Serosurvey of measles, mumps and rubella antibodies in Saudi children.

OBJECTIVE: A serosurvey study to evaluate the proportion of children with antibodies against diseases targeted by the Expanded Program of Immunization in the Kingdom of Saudi Arabia. METHODS: Using multistage sampling techniques, we collected samples and sent them for laboratory assay from the following age groups; 100 samples at 6 months, 12 months, 18 months, 6 years, 13 years, and 17 years. We conducted the study from September 2001 to February 2002. We assayed sera for measles, rubella, and mumps antibodies in the measles-mumps-rubella reference laboratory in Germany, using enzyme immunoassay and plaque neutralization (PN) as a backup test for equivocal and negative samples. We only carried out a backup test for measles samples. RESULTS: The age group of 6 months had the highest proportion with negative measles antibodies. After adding the backup test (PN), the proportions of children with protective measles antibody were; 64% at 6 months, 87% at 12 months, 91% at 18 months, 75% at 6 years, 96% at 13 years, and 98% at 17 years. Rubella antibody positivity rates (>7 IU) were 28% at 6 months, 49% at 12 months, 97% at 18 months, 98% at 6 years, and 100% at 13 years. While positivity rates in mumps were 14% at 6 months, 29% at 12 months, 59% at 18 months, 64% at 6 years, and 75% at 13 years. CONCLUSION: The unexpected low proportion of children with protective level at 6 years, despite being vaccinated with 2 measle doses is an important phenomenon. This reflects the interference between the first and the second measles dose. The Ministry of Health decided to conduct a catch up campaign targeting 1st through 3rd grade primary schools, who did not catch the mass campaign conducted in 2000. Also, this supports the decision taken by the ministry to change the measles immunization schedule to MMR at 12 months and a second dose at 6 years of age.

Screening of pregnant Saudi women for hepatitis B surface antigen.

BACKGROUND: The high prevalence of hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) in pregnant women is considered the most important factor contributing to the higher carrier rate of HBsAg in some populations, including Saudi Arabia. Universal hepatitis B vaccination in infancy was implemented in Saudi Arabia in 1990 to avoid early acquisition of infection. At the same time, another program was launched to vaccinate all school children at school entry as a second target group. The aim of this study was to evaluate the HBsAg prevalence rate in Saudi pregnant women 12 years after launching the program and to assess regional variation, if any. METHODS: In a cross-sectional study, 2664 pregnant Saudi women were recruited from the five main regions in Saudi Arabia. Blood samples were tested for HBsAg. Positive samples were tested also for HBeAg. RESULTS: Of 2664 pregnant Saudi women, 65 were positive for HBsAg (2.46%, 95% CI=2.11%-2.69%). Four were positive for HBeAg (0.15%). The HBsAg prevalence rate was higher in Gizan (4.2%) and lower in Tabuk (1.4%) (P=-0.035). Only one case was positive for HBsAg in women under the age of 20 years (1/186), a 0.5% positivity rate in this age group compared with 2.6% in the older age group (P=-0.049 for the one-sided test). A history of surgical procedures was associated with a higher (3%), but not significantly higher rate of HBsAg positivity. No significant association was found between HBsAg positivity and a history of dental procedures or blood transfusion. CONCLUSION: Although the HBsAg prevalence rate among Saudi pregnant women was lower than previously published data, the full impact of the hepatitis B vaccination program in infancy and childhood will take more years to decrease the prevalence rate in pregnant women. The MOH should continue to give the first dose of hepatitis B vaccine at birth to prevent early acquisition, but in the meantime a regional policy can be adopted to deal with the high prevalence rate of HBsAg among pregnant Saudi women.

Short-term outcome of preterms in two neonatology units in Al-qassim, saudi arabia.

OBJECTIVE: A follow-up study, to compare the short-term outcome of preterms, in two hospitals in Al Qassim region, Saudi Arabia. METHODS: Preterms admitted in two hospitals, 47 in hospital A and 36 in hospital B, were followed from admission until one month after discharge. Preterms were compared on gestational age, birth weight, birth head circumference and length of stay. Outcome measures were weight gain per day, feeding patterns on discharge and feeding patterns one month after discharge compared with the feeding of normal infants (200 infants) at the age of 6 weeks. RESULTS: No difference was found between the two hospitals on admission in gestational age, mean birth weight, birth head circumference and length of stay. Mean weight gain per day was significantly higher in hospital A, 9.56 (± 19.7) gm, compared to 1.22 (± 29.47) gm in hospital B. (P=0.049). But the proportion of exclusive breast fed infants, one month after discharge was higher in hospital B, 37.5% compared to 13.2% in hospital A. (p=0.0224). CONCLUSION: Our study showed that there is a clear hospital level difference in the same region, in the short-term outcome. This emphasizes that outcome should be continuously followed and that differences should be evaluated in perinatal audit procedure.

Sero-response to measles-mumps-rubella vaccine campaign in Saudi Arabia.

OBJECTIVE: To evaluate the measles-mumps-rubella vaccine campaign targeting primary school children in the Kingdom of Saudi Arabia during the months of January and February 2000. METHODS: Pre and post measles-mumps-rubella vaccine blood samples were collected from 54 children from the first grade and 96 children from the 6th grade. Antibodies against measles, mumps and rubella were assayed using enzyme immunoassay and a backup test of plaque neutralization test. This assay was carried out at the Reference Center, Koch Institute, Berlin, Germany. RESULTS: When the backup test results were added, 96%-98% of children had protection level against measles before the campaign. It is interesting to notice that pre-vaccination measles mean titer and positivity rate with enzyme linked immunoassay in the first grade were significantly lower than the 6th grade. One hundred percent and 96.8% were positive for rubella antibody before the campaign, in the first and 6th grades. Seventy-seven percent and 67% were positive for mumps before the campaign, in the first and 6th grade. After the measles-mumps-rubella vaccine campaign, protection rate reached 100% for the 3 antigens with a statistically significant boosting effect and increase in geometric mean of the titre. CONCLUSION: Measles-mumps-rubella vaccine campaign was effective in increasing protective levels and boosting antibodies against the 3 targeted diseases which can prevent epidemics in the primary schools.

Evaluation of continuing medical education in Al-qasim, saudi arabia.

OBJECTIVE: To evaluate CME activities in Al-Qassim region in the Kingdom of Saudi Arabia METHODS: A study using a pre-structured questionnaire was conducted in Al-Qassim, targeting physicians working in the hospitals. The survey was conducted in two phases. The first phase was conducted at the inception of the department of professional education and the second one year later. Questionnaires were given to a sample of physicians working in the hospitals. RESULTS: Mean CME hours in the region increased from 5.5(±5.9) to 14.2(±19.7), p=0.0001. 50% said that the CME should be presented differently. There was a need for regular courses (61%), departmental and bedside activities (52%) and visiting speakers (45%). Only 47% of the physicians were using the Internet. CONCLUSION: There is a need to shift from credit counting to a process that can yield professional development through practical courses and departmental activities. The use of the Internet in CME activities should be encouraged.

Clinical evaluation of disabled children in Al-Qassim region, Saudi Arabia.

OBJECTIVE: The study was conducted as part of an overall evaluation for an outreach program to evaluate the clinical status of all the participating children, identify management problems, if any, and offer relevant recommendations. METHODS: All the participating children were subjected to a detailed clinical evaluation using a structured questionnaire developed for the purpose. The subjects of this study were registered in the Center for Disabled Children in Buraidah and Unaizah, Al-Qassim region, Kingdom of Saudi Arabia. This study was conducted in 1998 to include all registered children in the centers, which were established in 1994. RESULTS: One hundred and eleven children were evaluated, 51.8% were males. Average age was 72.31 months (standard deviation 32.99). The children fell into 3 diagnostic groups: Cerebral palsy (CP) group (n=41), chromosomal abnormalities group (n=36) and miscellaneous group (n=34). Mothers were the direct care-givers in 98.1% of cases. The sample as a whole suffered from a number of disabilities, the most common of which was severe speech difficulty (88.3%). Fifty seven percent of the children were severely malnourished. The CP group suffered most, as they were significantly fewer mobiles and more dependants on the care-giver. History of neonatal asphyxia and severe malnutrition at the time of examination were also significantly more common in this group. CONCLUSION: This group of disabled children is enjoying a comprehensive rehabilitation service delivered through an efficient outreach program. It was observed that the families need extra support to improve mobility, nutrition and communication abilities of the participating children.