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Concept: Medina

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PURPOSE: Epilepsy is very common in the Kingdom of Saudi Arabia, with a prevalence of 6.54 per 1000. The present study was conducted to investigate the level of public awareness, and the attitudes and knowledge regarding epilepsy in the Saudi population in Riyadh - capital city of Saudi Arabia. METHODS: A survey consisting of 19 questions pertaining to epilepsy awareness was distributed to Saudi citizens living in Riyadh older than 15 years of age in malls, supermarkets, health clubs, mosques, universities and schools. RESULTS: Of the 7078 respondents who completed the questionnaire, 6756 (95.5%) had heard about epilepsy, 3024 (42.7%) had witnessed what they believed to be a seizure and 5164 (73%) would allow their children to interact with an individual who had epilepsy. However, 5382 (76%) respondents would not want their children to marry an individual with epilepsy, 1004 (14.2%) believed that epilepsy was infectious and 574 (8.1%) believed that epilepsy was a type of mental illness. A total of 1509 (21.3%) respondents were not aware of a single potential cause of epilepsy, 3493 (50.6%) would not seek medical advice if one of their relatives had epilepsy, 2221 (31.4%) did not know how to deal with an individual experiencing an epileptic episode and 6554 (92.6%) did not know that surgery was a treatment option for individuals with epilepsy in Saudi Arabia. Of the 7078 respondents, 3237 (45.7%) would not abide by a physician’s advice not to operate a motor vehicle because of their illness, of whom 1631 (50.4%) cited problems with the public transportation system as a reason for disregarding the doctor’s advice. The effect of age and level of education were statistically significant on most of the study variables. CONCLUSION: The level of epilepsy awareness in the Saudi population needs improvement.

Concepts: Saudi Arabia, Arabian Peninsula, Riyadh, Mecca, Jeddah, Ha'il, Dammam, Medina

28

 In spring 2014, a sudden rise in the number of notified MERS-Coronavirus infections occurred across Saudi Arabia with a focus in Jeddah. Hypotheses to explain the outbreak pattern include increased surveillance, increased zoonotic transmission, nosocomial transmission, changes in viral transmissibility, as well as diagnostic laboratory artifacts.

Concepts: Saudi Arabia, Arabian Peninsula, Riyadh, Mecca, Jeddah, Ha'il, Dammam, Medina

28

Dengue remains a major health problem in Jeddah, Saudi Arabia. A surveillance system was initiated to detect new cases in 2006. The study aims to examine these data for detection of space-time clustering and identify target areas for effective interventions.

Concepts: Saudi Arabia, Riyadh, Mecca, Jordan, Jeddah, Medina

23

The pattern of Mycobacterium tuberculosis susceptibility to first line drugs and multidrug resistance in Al-Madinah Al-Munawarah, a seasonally overcrowded are during Hajj and Omrah, is not well studied.

Concepts: Tuberculosis, Saudi Arabia, Arabian Peninsula, Riyadh, Mecca, Mycobacterium, Medina, Al Madinah Province

6

Tuberculosis (TB) is now the most common infectious disease cause of death globally. In 2014, an estimated 9.6 million people developed active TB and there were 3 million people with active TB, including 360,000 with multi-drug resistant TB (MDR-TB) who were not diagnosed and they continue to fuel TB transmission in the community. Accurate data on the actual burden of TB and transmission risk associated with mass gatherings are scanty and unreliable due to small numbers studied and methodological issues. Every year an estimated 10 million pilgrims from 184 countries travel to the Kingdom of Saudi Arabia to perform the Hajj and Umrah pilgrimages. A large majority of pilgrims come from high TB and MDR-TB endemic areas and thus many may have undiagnosed active TB, sub-clinical TB and latent TB infection. The Hajj pilgrimage provide unique opportunities for KSA and the 184 countries from which pilgrims originate, to conduct high quality priority research studies on TB under the remit of the Global Center for Mass Gatherings Medicine. We discuss research opportunities for defining the TB burden, transmission risk, and optimal surveillance, prevention and control measures at the annual Hajj pilgrimage-these data are for developing international recommendations and guidelines for TB management and control at mass gatherings events.

Concepts: Infectious disease, Tuberculosis, Saudi Arabia, Mecca, Hajj, Medina, Masjid al-Haram, Pilgrimage

3

Health care is a basic human right, and Saudi Arabia affirms these rights for all its citizens.

Concepts: Health care, Medicine, Saudi Arabia, Mecca, Law, Human rights, Jeddah, Medina

2

This study explores medicinal plant knowledge and use among Muslim women in the city of Mecca, Saudi Arabia. Ethnobotanical research in the region has focused on rural populations and male herbal healers in cities, and based on these few studies, it is suggested that medicinal plant knowledge may be eroding. Here, we document lay, female knowledge of medicinal plants in an urban centre, interpreting findings in the light of the growing field of urban ethnobotany and gendered knowledge and in an Islamic context.

Concepts: City, Saudi Arabia, Arabian Peninsula, Mecca, Botany, Herbalism, Ethnobotany, Medina

2

To assess hospital emergency nurses' self-reported knowledge, role awareness and skills in disaster response with respect to the Hajj mass gathering in Mecca.

Concepts: Saudi Arabia, Arabian Peninsula, Riyadh, Mecca, Jeddah, House of Saud, Medina, Masjid al-Haram

2

Mass gatherings are characterized by the concentration of people temporally and spatially that may lead to the emergence of infectious diseases due to enhanced transmission between attendees as well demonstrated in the context of the Hajj and Umrah pilgrimages in Saudi Arabia. The goal of this review is to present the available evidence on outbreaks associated with a variety of pathogens or also the lack thereof as assessed by thorough surveillance at any mass gatherings, except those in Saudi Arabia. A systematic search for relevant literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. 68 studies were identified. Although outbreaks are not frequently reported in or after mass gatherings outside the Hajj and Umrah pilgrimages, they did sometimes occur at Muslim, Christian and Hindu religious events, at sport events and large scale open air festivals. In this review we show that most common outbreaks at these mass gatherings were vaccine preventable diseases, mainly measles and influenza, but also outbreaks of mumps, hepatitis A. Meningococcal disease were rarely recorded. Additionally we show that transmission of various communicable diseases, which may not be prevented by vaccine, has been recorded in association with mass gatherings. These were mainly gastrointestinal infections due to a variety of pathogens. It is also noticeable that some outbreaks occurring at mass gatherings result in international spread of communicable diseases.

Concepts: Epidemiology, Disease, Infectious disease, Infection, Mecca, Measles, Hajj, Medina

2

Background A marked increase in the number of cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection occurred in Jeddah, Saudi Arabia, in early 2014. We evaluated patients with MERS-CoV infection in Jeddah to explore reasons for this increase and to assess the epidemiologic and clinical features of this disease. Methods We identified all cases of laboratory-confirmed MERS-CoV infection in Jeddah that were reported to the Saudi Arabian Ministry of Health from January 1 through May 16, 2014. We conducted telephone interviews with symptomatic patients who were not health care personnel, and we reviewed hospital records. We identified patients who were reported as being asymptomatic and interviewed them regarding a history of symptoms in the month before testing. Descriptive analyses were performed. Results Of 255 patients with laboratory-confirmed MERS-CoV infection, 93 died (case fatality rate, 36.5%). The median age of all patients was 45 years (interquartile range, 30 to 59), and 174 patients (68.2%) were male. A total of 64 patients (25.1%) were reported to be asymptomatic. Of the 191 symptomatic patients, 40 (20.9%) were health care personnel. Among the 151 symptomatic patients who were not health care personnel, 112 (74.2%) had data that could be assessed, and 109 (97.3%) of these patients had had contact with a health care facility, a person with a confirmed case of MERS-CoV infection, or someone with severe respiratory illness in the 14 days before the onset of illness. The remaining 3 patients (2.7%) reported no such contacts. Of the 64 patients who had been reported as asymptomatic, 33 (52%) were interviewed, and 26 of these 33 (79%) reported at least one symptom that was consistent with a viral respiratory illness. Conclusions The majority of patients in the Jeddah MERS-CoV outbreak had contact with a health care facility, other patients, or both. This highlights the role of health care-associated transmission. (Supported by the Ministry of Health, Saudi Arabia, and by the U.S. Centers for Disease Control and Prevention.).

Concepts: Epidemiology, Saudi Arabia, Arabian Peninsula, Riyadh, Mecca, Middle East, Jeddah, Medina