reasons were included. Through questionnaire interviews, data were collected regarding their sociodemographic status, housing conditions, animal contact and other relevant information. Blood samples were taken and tested for RVF-specific IgG and IgM utilizing commercially available enzyme-linked immunosorbent assays (ELISAs). Out of 2322 persons included in the study, only 139 were positive for RVF-specific IgG thus giving an overall prevalence of 6.0%. On the other hand, none of the study samples were found to be sero-positive to RVF-specific IgM. The study revealed zero prevalence of specific IgM and IgG among pre-school children born after the 2000-2001 outbreaks. Using multivariate binary logistic regression analysis to identify potential risk factors associated with sero-positive RVF IgG, the following significant risk factors were identified: lack of electricity, having animals in the house, history of slaughtering animals, contact with or transporting aborted animals. The study documented the lack of recent RVF activity among humans in the study areas since the outbreak of 2000 and therefore, the rigorous control measures undertaken together with fostering public health messages in the region should be maintained to reduce the risk of animal-to-human transmission as a result of unsafe animal husbandry and slaughtering practices.

Concentration of free vascular endothelial growth factor and its soluble receptor, sFlt-1 in the maternal and fetal circulations of normal term pregnancies at high and low altitudes.

OBJECTIVE: Vascular endothelial growth factor (VEGF) is regulated by hypoxia that is essential for placental development. It is antagonized by a soluble form of its receptor (sFlt-1). The purpose of this study was to measure these factors in the maternal and the cord bloods, at low and high altitude. METHODS: Samples were collected from full term births normal pregnant women. Free (unbound) VEGF and sFlt-1 levels were measured in plasma samples from cord and maternal blood for each subject by enzyme-linked immunosorbent assay (ELISA) using commercially available kits from R&D systems, UK (Cat # DVE00 and Cat # SVR100B, respectively). RESULTS: At high altitude, the average maternal free VEGF in pg/ml was significantly (p < 0.001) lower than that of the cord level (71.30 ± 282.14 and 431.35 ± 424.31, respectively). On the other hand, the average maternal sFlt-1 was significantly (p < 0.001) higher than that of the cord level (8205.41 ± 6244.72 and 1811.74 + 3469.30, respectively). At low altitude, the average maternal free VEGF was significantly lower than that of the cord level (0.47 ± 0.89 and 483.44 ± 457.31, respectively, p < 0.001). On the other hand, the average maternal sFlt-1 was significantly higher than that of the cord level (9267.82 ± 6345.68 and 958.66 ± 1359.92, respectively, p < 0.001). There were no significant differences by altitude. CONCLUSION: Secretion of sFlt-1 appears to be polarized, in that concentrations are higher in the maternal compartment than on the fetal side at both high and low altitudes. This may be a normal physiological phenomenon to permit angiogenesis in the placenta and fetus while protecting the mother. Chronic exposure to hypobaric hypoxia at high altitude does not affect these distributions.