Sustained Emergence of Influenza A H1N1 and Epidemiologic Aspects of H1N1 in Saudi Arabia

Background: In April 2009, an emergent strain of influenza A virus has been discovered and known as H1N1. Since the descriptive epidemiology report for the first reported 100 cases of this virus in Saudi Arabia in 2010, there are paucity of similar reports.
Objectives: This study aimed to describe some epidemiologic aspects of this emergent disease among all lobaratory confirmed cases in Riyadh, Saudi Arabia from Feb., 2014 to Dec., 2015.
Methods: A total of 107 influenza A H1N1 laboratory confirmed cases reported at Prince Sultan Miltary Medical City in Riyadh, Saudi Arabia were investigated based on their personal characteristics (age, sex, nationality, clinical presentation and associated medical condition), case fatality, and time distribution. The data was obtained form the medical files of the studied cases during the period from Feb., 2014 to Dec., 2015. The data of the cases were analysed by appropriate statistical methods.
Results: H1N1 infection was more among male Saudi subjects as most of the reported cases were male (60.8%). The reported cases were more among those aged ≥ 60 years (28%) and those aged from 30-< 45 years (26.2%). Of the reported 107, 21 cases (19.6%) were reported in March 2015. The overall case fatility rate was 10.3% and it was high among cases less than 15 years (21.4%) and those aged age ≥ 60 years (20.0). The risk factors associated with increased case fatality were cases admitted to ICU (OR= 4.2; 95% CI= 1.14-15.3), those aged ≥ 60 years (OR=3.6; 95% CI= 1.10-12.8), and associated co-morbidities (OR= 3.3; 95% CI= 1.02-12.90). Male sex, however, was associated with a low risk of mortality (OR= 0.75; 95% CI= 0.23-15.3).
Conclusions: Influeza A H1N1 infection in Saudi Arabia is still a threat with a reported high fataility rate of 10.3%. Because not much data are available regarding this disease in recent years, it has become a growing concern to enhance the Saudi surveillence system for this virus, especially during Hajj and Umrah seasons. National researches on large scale are also needed for a better understanding of epidemiology of this infection.

Ten (Eleven...) New Universal Public Health Measures

Samuel A. Nigro*

Simple clinical health improving procedures are offered which should be promoted by public health organizations everywhere. These procedures are the result of discovering the cure for the author’s severe laryngospasm disorder. Discovering the SAM prompted reflections on improving simple valuable self-care for all. All techniques are described and recommended for improving health care and comfortable living for everyone everywhere old enough to follow directions. They have to be daily practiced and made routine. Following these ten procedures will improve everyone’s health.

Clostridium Difficile Infection in Pediatric Inflammatory Bowel Disease Patients in the Era of Molecular Diagnostics and Advanced Therapeutics

Dhiren Patel* , Eric McGrath, Namir Al-Ansari , Ron Thomas, Mohammad El-Baba

Objective Increased prevalence of Clostridium difficile infection (CDI) in pediatric Inflammatory Bowel Disease (IBD) has been reported, primarily using stool toxin assay. Stool Polymerase Chain Reaction (PCR) testing for CDI has replaced toxin assay due to the higher sensitivity and specificity. No pediatric study has reviewed exclusive PCR testing to report CDI in IBD patients. Objective of this study is to analyze demographic and clinical features in IBD patient’s age 18 years and less, including Crohn’s disease (CD) or ulcerative colitis (UC) who had CDI diagnosed by PCR at a tertiary children’s hospital.
Materials and Methods IBD patients with CDI were identified retrospectively from October, 2010 - June, 2014. Patients’ demographics, IBD characteristics and treatment, treatment of CDI, response and recurrence were recorded. Comparisons between groups were analyzed using non-parametric tests.
Results Forty three CD and 27 UC patients with CDI were identified. CDI presentation was abdominal cramping, diarrhea with or without bleeding. Higher percentage of CDI in CD 28/43 (65%) did not have gross bleeding compared to 11/27 (41%) UC (p= 0.05). Significantly higher proportion of CD versus UC patients was on Infliximab. Majority of patients (64/70; 91%) received metronidazole.
Conclusions CDI should be considered while evaluating pediatric patients with IBD flare up. Absence of blood in stool does not rule out CDI. CD patients on infliximab had a significantly higher proportion of CDI in our study. Most patients responded to metronidazole in both groups. Future studies are needed to evaluate risk of CDI associated with biologic therapy.