Journal of Infection and Public Health RSS feed: Current Issue. The Journal of Infection and Public Health , first official journal of the Saudi Arabian National Guard Health Affairs and King Saud Bin Abdulaziz University for Health Sciences and Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control , microbiology , infectious diseases , public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The Journal will be useful to all health professionals who are partners in the management of patients with communicable diseases , keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health , as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control , public health and infectious diseases in all healthcare settings and the community. The Journal of Infection and Public Health will allow us to seek opportunities to work with others who share our aim, and to enhance our work through partnership, and to uphold the standards of our profession and contribute to its advancement. http://www.jiph.org/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. Journal of Infection and Public Health1876-034152April 2012 © 2012 Published by Elsevier Inc. healthpermissions@elsevier.comhttp://www.jiph.org/article/PIIS1876034112000299/abstract?rss=yesThe Ministry of Health of Saudi Arabia has issued the following requirements and recommendations for entry visas for the Hajj and Umra seasons in 2012. a) In accordance with the International Health Regulations 2005 all travellers arriving from countries or areas at risk of yellow fever (listed below) must present a valid yellow fever vaccination certificate showing that the person was vaccinated at least 10 days previously and not more than 10 years before arrival at the border.Health conditions for travellers to Saudi Arabia for the Umra and Hajj pilgrimage to Mecca: Requirements for 2012 (1433)Ziad A. Memish, Abdullah A. Al Rabeeah10.1016/j.jiph.2012.03.001Journal of Infection and Public Health 5, 2 (2012)2012-04-01Journal of Infection and Public Health2012-04-0152S1876-0341(12)X0003-0Editorial113115http://www.jiph.org/article/PIIS1876034112000238/abstract?rss=yesHighlights: ► Mucormycosis is a life-threatening fungal infection common in immunocompromised patients. ► Cerebro-rhino orbital mucormycosis is the most common type of mucormycosis. ► Iron metabolism, hypoxia and metabolic ketoacidosis play key roles in its pathophysiology. ► Antibiotics, immunosuppressive drugs and hematological malignancies are common risk factors. ► Laboratory investigations and imaging are important to confirm clinical diagnosis.Summary: Mucormycosis is an uncommon fungal infection which can lead to fulminant necrotizing infection under optimal host condition. Fungi have the ability to invade blood vessels and can affect different parts of the body. The most common, though the most aggressive, form is cerebro-rhino-orbital mucormycosis that occurs in debilitated patients, in conjunction with sinus or para-sinus involvement.Due to increased number of newly diagnosed cases of mucormycosis world-wide resulting from uncontrolled metabolic conditions, this paper intends to widen the reader's scope and knowledge about the nature of the disease and its multicomplexity that require a collaborative effort for careful management. Patients who are at risks both at the onset of the disease and during its management have been identified in the paper.Cerebro-rhino orbital mucormycosis: An updateUpender Wali, Abdullah Balkhair, Abdullah Al-Mujaini10.1016/j.jiph.2012.01.003Journal of Infection and Public Health 5, 2 (2012)2012-04-01Journal of Infection and Public Health2012-04-0152S1876-0341(12)X0003-0Review Article116126http://www.jiph.org/article/PIIS1876034111001377/abstract?rss=yesHighlights: ► Maintenance of immunity is proposed as an essential part of prevention and infection. ► Control schemes and vaccinations is strongly recommended for health-care workers (HCWs). ► Immunization of HCWs: immunity rate, screening cost, vaccines and side effects must be considered. ► Despite the availability of cheap vaccines, the prescreening of HCWs seems rational.Summary: A structured questionnaire was administered to health-care workers (HCWs). The HCWs were also screened for measles, rubella, mumps, and varicella (MMRV) using serological methods. One thousand two hundred and fifty-five HCWs were tested. Of the HCWs examined, 94% were immune to measles, 97% to rubella, 90% to mumps and 98% to varicella. The positive predictive values of histories of measles, mumps, rubella and varicella were 96%, 93%, 100% and 98%, respectively. The negative predictive values of histories of measles, mumps, rubella and varicella were 13%, 17%, 5% and 2%, respectively. The cost of vaccination without screening was significantly more expensive (cost difference: €24,385) for varicella, although vaccination without screening was cheap (cost difference: €5693) for MMR. Although the use of cheaper vaccines supports the implementation of vaccination programs without screening, the cost of vaccination should not be calculated based only on the direct costs. The indirect costs associated with lost work time due to vaccination and its side effects and the direct costs of potential side effects should be considered. However, if prescreening is not conducted, some HCWs (2–7%) would be unprotected against these contagious illnesses because of the unreliability of their MMRV history. In conclusion, the screening of HCWs before vaccination continues to be advisable.Prevaccination screening of health-care workers for immunity to measles, rubella, mumps, and varicella in a developing country: What do we save?Emine Alp, Fatma Cevahir, Selma Gökahmetoglu, Hayati Demiraslan, Mehmet Doganay10.1016/j.jiph.2011.11.003Journal of Infection and Public Health 5, 2 (2012)2012-04-01Journal of Infection and Public Health2012-04-0152S1876-0341(12)X0003-0Original Articles127132http://www.jiph.org/article/PIIS1876034111001419/abstract?rss=yesHighlights: ► We studied interactions of bacteria in nasopharynges of healthy preschoolers. ► Streptococcus pneumoniae and Haemophilus influenzae seem to antagonize each other. ► S. pneumoniae cooperated with Moraxella catarrhalis. ► Weekly time spent in child day care had no influence of occurrence of the pathogens. ► Public vaccination with pneumococcal vaccine may alter the interaction.Summary: The nasopharynges of preschool children are often colonized by potentially pathogenic bacteria. The interactions between these common pathogens and certain host factors were investigated in healthy preschool children 1–6 years of age. Nasopharynx samples were collected from all 63 children attending a day-care center that experienced an outbreak of penicillin-resistant Streptococcus pneumoniae. The samples were analyzed for S. pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Group A Streptococci. A model for the risk of carrying these bacteria was established using logistic regression. S. pneumoniae and H. influenzae antagonize each other, whereas M. catarrhalis and S. pneumoniae have a positively association. The risk of carrying M. catarrhalis decreases with age. The time spent in day care each week was not shown to influence the rate of carriage of any of these pathogens. The negative effect of H. influenzae on S. pneumoniae is discussed in relation to the carriage of penicillin-resistant S. pneumoniae, and possible mechanisms involved in this interaction are presented.Bacterial interactions in the nasopharynx – Effects of host factors in children attending day-care centersVictor Dahlblom, Margareta Söderström10.1016/j.jiph.2011.11.007Journal of Infection and Public Health 5, 2 (2012)2012-04-01Journal of Infection and Public Health2012-04-0152S1876-0341(12)X0003-0Original Articles133139http://www.jiph.org/article/PIIS1876034111001407/abstract?rss=yesHighlights: ► The most common histopathological diagnosis of 452 biopsies was reactive disease. ► Granulomatous disease was the second most common finding. ► Malignancy was more common in adults than children. ► Hodgkin's disease was found in 12.5% of the adolescents. ► Non-Hodgkin's disease was present in 10.3% of the adults and elderly.Abstract: Background and objective: Lymphadenopathy is a common medical problem. A lymph node biopsy may be necessary for definitive diagnosis in selected cases.Methods: The study group included a retrospective, hospital-based series of patients who had a cervical lymph node biopsy at the Saudi Aramco Medical Services organization between 1997 and 2008.Results: During the study period, there were a total of 452 cervical lymph node biopsies. Biopsies were performed on 122 (27%) children ≤18 years and 81 (18%) patients >60 years. The most common histopathological diagnosis was reactive disease (52.2%, n=236), which was followed by granulomatous disease (15.5%, n=70). We detected carcinoma in 14.6% of the patients (n=66), Hodgkin's lymphoma in 8.8% (n=40) and non-Hodgkin's disease in 8.8% (n=40). Malignancy was more common in adults than children (19.5% vs. 1.6%, respectively and reactive disease was more common in children than adults (65.3% vs. 47.3%, respectively). Metastatic disease was more likely in the older age group (17.7% vs. 0%), Hodgkin's disease was found in 12.5% of the adolescents, and non-Hodgkin's disease was present in 10.3% of the adults and elderly.Conclusion: The most common histopathological findings for cervical lymph node biopsies in eastern Saudi Arabia were reactive disease and granulomatous disease.The analysis of pathological findings for cervical lymph node biopsies in eastern Saudi ArabiaJaffar A. Al-Tawfiq, Wasim Raslan10.1016/j.jiph.2011.11.006Journal of Infection and Public Health 5, 2 (2012)2012-04-01Journal of Infection and Public Health2012-04-0152S1876-0341(12)X0003-0Original Articles140144http://www.jiph.org/article/PIIS1876034112000044/abstract?rss=yesHighlights: ► We retrospectively reviewed all patients infected with Acinetobacter infection. ► Acinetobacter pneumonia infects medical patients more than surgical. ► Multidrug resistant pathogens caused a majority of the ICU acquired infections. ► Inappropriate antibiotic selection was the most important determinant of mortality.Summary: Background: Nosocomial Acinetobacter infections are an increasing concern in intensive care units (ICU).Objectives: To study the demographic and clinical characteristics and the outcomes of ICU patients with Acinetobacter infections.Methods: A retrospective, 1-year audit of all Acinetobacter infections diagnosed in ICU patients between January 1 and December 31, 2009.Results: Acinetobacter infection occurred in 94 patients (108 episodes). The most common site of infection was the respiratory tract (83 patients, 76.85%), with medical patients being more susceptible than surgical patients to Acinetobacter lung infections (P=0.04), particularly late-onset ventilator-associated pneumonia (VAP) (P=0.04). The majority (63.8%) of infections were acquired in the ICU, and patients with ICU acquired infections were intubated significantly longer than the other patients (P=0.02). Seventy percent of the infections were caused by multidrug-resistant (MDR) strains, and the overall crude mortality rate was over 70%. The most important factors affecting mortality were the duration of intubation (P=0.001) and the inappropriate use of antibiotics (P=0.021) after diagnosis of the infection.Conclusions: Acinetobacter infections are highly prevalent in the ICU, with medical patients being more susceptible to lung infections, particularly late-onset VAP. The early and appropriate selection of antibiotics is the most important determinant of survival among these patients.Acinetobacter infections in a tertiary level intensive care unit in northern India: Epidemiology, clinical profiles and outcomesAshu Sara Mathai, Aroma Oberoi, Sheeba Madhavan, Parmdeep Kaur10.1016/j.jiph.2011.12.002Journal of Infection and Public Health 5, 2 (2012)2012-04-01Journal of Infection and Public Health2012-04-0152S1876-0341(12)X0003-0Original Articles145152http://www.jiph.org/article/PIIS1876034112000020/abstract?rss=yesHighlights: ► We tested all attended patients with gastritis and positive results for pathological examinations for rapid urease test and PCR analyses for Helicobacter pylori infection. ► Primers used for PCR in this study were from, 16S rRNa (bp: 521), Urease A (bp: 411), Cag A (bp: 400), 26kDa (bp: 303). ► Existence of Cag A (bp: 400) showed significant relation with higher gastritis grades (p=0.024) and higher scores for H. pylori infection (p=0.027). ► Patients infected with 26kDa (bp: 303) positive H. pylori had significantly higher scores (p=0.020).Summary: Introduction: Several factors have been suggested to account for differences in the virulence of Helicobacter pylori infections in various populations. Evidence suggests the existence of different strains of H. pylori with different degrees of virulence. The present study aimed to investigate the gastric histopathology in Iranian patients infected with H. pylori and to investigate the relationship between the severity of gastritis and four different bacterial virulence-associated genotypes.Methods and materials: All of the patients with positive results from a pathological examination, a rapid urease test, and PCR analysis for H. pylori infection were consecutively included into the study. The classification and grading of gastritis were performed according to the Sydney System. Esophagitis was classified endoscopically according to the Savary–Miller grading system. The primers used in this study targeted 16S rRNa (521bp), Urease A (411bp), Cag A (400bp), and 26kDa (303bp).Results: Twenty-eight patients were included in the study. The presence of Cag A showed a significant relationship with higher gastritis grades (3.0±0.7 vs. 2.3±0.9, p=0.024) and higher scores for H. pylori infection (3.0±0.7 vs. 2.3±0.7, p=0.027). The patients infected with 26kDa-positive H. pylori had significantly higher infection scores (3.5±0.6 vs. 2.5±0.6, p=0.020).Conclusion: This study showed that CagA-positive H. pylori infection is associated with more severe gastritis and with increased bacterial density and inflammation in the biopsy specimens. The 303-bp positive genotype was also significantly associated with higher grades of esophagitis. Additional in-depth trials will be helpful in extending our findings.Helicobacter pylori genotypes can predict gastric tissue histopathology: A longitudinal study of Iranian patientsHossein Khedmat, Ali Karami, Zahra Safiri, Mohsen Amini, Ali Bakhtiari, Ashraf Karbasi, Mojgan Jayhounian, Hamidreza Jalalian, Saeed Taheri10.1016/j.jiph.2011.10.009Journal of Infection and Public Health 5, 2 (2012)2012-04-01Journal of Infection and Public Health2012-04-0152S1876-0341(12)X0003-0Original Articles153158http://www.jiph.org/article/PIIS1876034112000093/abstract?rss=yesHighlights: ► High prevalence of WP smoking exists among high schools students in Riyadh, KSA. ► One-third of high school students have tried WP smoking at least once. ► WP smoking in early adulthood increases likely hood of current WP smoking. ► Accepting WP smoking from a friend increases likely hood of current WP smoking.Abstract: Objective: To identify the prevalence and predictors of the water-pipe (WP) smoking epidemic in the Kingdom of Saudi Arabia (KSA).Methods: A cross-sectional study conducted with 16–18 year-old high school students in Riyadh, Saudi Arabia.Results: Of the 1272 participants, 414 (33.0%) reported having tried WP smoking. Of this group, 141 (34.1%) were female and 273 (65.9%) were male. Further, 129 (10.2%) students were current WP smokers who had used at least one rock in the past month; 20 were female (1.6%) and 120 were male (8.6%). Regarding age, 276 (68.1%) students who tried WP smoking at least once began when they were over 11 years of age, whereas 129 (31.9%) began WP smoking at or before 11 years of age. Adjusted odds ratios showed that trying WP smoking at least once was associated with smoking after the age of 11 (p=0.021, OR 7.7; CI: 1.4–43.6) and accepting water-pipes from a friend (p=0.024, OR 10.6; CI: 1.4–83.4).Conclusion: A high prevalence of WP smoking exists among male and female high schools students in Riyadh, KSA. WP smoking was reported to begin in early adulthood.The prevalence and characteristics of water-pipe smoking among high school students in Saudi ArabiaMohamed S. Al Moamary, Mohamed A. Al Ghobain, Sulieman N. Al Shehri, Abdulrhman I. Alfayez, Ahmed Y. Gasmelseed, Mohamed S. Al-Hajjaj10.1016/j.jiph.2012.01.002Journal of Infection and Public Health 5, 2 (2012)2012-04-01Journal of Infection and Public Health2012-04-0152S1876-0341(12)X0003-0Original Articles159168http://www.jiph.org/article/PIIS1876034112000081/abstract?rss=yesHighlights: ► Blood stream infection is the most prevalent HAI. ► Urinary catheter, intubation and vascular line are important factors in the incidence of HAI. ► Antibiotic administration is very prevalent in most wards. ► Hospital acquired infections are most prevalent in males. ► The prevalence of hospital acquired infection is not influenced by seasons.Summary: Background: Hospital-acquired infections (HAIs) are critical and mostly preventable complications that occur in hospitalized patients and lead to major health and economic burdens. Most of the information on HAI risk factors and the recommended preventive measures is based on data acquired from only a few countries. The aim of this point prevalence HAI study conducted in Shiraz, Iran, was to study the local epidemiology of HAIs and the major risk factors for acquiring HAIs in a Middle-Eastern region.Methods: The study employed four identical point prevalence surveys in eight university hospitals, each consisting of 60–700 beds. The study was conducted during all four season of 2008–2009. All of the patients admitted for ≥48h were studied, although the patients admitted to emergency wards were excluded. A standardized data collection form that included name, age, gender, presence or absence of HAI, administration of any antibiotics, insertion of a central line, use of an endotracheal tube, mechanical ventilation, and use of an urinary catheter was completed for each patient. The HAI definitions used in this study were based on the US National Nosocomial Infection Surveillance (NNIS) guidelines.Results: Data from 3450 patients were prospectively collected and analyzed. The overall HAI prevalence was 9.4%. The most common HAIs were blood stream infections (2.5%), surgical site infections (2.4%), urinary tract infections (1.4%), and pneumonia (1.3%). A logistic regression analysis showed that the odds ratio OR for males rather than females acquiring infections was 1.56 (95% confidence interval [CI] 1.21–2.02). Other HAI risk factors included using a central intravascular catheter, adjusted OR of 3.86 (95% CI 2.38–6.26), and using an urinary catheter, adjusted OR of 3.06 (95% CI 2.19–4.28). Being admitted to an ICU was not an independent HAI risk factor. For all HAIs, the OR of acquiring infection was 3.24 (95% CI 2.34–4.47) in the patients with hospital stays longer than eight days. A high discrepancy between HAIs and antibiotic use was observed. Antibiotics were administered to 71% of the patients, but only 9.4% of the patients also had at least one documented infection.Conclusion: This point prevalence study showed that HAIs are frequent in Shiraz university hospitals, and that the proportion of patients receiving antibiotics is high. The results imply that more primary prevention efforts are necessary to address HAIs associated with using indwelling devices and to prevent surgical site infections.Point prevalence and risk factors of hospital acquired infections in a cluster of university-affiliated hospitals in Shiraz, IranMehrdad Askarian, Mahnaz Yadollahi, Ojan Assadian10.1016/j.jiph.2011.12.004Journal of Infection and Public Health 5, 2 (2012)2012-04-01Journal of Infection and Public Health2012-04-0152S1876-0341(12)X0003-0Original Articles169176http://www.jiph.org/article/PIIS1876034112000056/abstract?rss=yesHighlights: ► All the injections were administered with disposable syringes and needles. ► Majority (95.4%) of nurses did not wash their hands before administering injection. ► Nurses did not wear/changed gloves (61.6%) before administering injection. ► Breaking of ampoule with solid object (44.4%) and use of multi vial (44.6%) was frequent. ► Advocating safe injection practices may reduce the risks of transmission of infections.Abstract: Background: Unsafe injection practices are prevalent worldwide and may result in spread of infection. Thus the present study was planned to observe the injection practices of healthcare professionals (HCP), including aseptic precautions and disposal of used syringes/needle.Materials and methods: Injection practices were observed in the outpatients and inpatients departments. Questionnaire was designed, tested and administered for this purpose.Results: 130 patients receiving injections were observed. Overall injection practices of the HCP were satisfactory. However, unsafe practices with respect to not washing hands (95.4%), not wearing/changing gloves (61.6%), recapping of needles (12.2%), wiping of needle with swab (15.4%) and breaking of ampoule with solid object (44.4%) were observed.Conclusion: The problem of unsafe injections can be successfully addressed by organizing continuing medical education/symposium/workshops for improving the knowledge, attitude and practices of the HCP. Periodic monitoring and such interventions may also further improve safe injection practices.Injection practices of healthcare professionals in a Tertiary Care HospitalH.S. Rehan, Deepti Chopra, Ravinder Kumar Sah, Tanuj Chawla, Arpit Agarwal, G.K. Sharma10.1016/j.jiph.2012.01.001Journal of Infection and Public Health 5, 2 (2012)2012-04-01Journal of Infection and Public Health2012-04-0152S1876-0341(12)X0003-0Original Articles177181http://www.jiph.org/article/PIIS1876034112000263/abstract?rss=yesHighlights: ► This is a multi-center study of disposal practices of diabetic patients taking insulin. ► Majority of the patients used syringes for insulin administration. ► More than 90% of patients dispose their syringes and lancets directly in the household garbage.Summary: Objective: To assess the use, handling and disposal of insulin injection equipment by diabetic patients in Pakistan.Methods: We conducted a cross-sectional study at diabetic clinics in five tertiary centers in Pakistan. All diabetic patients (type 1/type 2) who were on insulin for more than 1 month, were included. An Urdu (local language)-translated questionnaire was used to collect information on insulin administration equipment, the site and frequency of needle use, insulin syringe/pen/lancet disposal, sharing of needles and knowledge about diseases that are spread by sharing contaminated needles.Results: Of 375 patients, 58% were female. The mean (SD) duration of diabetes was 12.3 (7.3) years, and the duration of insulin use was 4.4 (4.3) years. The majority of the patients used syringes (88.3%) for insulin administration. Additionally, the majority of the patients disposed of used devices (syringes, 92%; pens, 75%; and lancets, 91%) in the household garbage collection bin. About half of the patients (n=185) reported being educated by their physicians about the disposal of sharps. Those who were educated by a physician (adjusted odds ratio (adjOR): 0.36; 95%CI: 0.16–0.81) or could read/write English (adjOR: 0.32; 95%CI: 0.11–0.92) were less likely to dispose of syringes and needles in the household garbage.Conclusion: The common disposal of sharps in the household garbage has implications for disease transmission. Education on the safe disposal of sharps may improve the disposal practices.Disposal of syringes, needles, and lancets used by diabetic patients in PakistanOsama Ishtiaq, Asif Mehmood Qadri, Saeed Mehar, Ghulam Murtaza Gondal, Tahir Iqbal, Sobia Ali, Mati-ur-Rahman, Naveed Zafar Janjua10.1016/j.jiph.2012.02.002Journal of Infection and Public Health 5, 2 (2012)2012-04-01Journal of Infection and Public Health2012-04-0152S1876-0341(12)X0003-0Original Articles182188http://www.jiph.org/article/PIIS1876034112000251/abstract?rss=yesHighlights: ► The ELISA offers an advantage in the diagnosis of brucellosis in endemic areas. ► The specificity of ELISA can help to confirm the clinical stage of brucellosis. ► The PCR is important for the early and rapid confirmation of brucellosis.Summary: This study aimed to investigate the prevalence of human brucellosis in Najran, southwestern Saudi Arabia, and to assess the performances of ELISA and PCR as diagnostic tools for brucellosis with respect to conventional methods. The study included 340 patients with clinical characteristics of brucellosis. Blood samples from cases and controls were subjected to culture, standard tube agglutination test (SAT), ELISA for IgM and IgG, and brucella PCR. The diagnosis of brucellosis was confirmed in 54 (15.9%) of the 340 provisionally diagnosed brucellosis patients. Blood culture identified only 14 (25.9%) cases. The SAT was positive for 50 (92.6%) cases, whereas ELISA IgM, IgG and PCR were found positive in 46, 52 and 38 cases respectively. The sensitivities of ELISA IgM and IgG were 85.2% and 96.3% respectively and the specificity was 100% for each. For PCR, the sensitivity and specificity were 70.4% and 100% respectively. In conclusion, ELISA offers a significant advantage over conventional serological methods in the diagnosis of brucellosis in endemic areas. The PCR test results can be particularly important in patients with clinical signs and symptoms, and negative serological results, allowing the early and rapid confirmation of the brucellosis.Serological and molecular diagnosis of human brucellosis in Najran, Southwestern Saudi ArabiaAhmed Morad Asaad, Jobran Miree Alqahtani10.1016/j.jiph.2012.02.001Journal of Infection and Public Health 5, 2 (2012)2012-04-01Journal of Infection and Public Health2012-04-0152S1876-0341(12)X0003-0Original Articles189194http://www.jiph.org/article/PIIS1876034112000032/abstract?rss=yesHighlights: ► People in low-endemic countries are aware of differences regarding Hepatitis A, B, and C. ► People in low-endemic countries lack practical knowledge regarding Hepatitis. ► Higher educated people tend to have higher levels of awareness and practical knowledge.Summary: Aim: To assess the level of public awareness and practical knowledge regarding Hepatitis A, B, and C in two low-endemic countries (Germany and The Netherlands).Methods: Two large-scale surveys (N=1989 and 668).Results: Although public awareness was high, practical knowledge regarding differences in the mode of transmission, consequences, and prevention was very low in both countries, especially among those with a lower level of education.Conclusion: Future public health initiatives are warranted to increase knowledge as a first step to empower people, especially those with a lower level of education.Public awareness and practical knowledge regarding Hepatitis A, B, and C: A two-country surveyRik Crutzen, Anja S. Göritz10.1016/j.jiph.2011.12.001Journal of Infection and Public Health 5, 2 (2012)2012-04-01Journal of Infection and Public Health2012-04-0152S1876-0341(12)X0003-0Original Articles195198http://www.jiph.org/article/PIIS187603411200024X/abstract?rss=yesHighlights: ► Combined infection of dengue and Influenza A H1N1 2009 from Jeddah, Saudi Arabia is reported. ► Both presented as febrile illness with non specific symptoms. ► Co-existence of both viruses was confirmed by PCR. ► Influenza A H1N1 2009 strain was wild-type not carrying H275Y Oseltamivir resistance. ► Co-existence of influenza with viral hemorrhagic fevers should be considered in endemic ares.Summary: It is difficult to distinguish dengue fever from other febrile illnesses in a dengue-endemic area. This issue was compounded during the H1N1 2009 pandemic of influenza, which also presents as a febrile illness. This first laboratory-confirmed case of co-infection with dengue and influenza A H1N1 2009 strain in Jeddah, Saudi Arabia, highlights the importance of considering co-infections because not only is influenza an ongoing concern in Jeddah, but several viral hemorrhagic fever viruses circulate in this region.The diagnostic challenge of pandemic H1N1 2009 virus in a dengue-endemic region: A case report of combined infection in Jeddah, Kingdom of Saudi ArabiaRaheela Hussain, Ibraheem Al-Omar, Ziad A. Memish10.1016/j.jiph.2011.12.005Journal of Infection and Public Health 5, 2 (2012)2012-04-01Journal of Infection and Public Health2012-04-0152S1876-0341(12)X0003-0Case Reports199202http://www.jiph.org/article/PIIS1876034111001390/abstract?rss=yesHighlights: ► TB is still a major health problem in many countries. ► TB can present in a variety of ways, with or without pulmonary involvement. ► High index of suspicion is required for early diagnosis of unusual forms of TB.Summary: We report the case of a 10-year-old girl who presented to the emergency department with acute abdominal pain. She was diagnosed as having extrapulmonary tuberculosis (TB) with multifocal osteomyelitis of the spine and ribs, peritonitis and intestinal involvement. We describe the clinical presentation of this unusual constellation of the disease in the absence of pulmonary involvement in a child and discuss the diagnostic challenges and treatment of these rare forms of TB.An unusual combination of extrapulmonary manifestations of tuberculosis in a childAbdulnasir Al-Otaibi, Maha Almuneef, Tahir Hameed10.1016/j.jiph.2011.11.005Journal of Infection and Public Health 5, 2 (2012)2012-04-01Journal of Infection and Public Health2012-04-0152S1876-0341(12)X0003-0Case Reports203206http://www.jiph.org/article/PIIS1876034112000068/abstract?rss=yesHighlights: ► We report a case with membranous glomerulonephritis an HIV-positive Caucasian patient. ► The disease is very rare in HIV-positive patients without any coinfections. ► Outcome of treatment with HAART and an angiotensin-receptor blocker was favorable.Summary: The most common manifestation of HIV in the kidney is HIV-associated nephropathy (HIVAN). In this report, we describe the first documented case of membranous glomerulonephritis in an HIV-positive individual in Turkey, the country with the lowest HIV prevalence in the region. The case occurred in an HIV-positive, hepatitis C (HCV)-negative, and hepatitis B (HBV)-negative Caucasian male, who presented with nephrotic-range proteinuria. The patient had a favorable response to HAART and an angiotensin-receptor blocker.A patient with HIV infection presenting with diffuse membranous glomerulonephritis in a country with a low HIV prevalence—Remarkable remission with therapySelda Aydin, Bilgül Mete, Mesut Yilmaz, Gulsah Yenidünya, Reşat Zaras, Aydın Tunckale, Fehmi Tabak10.1016/j.jiph.2011.12.003Journal of Infection and Public Health 5, 2 (2012)2012-04-01Journal of Infection and Public Health2012-04-0152S1876-0341(12)X0003-0Case Reports207210http://www.jiph.org/article/PIIS187603411200007X/abstract?rss=yesHighlights: ► We describe a case of influenza A (H1N1) 2009 reinfection that occurred within an interval of 5months in Thailand. ► Influenza A (H1N1) 2009 reinfection is possible; however, the severity of disease was significantly lower upon reinfection. ► Our finding suggests the possibility of a sub-optimal immune response that failed to provide protection after exposure to the first natural infection.Summary: In 2009, a novel influenza A (H1N1) virus emerged and rapidly spread around the world, leading to a pandemic. In contrast to the high rate of primary infection, reinfection with influenza A (H1N1) 2009 is rather rare. In this report, we describe a case of influenza A (H1N1) 2009 reinfection that occurred within an interval of 5months in Thailand.Influenza A (H1N1) 2009 reinfection in ThailandSatariya Trakulsrichai, Siriorn P. Watcharananan, Wasun Chantratita10.1016/j.jiph.2011.10.010Journal of Infection and Public Health 5, 2 (2012)2012-04-01Journal of Infection and Public Health2012-04-0152S1876-0341(12)X0003-0Case Reports211214http://www.jiph.org/article/PIIS1876034111001110/abstract?rss=yesPakistan is facing a concentrated and expanding HIV epidemic among certain high-risk population groups, including injection drug users (IDUs), emigrant workers, men who have sex with men, transgender sex workers, female sex workers (FSWs), long-distance truck drivers and prisoners. The National AIDS Control Program has developed a consolidated strategic framework to confront the challenge, the ‘HIV/AIDS Strategic Framework’ , which presents a multifaceted plan of action for vulnerable and high-risk groups. This framework seeks, on the one hand, to empower these individuals and enhance their participation in patient support groups and other services related to HIV care and treatment and, on the other hand, to ensure the effective delivery of HIV/AIDS-related services. These services encourage the use of condoms among sex workers and fresh, disposable syringes for IDUs and facilitate the provision of these supplies at reduced prices or free of cost. Despite the extensive interventions of the National Aids Control Program, the prevalence of HIV in high-risk groups continues to rise. Between 2005 and 2009, the HIV prevalence among IDUs increased from 10.8% to 20.8%; among male sex workers (MSWs), the prevalence of HIV increased from 0.4% to 0.9%; among ‘hijra’ sex workers, the prevalence increased from 0.4% to 6.1%; and among female sex workers, the prevalence of HIV increased from 0.4% to 0.91% .An assessment of the Pakistan national HIV/AIDS strategy for sex workersHafsa Muhammad Hanif10.1016/j.jiph.2011.09.009Journal of Infection and Public Health 5, 2 (2012)2012-04-01Journal of Infection and Public Health2012-04-0152S1876-0341(12)X0003-0Letters to the Editor215216http://www.jiph.org/article/PIIS1876034111001092/abstract?rss=yesCholera is still a major health challenge in several countries including India. Vibrio cholerae, the causative agent of cholera has exhibited several changing pattern in its biotype as well as in drug resistance for its better survival and infection . V. cholerae classical biotype strains after causing earlier six cholera pandemics were replaced by El Tor biotype in the seventh pandemic. The variant V. cholerae O1 El Tor strain possessing cholera toxin of classical biotype appeared after O139, and has now become a major threat worldwide . Likewise, antimicrobial susceptibility pattern also has continuously changed for V. cholerae. Tetracycline is an important broad spectrum antibiotic used for the prophylaxis and treatment of variety of bacterial infections including listed biothreat agents like Bacillus anthracis, Francisella tularensis, Yersinia pestis . This is also a preferred choice for control of cholera as recommended by WHO. Earlier, in 2007, during the investigation of a large cholera outbreak in Rayagada (19.09°N 83.27°E), Orissa, Eastern India, we reported a novel mutation in ctxB gene of V. cholerae O1 El Tor isolates indicating the enhanced virulence potential . The same allelic variation has recently been found in the V. cholerae isolates from a recent outbreak in Haiti . These isolates from India were multidrug resistant but sensitive to tetracycline . In this communication, we report the emergence of tetracycline resistant V. cholerae O1 El Tor Ogawa in a recent cholera outbreak from the same place i.e. Rayagada (19.09°N 83.27°E), Orissa, Eastern India during September–October 2010.Tetracycline resistant V. cholerae O1 biotype El Tor serotype Ogawa with classical ctxB from a recent cholera outbreak in Orissa, Eastern IndiaPramod Kumar, Meenu Jain, Ajay K. Goel, Dev V. Kamboj, Om Kumar10.1016/j.jiph.2011.09.007Journal of Infection and Public Health 5, 2 (2012)2012-04-01Journal of Infection and Public Health2012-04-0152S1876-0341(12)X0003-0Letters to the Editor217219