A Large Outbreak of Hepatitis E Among a Displaced Population in Darfur, Sudan, 2004: The Role of Water Treatment Methods.

BACKGROUND: The conflict in Darfur, Sudan, was responsible for the displacement of 1.8 million civilians. We investigated a large outbreak of hepatitis E virus (HEV) infection in Mornay camp (78,800 inhabitants) in western Darfur. METHODS: To describe the outbreak, we used clinical and demographic information from cases recorded at the camp between 26 July and 31 December 2004. We conducted a case-cohort study and a retrospective cohort study to identify risk factors for clinical and asymptomatic hepatitis E, respectively. We collected stool and serum samples from animals and performed a bacteriological analysis of water samples. Human samples were tested for immunoglobulin G and immunoglobulin M antibody to HEV (for serum samples) and for amplification of the HEV genome (for serum and stool samples). RESULTS: In 6 months, 2621 hepatitis E cases were recorded (attack rate, 3.3%), with a case-fatality rate of 1.7% (45 deaths, 19 of which involved were pregnant women). Risk factors for clinical HEV infection included age of 15-45 years (odds ratio, 2.13; 95% confidence interval, 1.02-4.46) and drinking chlorinated surface water (odds ratio, 2.49; 95% confidence interval, 1.22-5.08). Both factors were also suggestive of increased risk for asymptomatic HEV infection, although this was not found to be statistically significant. HEV RNA was positively identified in serum samples obtained from 2 donkeys. No bacteria were identified from any sample of chlorinated water tested. CONCLUSIONS: Current recommendations to ensure a safe water supply may have been insufficient to inactivate HEV and control this epidemic. This research highlights the need to evaluate current water treatment methods and to identify alternative solutions adapted to complex emergencies

Meningococcal, influenza virus, and hepatitis B virus vaccination coverage level among health care workers in Hajj

Abstract Background The objective of this study was to assess the compliance of health care workers (HCWs) employed in Hajj in receiving the meningococcal, influenza, and hepatitis B vaccines. Methods A cross-sectional survey of doctors and nurses working in all Mena and Arafat hospitals and primary health care centers who attended Hajj-medicine training programs immediately before the beginning of Hajj of the lunar Islamic year 1423 (2003) using self-administered structured questionnaire which included demographic data and data on vaccination history. Results A total of 392 HCWs were studied including 215 (54.8%) nurses and 177 (45.2%) doctors. One hundred and sixty four (41.8%) HCWs were from Makkah and the rest were recruited from other regions in Saudi Arabia. Three hundred and twenty three (82.4%) HCWs received the quadrivalent (ACYW135) meningococcal meningitis vaccine with 271 (83.9%) HCWs receiving it at least 2 weeks before coming to Hajj, whereas the remaining 52 (16.1%) HCWs received it within Conclusion The meningococcal and hepatitis B vaccination coverage level among HCWs in Hajj was suboptimal and the influenza vaccination level was notably low. Strategies to improve vaccination coverage among HCWs should be adopted by all health care facilities in Saudi Arabia.</p

Estimation of insulin resistance in non-diabetic normotensive Saudi adults by QUICKI, HOMA-IR and modified QUICKI: A comparative study

Background and Objectives :Identification of insulin resistance (IR) in the general population is important for developing strategies to reduce the prevalence of non-insulin-dependent diabetes mellitus (NIDDM). We used the original and a modified version of the Quantitative Insulin Sensitivity Check Index (QUICKI, M-QUICKI), and the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) to divide non-diabetic normotensive adults into high- (HIR) and low-insulin-resistant (LIR) subgroups to investigate similarities and differences in their characteristics. Subjects and Methods : Three hundred fifty-seven healthy adults aged 18-50 years were recruited randomly from health centers in Jeddah in a cross-sectional study design. Anthropometric and demographic information was taken. Insulin, glucose, lipid profile and free fatty acid were determined in fasting blood samples. M-QUICKI, HOMA-IR and QUICKI were calculated. Reported cut-off points were used to identify HIR subjects, who were then matched for age and sex to others in the study population, resulting in 3 HIR and 3 LIR subgroups. Results : Two hundred nine subjects satisfied the selection criteria. M-QUICKI correlated significantly (P=.01) with HOMA-IR and QUICKI values. Increased adiposity was the common characteristic of the three HIR subgroups. HIR subgroups identified using M-QUICKI (97 subjects) and HOMA (25 subjects), but not QUICKI (135 subjects), had statistically different biochemical characteristics compared to corresponding LIR sub-groups. Conclusion : Adiposity, but not sex, is a risk factor for IR in the studied population. Further studies are needed to choose the most appropriate index for detecting IR in community-based surveys

Diabetic nephropathy as a cause of end-stage renal disease in Tabuk area, Saudi Arabia: A four-year study

Diabetic nephropathy (DN) as a cause of end-stage renal disease (ESRD) is increa-sing worldwide. In some countries, it is the most common cause of ESRD. Our objective was to assess the incidence of DN as a cause of ESRD in Tabuk, to evaluate its changes in four years, and to compare the data of Tabuk with data from the United States (US) to be aware of factors causing the difference. Data of ESRD patients with DN treated with renal replacement therapy (RRT) was evaluated from 2009 to 2012. RRT was defined as ESRD patients who were treated either with chronic regular hemodialysis (HD), renal transplantation (Tx) or continuous ambulatory peritoneal dialysis (PD). The incidence of DN as a cause of ESRD increased from 8% in 2009 to 18% in 2012. The mean age of this group was significantly higher than in patients on RRT due to other etiologies. Also, DN was more widespread in built-up areas than pastoral areas. The mortality rate decreased from 20% in 2009 to 14% in 2012. Despite this decrease, the mortality rate was still higher than that in patients on RRT due to other etiologies. When we restricted our analysis to patients treated by HD (76%), Tx (17%) or PD (7%), the results were not significantly different. DN in the Tabuk area is rising, but is less widespread than in the US possibly because of an increased occurrence of other causes of ESRD or early loss of diabetic patients. Therefore, careful management of diabetic patients is obligatory

Causes of hospitalization of pilgrims in the Hajj season of the Islamic year 1423 (2003)

<b>Background: </b> Approximately 2 to 3 million pilgrims perform Hajj every year. Planning for health care requires knowledge of the pattern of dis-eases, complications, and outcome of pilgrims who require hospitaliza-tion during the Hajj period. <b> Methods: </b> In a cross-sectional study we compiled data on all patients admitted to 1487 beds in four hospitals in Mena (793 beds) and three hos-pitals in Arafat (694 beds) from the seventh to the thirteenth day of the Hajj season of the Islamic year 1423, corresponding to 8 to 14 February 2003. <b> Results: </b> Of 808 patients hospitalized, most (79&#x0025;) were older than 40 years. There was no sex preponderance. A total of 575 (71.2&#x0025;) patients were admitted to medical wards, 105 (13.0&#x0025;) to surgical wards, and 76 (9.4&#x0025;) to intensive care units. Most patients (84.8&#x0025;) had one acute medical problem. Pneumonia (19.7&#x0025;), ischemic heart disease (12.3&#x0025;), and trauma (9.4&#x0025;) were the most common admitting diagnoses. More than one third (39&#x0025;) had co-morbid conditions. A total of 644 (79.7&#x0025;) pa-tients were discharged from the hospital in stable condition to continue therapy in their residential camps, 140 (17.3&#x0025;) were transferred to other hospitals in Makkah for specialized services or further care, 19 (2.3&#x0025;) were discharged against medical advice, and 5 (0.7&#x0025;) patients died. <b> Conclusion: </b> This study provided information on the most common causes of hospitalization, pattern of diseases, and required medical ser-vices for pilgrims in Hajj. It is hoped that this data will be of help to health sector planners and officials to provide optimal and cost-effective health care services to pilgrims in Hajj