Pneumococcal disease in the Arabian Gulf: recognizing the challenge and moving toward a solution

Pneumococcal disease has substantial incidence, morbidity and mortality in older adults. Decreased birth rates and longer lifespans indicate that the global population is aging, although rates of aging differ between countries[1]. In 2010, the proportion of the population aged >60 years in the general Arab Region was 7%, and this proportion is expected to rise to 19% by 2050 for the region as a whole[2]; the United Nations estimates for the individual countries of the Arabian Gulf by 2050 are 25.7%, 24.9%, 20.7%, 26.7% and 10.5% in the Kuwait, Bahrain, Qatar, United Arab Emirates [UAE] and Oman, respectively, which are comparable to the 26.9% predicted for the USA and lower than that predicted in European countries, in which the 2050 estimates are 32.7%, 34.0% and 38.1% for France, the UK and Germany, respectively [1]. Globally and in the Gulf Region, pneumococcal disease is an increasingly important public health burden in the elderly. The burden of pneumococcal disease can be reduced by effective vaccination programs, but the recommendations on pneumococcal vaccination in adults vary widely. The major barriers to vaccine implementation among healthcare professionals are an incomplete awareness of pneumococcal disease and the vaccination options in adults. The Gulf Advocate Group calls for healthcare providers in the countries of the Arabian Gulf [Kuwait, Bahrain, Qatar, United Arab Emirates and Oman] to support awareness and education programs about adult pneumococcal disease, particularly in high-risk groups such as those >65 years of age, those with type 2 diabetes mellitus, hematological malignancy, organ and bone marrow transplantation or chronic kidney or lung diseases and pilgrims undertaking the Hajj to improve pneumococcal disease surveillance and optimize and disseminate recommendations for adult vaccination. The Gulf Advocate Group recommends following the U. S. Centers for Disease Control and Prevention [CDC] guidelines for pneumococcal vaccination [3, 4]

Impact of serum interleukin-10 in pathogenesis of chronicity in hepatitis C virus patients

Hepatitis C virus [HCV] has emerged as a major cause of liver disease worldwide. Most people who contact HCV infection become persistently infected, and the mechanism by which infection is established seems to be related to the lack of development of effective immune response. The aim of this study was evaluation of the role of IL-10 which is a marker of T helper-2 [Th-2] cell activities in the pathogenesis of chronicity of HCV

Methods: Forty five subjects were included in the study. They were divided into three groups as follows: group I [Control group] included 15 healthy individuals, group II included 15 individuals with positive ELISA test for hepatitis C antibodies but with negative PCR test for HCV RNA and Group III included 15 patients with positive ELISA test for hepatitis C antibodies and positive PCR test for HCV RNA. Complete history taking, full clinical examination and ultrasonography were done for all individuals included in this study. All individuals were subjected to the laboratory investigations including Liver function tests, measurements of liver enzymes, ELISA test for HCV antibodies, PCR for HCV RNA and determination of IL-10 by ELISA technique

Results: there was a highly significant increase in the level of IL-10 in group II and group III when compared with control group [P<0.001], also, IL-10 showed a highly significant increase in group III when compared with group II [P<0.001]. There was also a highly significant positive correlation between IL-10 and each of the liver enzymes: ALT, AST, ALP and GGT. In conclusion, this study shows that patients with chronic HCV infection have an elevated level of serum IL-10 which reflects increased T-helper type 2 cell activities that may lead to suppression of Th1 cells which may contribute to the pathogenesis of chronic HCV infection. According to these findings, IL-10 assay may be used as a test to predict those who are liable to develop progressive chronic hepatitis C or the possible response to different lines of treatment. Moreover, the findings of this study drive the attention to the need to develop new therapeutic approaches to help in treatment of HCV patients applying immunological manipulations that suppress Th2 immune activity and stimulate Th1 immune response which is needed to control this type of infection. These possible new strategies for immunotherapy may help HCV patients for viral clearance or at least may allow better control of the infectious process