Faleh Z. Al-Faleh

Long-term protection of hepatitis B vaccine 18 years after vaccination

INTRODUCTIONnThis is the third evaluation study of the hepatitis B virus (HBV) vaccination program, initiated in 1989 in Saudi Arabia.nnnAIMSnThis study sought to assess the efficacy and long-term protection of the hepatitis B vaccine among Saudi adolescents.nnnMETHODSnSchool students between the ages of 16 and 18 years were randomly chosen from high endemic (Aseer), intermediate endemic (Madinah), and low endemic (Al-Qaseem) areas of the country. Hepatitis B surface antigen (HBsAg), hepatitis B core IgG antibody (anti-HBc), and hepatitis B surface antibody (anti-HBs) were measured using standard techniques.nnnRESULTSnA total of 1355 students (689 males and 666 females) were selected randomly from the three areas. No cases of positive HBsAg or anti-HBc were detected among the study population. Five hundred and ten students (38%) showed protective anti-HBs titers (>/= 10mIU/ml), while 528 (39%) students had undetectable anti-HBs titers (<1 mIU/ml).nnnCONCLUSIONSnThis study shows the excellent efficacy of the HBV vaccination program in Saudi Arabia 18 years after its launch. Based on this study and others, a booster dose for the adult population appears to be unnecessary.

Peginterferon alpha-2b plus ribavirin compared with interferon alpha-2b plus ribavirin for initial treatment of chronic hepatitis C in Saudi patients commonly infected with genotype 4.

Abstract: Aim: Comparing the efficacy of peginterferon α‐2b plus ribavirin with interferon α ‐2b plus ribavirin in Saudi patients with chronic hepatitis C virus (HCV) commonly infected with genotype 4.

Frequency of Glucose-6-phosphate Dehydrogenase, Pyruvate Kinase and Hexokinase Deficiency in the Saudi Population

The frequencies of glucose-6-phosphate dehydrogenase (G-6-PD), pyruvate kinase (PK) and hexokinase (HK) deficiency were determined in different regions of Saudi Arabia. G-6-PD deficiency was found to range from 0.045 to 0.220 for the male and 0.020 to 0.125 for the female population. The highest frequencies were found to exist in the regions which are endemic to malarial parasite and have high frequencies of sickle cell and thalassaemia genes. Partial deficiencies of PK and HK were encountered in each region, however, no case of complete deficiency of these enzymes was identified. Further investigations are in progress to determine the clinical manifestations of enzyme deficiencies in the Saudi population.

Hepatitis C virus genotypes in patients with chronic liver disease and haemodialysis patients from Saudi Arabia

Summary. The genotypes of hepatitis C virus (HCV) were investigated in 28 Saudi patients (21 males, seven females; age range 23–68 years; mean 45.0 years) with histologically proven chronic hepatitis (13 chronic active hepatitis and 15 liver cirrhosis) and in 32 Saudi patients with chronic renal failure maintained on haemodialysis (22 males, 10 females; age range 18–60 years; mean 40.0 years) who also had liver disease due to HCV. Among the 28 patients with chronic liver disease genotype 4 was the predominant one (60.7%), followed by types 1b (21.4%), 1a (14.3%) and 2a (3.6%). The distribution of genotypes was similar in patients with chronic active hepatitis to those with liver cirrhosis. Among the 32 patients with chronic renal failure and maintained on haemodialysis, genotype 4 was also the dominant type (55.0%), followed by 1a (25.0%), 1b (21.9%) and 2a (3.1%). In all categories studied the prevalence of genotypes between males and females was the same. As our patients were selected from various regions of Saudi Arabia, we believe that genotype 4 is the predominant one throughout the whole kingdom.

Epidemiology of hepatitis E virus (HEV) infection in Saudi Arabia.

A newly developed assay for antibody to hepatitis E virus (anti-HEV) was used to study the rate of exposure to HEV infection in two Saudi areas: Riyadh (Central Province-788 people) and Gizan (Southern Province-630 people). These two regions were chosen for the study because the Riyadh area is an urban area and Gizan is considered rural, based on sewage disposal and water sanitation systems in each area. In both areas, HEV is endemic and acquisition of infection to the virus starts early in life and increases with age. In both areas, males are also at higher risk of acquiring the infection than females and this is probably because of social habits rather than genetic factors. The observation of higher anti-HEV prevalence in Gizan (14.9%) than in Riyadh (8.4%) (P < 0.0002) confirms earlier observations that the level of exposure to HEV is related to the hygienic conditions in the community and that improvement in sanitation is an effective measure in lowering the spread of infection.

Patterns of Sickle Cell, Thalassaemia and Glucose-6-Phosphate Dehydrogenase Deficiency Genes in North-Western Saudi Arabia

This study was conducted on 429 blood samples collected from Saudi males and females from Al-Ula in the north-western province of Saudi Arabia in order to determine the frequency of the sickle cell gene, glucose-6-phosphate dehydrogenase (G6PD) deficiency gene, and alpha- and beta-thalassaemia genes, and to investigate the pattern of their interactions. The frequency of the sickle cell gene was 0.0785, while that of the beta-thalassaemia gene was 0.1195. Heterozygous alpha-thalassaemia 2 (- alpha/alpha alpha) was encountered at a frequency of 0.121, while homozygous alpha-thalassaemia 2 (- alpha/- alpha) occurred at a frequency of 0.0046. HbH disease and hydrops fetalis were not encountered. One case with triple alpha-gene arrangement, alpha alpha alpha anti-3.7, was identified. The G6PD deficiency gene frequency was 0.08 and 0.032 in males and females, respectively. Several cases with 2 abnormal genes were encountered. The haematological and biochemical data from the patients with sickle cell disease suggest that the disease in this population is more severe in comparison with cases reported from the eastern population.

The natural history and long-term outcomes in patients with chronic hepatitis C genotype 4 after interferon-based therapy.

Hepatitis C virus (HCV) genotype 4 (G4) infection is common in the Middle East. Post‐treatment long‐term outcomes have not been reported in these patients. This study evaluates these outcomes in patients after interferon‐based therapy.

SASLT guidelines: Update in treatment of Hepatitis C virus infection.

Hepatitis C virus (HCV) has been reported to be on the decline over the past decade, although it remains a major public health concern in Saudi Arabia. Its prevalence in Saudi Arabia is generally uncertain because most studies were conducted more than 10 years ago. However, data from blood donor screening centers indicates prevalence rates of 0.4–1.1%.[1] The premarital screening data in a predominantly young population from a survey among 74662 individuals conducted in the period between January and May 2008, the results of which were published by the Ministry of Health, showed an HCV prevalence of only 0.33%.[2] Similarly, a community-based study in 16–18 years old Saudi adolescents in 2008 showed a prevalence of HCV at 0.22% in the group.[1] n nThe most prevalent genotype is genotype (GT) 4, followed by GT1. HCV GT4 accounts for 60% of the cases, GT1 for 25.9%, GT2 for 4.3%, GT3 for 2.9%, and GT5/GT6 for 0.3%. 6.3% of the cases were of mixed genotypes, predominantly between GT1 and GT4.[3] The most common subtypes of GT4 are 4a (48%) and 4d (39%), followed by subtypes 4n (6%) and others (6%).[4] Up to 63% of Saudi patients have minimal to moderate (Metavir, F0–2) histological disease.[5]

SASLT practice guidelines: Management of hepatitis C virus infection

This guideline has been approved by the Saudi Association for the Study of Liver diseases and Transplantation and represents the position of the Association. n nThese practice guidelines have been written to assist physicians and other health care providers to aid in the recognition, diagnosis, and management of chronically infected hepatitis C virus (HCV) patients. They are based on a formal review and analysis of published literature on the topic that impact the management of chronic HCV infection, and the experience of the authors in hepatitis C. In addition, various international practice guidelines and consensus documents on management of chronic hepatitis C were considered in the development of these guidelines. The recommendations contained herein suggest preferred approaches to the diagnostic, therapeutic, and preventive aspects of care related to the disease. n nOur understanding of the natural history of HCV infection and the potential for therapy of the resultant disease is continuously improving. However, despite the increasing knowledge, areas of uncertainty still exist and therefore clinicians, patients, and public health authorities must continue to make choices on the basis of the evolving evidence. Therefore, these guidelines are intended to be flexible and may be updated periodically as new information becomes available.