Pattern of varicella and associated complications in children in Unite Arab Emirates: 5-year descriptive study.

The objective of this study was to characterize the epidemiology of varicella and varicella-associated complications in Al-Ain, United Arab Emirates (UAE) during 2000-04. The annual number of reported cases varied from 373 to 790 per 100 000 population. Most (89%) occurred in children < 15 years old. Of 187 children requiring hospital admission, 50.3% had febrile illness due to secondary bacterial infection and 17.6% had neurological complications. The overall mortality rate among hospitalized children was 1.1%, all due to invasive group A Streptococcus. Varicella and associated complications in previously healthy children is becoming an important clinical and public health problem in the UAE.

Pattern of varicella and associated complications in children in United Arab Emirates: 5-year descriptive study

The objective of this study was to characterize the epidemiology of varicella and varicella associated complications in Al-Ain, United Arab Emirates [UAE] during 2000-04. The annual number of reported cases varied from 373 to 790 per 100 000 population. Most [89%] occurred in children < 15 years old. Of 187 children requiring hospital admission, 50.3% had febrile illness due to secondary bacterial infection and 17.6% had neurological complications. The overall mortality rate among hospitalized children was 1.1%, all due to invasive group A Streptococcus. Varicella and associated complications in previously healthy children is becoming an important clinical and public health problem in the UAE

Clinical utility of a new rapid test for the detection of group A Streptococcus and discriminate use of antibiotics for bacterial pharyngitis in an outpatient setting.

OBJECTIVE: To evaluate the clinical usefulness of the Diaquick Strep. A Test (SAT) as a rapid streptococcal antigen test, and its effect on antibiotic use in children. METHODS: This was a prospective study of children with acute catarrh, fever, and acutely inflamed throat/tonsils. Paired throat swabs for SAT and culture were collected. None of the children received antibiotics prior to testing. RESULTS: Five hundred and five children were included in the study: 278 were boys (55%) and 409 (81%) were aged under 5 years. The SAT was negative in 434 cases (86%) and positive in 71 (14%); culture was negative in 425 cases (84%) and positive in 80 (16%), including nine cultures that grew bacteria other than group A beta-hemolytic streptococci (GAS). Both the SAT and culture were negative in 422 cases (84%) and positive in 68 (13%), but were inconsistent in 15 cases (3%). For GAS infection, the SAT positive predictive value was 95.8% (68/71). The negative predictive value for the whole group as well as for children under five years of age was over 99% (422/425 and 355/358, respectively). SAT sensitivity was almost 96%. Finally, only 74 children (15%) were given antibiotics, while a staggering 431 (85%) were not. CONCLUSION: The Diaquick Strep. A Test (SAT) is a quick, reliable, and clinically useful test, which could help to dramatically reduce the usage of antibiotics in children with fever, catarrh, and acute pharyngotonsillitis.

An outbreak of Serratia marcescens infection in a special-care baby unit of a community hospital in United Arab Emirates: the importance of the air conditioner duct as a nosocomial reservoir.

We report an outbreak of Serratia marcescens infection in a special-care baby unit (SCBU) of a university-affiliated community hospital in the United Arab Emirates. The outbreak involved 36 infants and lasted for 20 weeks. Seven of the colonized infants developed invasive illnesses in the form of bacteraemia (four cases), bacteraemic meningitis (two) and clinical sepsis (one). Three other term infants had purulent conjunctivitis. There were five deaths with an overall mortality of 14%. S. marcescens was cultured from airflow samples from the air conditioning (AC) which was the reservoir of infection in this outbreak. Elimination of the nosocomial source and outbreak containment were eventually achieved by specialized robotic cleaning of the entire AC duct system of the SCBU. Strict adherence to the infection control policies was reinforced to prevent transmission of cross-infection.

Prevalence of Helicobacter pylori infection among low socio-economic workers.

Epidemiological studies have shown that the prevalence of Helicobacter pylori infection in a community and occupational health are closely related to lifestyle and socio-economic status. There is little information on H. pylori profile in industrial workers in the literature. The aim of this study was to investigate the prevalence rate of H. pylori profiles among low socio-economic workers in the United Arab Emirates (UAE). This study was undertaken by determining IgG H. pylori antibody profiles among industrial exposed and referent workers, sera. Presence of anti-H. pylori antibodies in the frozen stored sera was determined by ELISA. Also, data on dietary and lifestyle were obtained. The result was considered positive if IgG anti-H. pylori antibody titers was > 300. People with seropositive levels of IgG antibodies to H. pylori were assumed to be infected with H. pylori. Most of the industrial workers lived in less modern accommodation, were less educated, ate their vegetable products unwashed and did not have drinking water facilities, when compared to referents. H. pylori serology by IgG was positive in 167 industrial workers (78.4%) and 137 in referent workers (64.3%) respectively, (p < 0.002). The sensitivity and specificity of the IgG serology assay were 94.5%, and 97.2% respectively. There was statistically significant difference between the exposed industrial and non-exposed control groups in respect of their H. pylori profiles.

Haemophilus influenzae type b diseases in children: a pre-vaccination study.

Haemophilus influenzae type b (Hib) can now be prevented by vaccination. We present the clinical and laboratory characteristics of acute invasive H. influenzae diseases in children admitted over a 4-year period to a tertiary paediatric ward of the Al-Ain medical district hospital, before vaccination became available in the United Arab Emirates. In all, 38 children had bacteriologically proven H. influenzae invasive diseases and all the isolates were serotype b. Meningitis was diagnosed in 60.5% of the children and 66% of the studied children were under 12 months. There were no deaths but substantial morbidity occurred in 12 children.

Varicella susceptibility among children and healthy adults in the United Arab Emirates.

The serological evidence of varicella zoster virus infection was determined among healthy individuals from infancy to 47 years of age living in this region. Of 648 people, 126 (19.4%) had no detectable antibody and were susceptible to infection. The overall adult seroprevalence rate was 81.3%. The rate among Emirati citizens increased with age; < 10 years, 45.8%; 11-20 years, 68.4%; 21-30 years, 89.5%; 31-40 years, 94.7%; and > 41 years, 88.9%. Adults from the Indian subcontinent and Philippines had variable prevalence rates and Sri Lankans living in the region were highly serosusceptible (35%). Because of the clinical impact of varicella in adult populations, vaccine prevention might be beneficial.

Varicella susceptibility among children and healthy adults in the United Arab Emirates

The serological evidence of varicella zoster virus infection was determined among healthy individuals from infancy to 47 years of age living in this region. Of 648 people, 126 [19.4%] had no detectable antibody and were susceptible to infection. The overall adult seroprevalence rate was 81.3%. The rate among Emirati citizens increased with age; < 10 years, 45.8%; 11-20 years, 68.4%; 21-30 years, 89.5%; 31-40 years, 94.7%; and > 41 years, 88.9%. Adults from the Indian subcontinent and Philippines had variable prevalence rates and Sri Lankans living in the region were highly serosusceptible [35%]. Because of the clinical impact of varicella in adult populations, vaccine prevention might be beneficial

Haemophilus influenzae type b diseases in children: a pre-vaccination study

Haemophilus influenzae type b [Hib] can now be prevented by vaccination. We present the clinical and laboratory characteristics of acute invasive H. influenzae diseases in children admitted over a 4-year period to a tertiary paediatric ward of the Al-Ain medical district hospital, before vaccination became available in the United Arab Emirates. In all, 38 children had bacteriologically proven H. influenzae invasive diseases and all the isolates were serotype b. Meningitis was diagnosed in 60.5% of the children and 66% of the studied children were under 12 months. There were no deaths but substantial morbidity occurred in 12 children

Genetic and environmental factors associated with migraine in schoolchildren.

OBJECTIVE: The aim of this study was to find the prevalence of migraine and headache in schoolchildren in the United Arab Emirates and to determine the genetic and environmental factors associated with these conditions. METHODS: A cross-sectional population study was performed from October 1995 to June 1996. Subjects were selected by a multistage stratified sampling procedure. Data were collected by screening questionnaires followed by clinical interviews. Twelve primary schools and 1400 schoolchildren of United Arab Emirates nationality resident in the Al Ain City, Dubai, and Sharjah emirates were recruited for this study. A total of 1159 (82.7%) schoolchildren gave their consent to the study. RESULTS: The estimated prevalence rates for headache and migraine were 36.9% and 13.7%, respectively. The prevalence of headache is increased with age, the highest prevalence being in 13-year-old children (17.5%). Of the 159 children who fulfilled the diagnostic criteria for migraine, 76 were boys whose mean age (+/- SD) was 10.3 years +/- 2. 8 years, and 83 were girls (mean age 9.9 +/- 2.5 years). Of the children who had migraine, 20 (12.6%) had migraine without aura, and 13 (8.2%) had migraine with aura. The most common migraine symptoms in schoolchildren had been aggravated by physical activity (47.2%) and a positive family history of migraine (46.5%). The most common illnesses were infectious illnesses (41.5%). There was a strong relationship between migraine and the timing of examinations (46.5%). The most common environmental exposure for migraine was found to be playing on a computer (45.9%), followed by loud noise (41.5%), and a hot climate (37.1%). In familial occurrence of headache among immediate relatives, the most frequently affected relative was the mother (17.6%). CONCLUSION: .-Headache and migraine are common in childhood and may be influenced by social, familial, environmental, and psychological factors.

Haemophilus influenzae type b still remains a leading cause of meningitis among unvaccinated children--a prospective CSF analysis study.

A prospective, hospital-based cerebrospinal fluid (CSF) analysis study was undertaken in 65 children who had diagnostic lumbar puncture on admission for suspected central nervous system infections. Twenty-three children were clinically diagnosed to have had sepsis and/or meningitis. CSF bacterial culture grew Haemophilus influenzae type b (Hib) in four cases and Streptococcus pneumonia (SP) was cultured in another child. Bacterial antigen was detected in 13 other CSF specimens and the pathogens were Hib (n = 9), SP (n = 3) and Group B Streptococcus (n = 1). No etiologic cause was identified to explain the abnormal CSF pleocytosis and biochemistry in the remaining five cases. In contrast, the CSF analysis was normal in 42 other children with probable viral and non-infectious neurological condition, mostly febrile convulsions. The overall frequency rate for all types of meningitis and especially for Hib meningitis were 43 and 31 cases per 100,000 children < 5 years of age, respectively. These findings support our earlier observations that Hib meningitis still remains the leading cause of childhood meningitis in our region. Also it reaffirms the observation that bacterial meningitis may often be under-reported if CSF positive culture alone is considered for the diagnosis.

The prevalence of Toxoplasma gondii specific IgG and IgM antibodies in blood donors in Al Ain, United Arab Emirates indicates a potential risk to recipients.

The results of a prospective cross-sectional study on the anti-toxoplasma IgG and IgM specific antibody profile among blood donors in Al Ain United Arab Emirates are presented. The overall infection rate was 34%. Based on IgM specific antibody positive rate, acute toxoplasmosis was evident among 3% of the blood donors studied. The theoretical implications of these findings are discussed.

Toxoplasma antibody prevalence among healthy adults in United Arab Emirates.

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

Impact of pregnancy on maternal AIDS.

OBJECTIVE: To assess the impact of pregnancy on maternal acquired immunodeficiency syndrome (AIDS) among tribal women in India. STUDY DESIGN: From February 1992 to February 1996, 71 tribal women from Manipur, India, with AIDS (Centers for Disease Control stage iii/iv), matched for age, parity, CD4 lymphocyte count and demographic characteristics, were recruited into a prospective study. Thirty-two (49%) of these women were pregnant (8-10 weeks) (group A) and 38 (51%) nonpregnant (group B). RESULTS: Pneumocystis carinii pneumonia followed by miliary tuberculosis and wasting disease were the most common AIDS-defining illness and cause of maternal death in both groups. A total of 28 (39%) women died as a direct result of their AIDS-defining illness; 10 (27%) of them were among the nonpregnant women as compared to 18 (56%) deaths among the pregnant women (P = .17, odds ratio 3.7285, 95% confidence interval 1.23, 11.58). Three (16%) of these 18 deaths occurred within 14 weeks of an uneventful first-trimester medical termination of pregnancy. Thirteen women (41%) died undelivered at 30-34 weeks' gestation, and two died within 3 weeks of delivery. Fourteen (44%) women vaginally delivered 14 preterm infants, between 28 and 35 weeks' gestation. Eleven of these infants died within six weeks; nine deaths were a direct result of prematurity and clinical diagnosis of an AIDS-defining illness. The mean survival time was 9.72 months for the pregnant women and 22.6 months for the nonpregnant women (P = .066). CONCLUSION: Pregnancy increased maternal and fetal mortality in these AIDS-infected women.

PIP: The effects of pregnancy on maternal AIDS were investigated in a prospective study (1992-96) of 71 HIV-positive tribal women from Manipur, India. 32 women (49%) were pregnant during the study period. Both pregnant and non-pregnant women were matched in terms of age, parity, CD4 lymphocyte counts, and demographic attributes. The most frequent AIDS-defining illnesses were Pneumocystis carinii pneumonia (PCP), miliary tuberculosis, and wasting syndrome. 3 pregnant women with PCP died after early induced abortion and another 13 died undelivered at 30-36 weeks' gestation; the remaining 14 women vaginally delivered a preterm infant at 28-35 weeks' gestation. As pregnancy progressed, these women's CD4 counts declined in association with their AIDS-related clinical deterioration. 11 of the 14 infants died within 6 weeks of delivery. 2 of the 14 surviving HIV-infected mothers died of fulminating PCP within 3 weeks of delivery. Overall, 18 (56%) of the HIV-infected pregnant women died within 17 months of becoming pregnant as a result of a rapidly progressing AIDS-defining illness, while only 10 (26%) of the non-pregnant women with AIDS died within 42 months of their AIDS diagnosis. The mean survival time was 9.72 months in the former group and 22.6 months in the latter group. These findings indicate that pregnancy in women with AIDS has a significant detrimental effect on both maternal and obstetric outcome and accelerates disease progression. Large prospective, multicenter studies of pregnant HIV-infected women would facilitate better understanding of the variables determining disease progression and clinical outcomes in both mother and child.

Neonatal BCG vaccination and tuberculin skin sensitivity among schoolchildren of the United Arab Emirates.

A cross-sectional survey of 785 schoolchildren living in the Al Ain region was undertaken between January and June 1994 to assess the effect of neonatal BCG vaccination on tuberculin sensitivity and to study the risk of exposure to tuberculosis in the same population. A documented history of BCG vaccination was obtained in 547 (69.7%) schoolchildren. The prevalence of a 10 mm or greater induration of tuberculin skin reactivity varied from 8% in unvaccinated to 11.5% among vaccinated children. This was not statistically significant. Children living in urban areas irrespective of vaccination status had a higher rate of tuberculin reactivity than those living in rural areas (relative risk 5.77; 95% confidence interval 1.85-18.00; p < 0.0004). The pattern and rate of tuberculin sensitivity were similar among the other socio-demographic standards investigated. Earlier BCG vaccination had no effect on subsequent tuberculin sensitivity of either negative (0.4 mm), intermediate (5-9 mm) or positive (> or = 10 mm) type skin reactions. It is concluded that the risk of exposure to tuberculous infection is several times higher among children living in urban areas than among those living in a rural environment. Earlier BCG vaccination should not interfere with diagnostic tuberculin skin sensitivity and is still a useful tool in assessing the risk of tuberculous infection in such populations.

Respiratory syncytial virus infection among hospitalized young children with acute lower respiratory illnesses in Al Ain, UAE.

To establish the frequency and clinical pattern of Respiratory Syncytial virus (RSV) infection in the region, children under 3 years of age admitted for acute lower respiratory illness during two winter seasons of the years 1993-94 and 1994-95 were studied prospectively. Seventy two cases were diagnosed to have RSV infection among the 252 studied, representing 28.57% of these patients. The overall infection rate was 32.1% and 36.5% respectively for the two studied winter seasons. Among these children, 90% were under 12 months of age. A clinical diagnosis of sepsis and respiratory distress was entertained in five RSV positive cases and they were < 1 month of age. The clinical pattern of RSV infection included bronchiolitis in 58.3% of cases, bronchopneumonia (19.4%) and pneumonia (11.1%). RSV activity was detected throughout the year with predominance during cooler months with an associated relative humidity (RH) between 50-60%. These results indicate that RSV plays a significant etiologic role among ALRI in hospitalized infants and young children in the Oasis region of the UAE. Factors such as RH, environmental temperature and lifestyle probably play an additional role in our region for the maintenance and dissemination of infection around the year.

A prospective study of mother-to-infant HIV transmission in tribal women from India.

The transmission of human immunodeficiency virus type 1 from infected mothers to their babies was assessed by serologic, virologic, and clinical means. Of the 160 antibody-positive women enrolled at the beginning of the study, 13 had overt clinical symptoms (CDC stage III/IV). Termination of pregnancy was done, on request, in seven of these cases. The rest delivered prematurely. A total of 143 parturient women and their infants were followed prospectively until the babies were 18 months of age. Fifteen infants (9%) died of AIDS before 14 months of age. The remaining 128 children (91%) were alive at the end of the study period. Seventy-four seropositive children (46%) became seronegative and were considered noninfected. None of the seronegative children reverted to seropositive status despite the fact that they were breast-fed. The majority of the seropositive children (63%) became symptomatic and clinically ill during infancy. The overall mother-to-infant vertical transmission rate was 48%.

PIP: A prospective study was undertaken from January 1990 to June 1993 to investigate the rate and mode of perinatal transmission of HIV-1 among 160 infected pregnant tribal women in India as well as the natural history of maternally-derived HIV infection in infancy and early childhood. After screening and serological testing, seven of the 13 women who presented with clinical signs of severe AIDS choose to end their pregnancies (the other six women delivered live preterm infants), and a total of 153 children were born. None of the women received antiretroviral therapy because of economic constraints. The babies were tested for HIV-1 through serological blood tests and viral cultures within 2 days of birth and at 6-9 months and 15-18 months. Follow-up was achieved in 143 infants. Two of the preterm infants exhibited clinical signs of infection at birth. All six of the preterm infants and nine other infants died of severe AIDS by 15 months. An additional 54 infants became symptomatic during the period of observation but were alive at the conclusion of the study. 74 infants (46%) were seronegative at the end of the study. Virtually all of the infants were breast fed. In this study, the rate of vertical transmission based on the 143 infants available to follow-up was 48%. Placental membrane inflammation was detected in 42 cases, 36 of whom had HIV-1 infection; 15 of these (including the six preterm infants) died by age 15 months. It was concluded that transplacental and perinatal vertical transmission occurs most commonly shortly before and during delivery. Thus, strategies to prevent vertical transmission are urgently needed.

Impact of maternal HIV-1 infection on perinatal outcome.

OBJECTIVES: To study the impact of HIV-1 infection on pregnancy and maternal and early fetal outcome. METHOD: From January 1992 to January 1993, 160 HIV-1 seropositive women and 164 HIV-1 seronegative age- and parity-matched pregnant tribal women from Manipur, India, were recruited into a prospective study. Mother and infant were followed until 6 weeks postpartum. RESULTS: Nine percent (15/160) of subjects had AIDS (CDC IV), 38% (60/160) were symptomatic (CDC III) and 53% (85/160) were asymptomatic (CDC I/II). Symptomatic (CDC III/IV) HIV-1 infection is associated with a significantly increased rate of miscarriage, low birth weight, intrauterine fetal death and preterm delivery. Perinatal, infant and maternal deaths were limited to symptomatic women. HIV-1 infected women were significantly younger than their HIV-1 negative counterparts both in age and age at sexual debut. Placental membrane inflammation was significantly higher in the seropositive group and this correlated well with a higher risk of preterm delivery and postpartum endometritis. Asymptomatic HIV-1 infection was not associated with adverse pregnancy outcome. CONCLUSION: Symptomatic (CDC III/IV) HIV-1 infection in Indian tribal women is associated with adverse maternal and fetal outcome.

Seasonality and prevalence of rotavirus in Al-Ain, United Arab Emirates.

BACKGROUND: Rotaviruses are the single most important causative agent of acute neonatal enteritis in most avian and mammalian species including humans. Rotaviruses infections have also been shown to be associated with the elderly, immunocompromised individuals and more recently with epidemic diarrheal illness in adults. OBJECTIVES: To study the incidence and the effect of seasonality on the prevalence of rotaviruses in Al-Ain, United Arab Emirates. STUDY DESIGN: A total of 650 stool samples submitted to the laboratories of two University Teaching Hospitals (Al-Ain and Tawam) and a private hospital (Oasis) were examined for the presence of rotaviruses from January 1990-December, 1992, using a commercially available latex agglutination assay. The meteorological data (temperature, relative humidity and rainfall) recorded during the sampling period was analyzed statistically to examine the effect of seasonality on the prevalence of rotavirus cases in Al-Ain, United Arab Emirates. RESULTS: Rotavirus was detected in 21.4% of the samples examined. The predominant number of positive cases (35%) were in the 7-12 months age group. It was interesting to find rotavirus-positive cases in as low an age group as < 3 months (3.6%) and as high as 10 years (8.04%). There was no significant difference on infection rates between male and female groups in the study. However, there was a significant difference between the national (38.18%) and non-national children (61.28%). The higher rate of the latter may be due to import of infections. There appeared to be a seasonal pattern of rotavirus occurrence in the cases studied, with a marked increase in the number of positive cases during the months when the relative humidity was low (25-45%) and there was no rainfall. CONCLUSIONS: Rotavirus was detected in all age groups with a predominance in 7-12 month age groups, and a higher incidence in non-nationals. There was a marked increase in the number of positive cases during the months when the relative humidity was low (25-45%) and there was no rainfall. These findings are discussed in relation to the epidemiology and prophylaxis of rotavirus infections.