1
|
Lack of Evidence on Association between Iron Deficiency and COVID-19 Vaccine-Induced Neutralizing Humoral Immunity. Vaccines (Basel) 2023; 11:vaccines11020327. [PMID: 36851205 PMCID: PMC9965425 DOI: 10.3390/vaccines11020327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
Iron is a crucial micronutrient for immunity induction in response to infections and vaccinations. This study aimed to investigate the effect of iron deficiency on COVID-19-vaccine-induced humoral immunity. We investigated the effectiveness of COVID-19 vaccines (BNT162b2, mRNA-1273, and ChAdOx nCov-2019) in iron-deficient individuals (n = 63) and provide a side-by-side comparison to healthy controls (n = 67). The presence of anti-SARS-CoV-2 spike (S) and anti-nucleocapsid (NP) IgG were assessed using in-house S- and NP-based ELISA followed by serum neutralization test (SNT). High concordance between S-based ELISA and SNT results was observed. The prevalence of neutralizing antibodies was 95.24% (60/63) in the study group and 95.52% (64/67) in the controls with no significant difference. The presence/absence of past infection, period since vaccination, vaccine type, and being iron-deficient or having iron-deficiency anemia did not exert any significant effect on the prevalence or titer of anti-SARS-CoV-2 neutralizing antibodies. NP-based ELISA identified individuals unaware of exposure to SARS-CoV-2. Moreover, absence of anti-NP IgG was noted in participants who were previously diagnosed with COVID-19 suggesting the unpredictability of after-infection immunity. To sum up, this study demonstrated an initial lack of evidence on the association between iron deficiency and the effectiveness of COVID-19-vaccine-induced neutralizing humoral immunity. Similar studies with larger sample size remain necessary to obtain comprehensive conclusions about the effect or lack of effect of iron on COVID-19-vaccine effectiveness.
Collapse
|
2
|
Faizo AA, Qashqari FS, El‐Kafrawy SA, Barasheed O, Almashjary MN, Alfelali M, Bawazir AA, Albarakati BM, Khayyat SA, Hassan AM, Alandijany TA, Azhar EI. A potential association between obesity and reduced effectiveness of COVID-19 vaccine-induced neutralizing humoral immunity. J Med Virol 2022; 95:e28130. [PMID: 36068377 PMCID: PMC9539352 DOI: 10.1002/jmv.28130] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/05/2022] [Accepted: 09/04/2022] [Indexed: 01/11/2023]
Abstract
Due to the adverse effects of obesity on host immunity, this study investigated the effectiveness of COVID-19 vaccines (BNT162b2, ChAdOx-nCov-2019, and mRNA-1273) in inducing anti-SARS-CoV-2 Spike (S) neutralizing antibodies among individuals with various obesity classes (class I, II, III, and super obesity). Sera from vaccinated obese individuals (n = 73) and normal BMI controls (n = 46) were subjected to S-based enzyme-linked immunosorbent assay (ELISA) and serum-neutralization test (SNT) to determine the prevalence and titer of anti-SARS-CoV-2 neutralizing antibodies. Nucleocapsid-ELISA was also utilized to distinguish between immunity acquired via vaccination only versus vaccination plus recovery from infection. Data were linked to participant demographics including age, gender, past COVID-19 diagnosis, and COVID-19 vaccination profile. S-based ELISA demonstrated high seroprevalence rates (>97%) in the study and control groups whether samples with evidence of past infection were included or excluded. Interestingly, however, SNT demonstrated a slightly significant reduction in both the rate and titer of anti-SARS-CoV-2 neutralizing antibodies among vaccinated obese individuals (60/73; 82.19%) compared to controls (45/46; 97.83%). The observed reduction in COVID-19 vaccine-induced neutralizing humoral immunity among obese individuals occurs independently of gender, recovery from past infection, and period from last vaccination. Our data suggest that COVID-19 vaccines are highly effective in inducing protective humoral immunity. This effectiveness, however, is potentially reduced among obese individuals which highlight the importance of booster doses to improve their neutralizing immunity. Further investigations on larger sample size remain necessary to comprehensively conclude about the effect of obesity on COVID-19 vaccine effectiveness on humoral immunity induction.
Collapse
Affiliation(s)
- Arwa A. Faizo
- Special Infectious Agents Unit, King Fahd Medical Research CenterKing Abdulaziz UniversityJeddahSaudi Arabia,Department of Medical Laboratory Sciences, Faculty of Applied Medical SciencesKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Fadi S. Qashqari
- Special Infectious Agents Unit, King Fahd Medical Research CenterKing Abdulaziz UniversityJeddahSaudi Arabia,Department of Microbiology, College of MedicineUmm Al‐Qura UniversityMakkahSaudi Arabia
| | - Sherif A. El‐Kafrawy
- Special Infectious Agents Unit, King Fahd Medical Research CenterKing Abdulaziz UniversityJeddahSaudi Arabia,Department of Medical Laboratory Sciences, Faculty of Applied Medical SciencesKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Osamah Barasheed
- Department of Research and InnovationKing Abdullah Medical CityMakkahSaudi Arabia
| | - Majed N. Almashjary
- Special Infectious Agents Unit, King Fahd Medical Research CenterKing Abdulaziz UniversityJeddahSaudi Arabia,Department of Medical Laboratory Sciences, Faculty of Applied Medical SciencesKing Abdulaziz UniversityJeddahSaudi Arabia,Hematology Unit, King Fahd Medical Research CenterKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Mohammed Alfelali
- Department of Family and Community Medicine, Faculty of MedicineKing Abdulaziz UniversityRabighSaudi Arabia
| | - Asma A. Bawazir
- Special Infectious Agents Unit, King Fahd Medical Research CenterKing Abdulaziz UniversityJeddahSaudi Arabia,Department of Medical Laboratory Sciences, Faculty of Applied Medical SciencesKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Boshra M. Albarakati
- Department of Microbiology, College of MedicineUmm Al‐Qura UniversityMakkahSaudi Arabia
| | - Soud A. Khayyat
- Department of Microbiology, College of MedicineUmm Al‐Qura UniversityMakkahSaudi Arabia
| | - Ahmed M. Hassan
- Special Infectious Agents Unit, King Fahd Medical Research CenterKing Abdulaziz UniversityJeddahSaudi Arabia,Department of Medical Laboratory Sciences, Faculty of Applied Medical SciencesKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Thamir A. Alandijany
- Special Infectious Agents Unit, King Fahd Medical Research CenterKing Abdulaziz UniversityJeddahSaudi Arabia,Department of Medical Laboratory Sciences, Faculty of Applied Medical SciencesKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Esam I. Azhar
- Special Infectious Agents Unit, King Fahd Medical Research CenterKing Abdulaziz UniversityJeddahSaudi Arabia,Department of Medical Laboratory Sciences, Faculty of Applied Medical SciencesKing Abdulaziz UniversityJeddahSaudi Arabia
| |
Collapse
|
3
|
Dandachi I, Aljabr W. Prognosis of COVID-19 in the middle eastern population, knowns and unknowns. Front Microbiol 2022; 13:974205. [PMID: 36118201 PMCID: PMC9471247 DOI: 10.3389/fmicb.2022.974205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/09/2022] [Indexed: 01/08/2023] Open
Abstract
Since its emergence in China in 2019, the SARS-CoV-2 virus has affected all countries worldwide. The virus is easily transmitted from one person to another via infected aerosols or contaminated surfaces. Unlike its counterparts, the prognosis of COVID-19 ranges from asymptomatic to critical disease or death. Several factors play a role in determining the severity of the disease in infected patients. Among others, is the pre-existence of an underlying medical condition such as diabetes, cancer, and others. Furthermore, although children are less prone to the severe form of the COVID-19 disease, they require attention due to the report of many atypical presentations of the infection, post-asymptomatic exposure. In the Middle East, little is known about the prognosis of the SARS-CoV-2 infection in high-risk categories, notably patients with diabetes, cancer, and pregnant women. The aim of this review is to summarize the current knowledge about this group of population in the middle eastern region as well as to highlight the gap in the literature. We have found that the majority of the papers were from the Gulf countries. Although, few studies were conducted; high-risk patients appear to have an increased risk of morbidity and mortality from COVID-19 compared to their counterparts. Higher levels of inflammatory markers, C-reactive protein, erythrocyte sedimentation rate, D-dimer, and ferritin levels were also observed. Children are often asymptomatic or present with atypical presentations. More studies should be conducted to determine the clinical biomarkers of COVID-19 in high-risk categories to help in patient risk stratification and management in the middle eastern population.
Collapse
|
4
|
Mushcab H, Al-Tawfiq JA, Ghamdi M, Babgi A, Amir A, Sheikh SS, Darwisheh A, Alobaid A, Jebakumar AZ, Qahtani S, Al Sagheir A. A Cohort Study of Seroprevalence of Antibodies Against SARS-CoV-2 Infection Among Healthcare Workers at a Tertiary Hospital in Saudi Arabia. Infect Drug Resist 2022; 15:4393-4406. [PMID: 35974896 PMCID: PMC9375977 DOI: 10.2147/idr.s369755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/12/2022] [Indexed: 11/24/2022] Open
Abstract
Background The nature of the healthcare workers’ jobs standing at the frontline against the coronavirus disease 2019 (COVID-19) puts them at a higher risk of unknowingly contracting the disease and potentially contributing to the spread. This study aims to assess the overall positive seroconversion prevalence of SARS-CoV-2. Methods This is a longitudinal cohort study of healthcare workers at Johns Hopkins Aramco Healthcare (JHAH). JHAH is a tertiary hospital located in Dhahran serving patients in several districts in the Eastern Province of Saudi Arabia. Participants were recruited between June and December 2020. Each participant had a serology blood test and completed the World Health Organization’s risk factor assessment questionnaire. Results This study included 682 participants working in JHAH, representing 15.7% of our population. Out of the 682 participants, 15.2% had a positive SARS-CoV-2 rt-PCR before taking part in the study. However, only 87 tested positive for SARS-CoV-2 antibodies, a prevalence of 12.7% of all participants. Out of the 87 positives for SARS-CoV-2 antibodies, 17 participants never tested positive for COVID-19 rt-PCR, a prevalence of 2.9%. Moreover, not properly using alcohol-based hand rub or soap and water after the risk of body fluid exposure and wearing personal protective equipment when indicated were found to be statistically significant to having a positive SARS-CoV-2 IgG assay. Conclusion Positive seroconversion rate was considerably low during the first wave of COVID-19 amongst JHAH’s healthcare workers and similar to other healthcare organizations in Saudi Arabia. Seropositivity correlated significantly with following infection prevention and control recommendations. Clinicaltrials.gov Identifier NCT04469647.
Collapse
Affiliation(s)
- Hayat Mushcab
- Research Office, Johns Hopkins Aramco Healthcare, Dhahran, Eastern Province, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Infectious Disease Unit - Specialty Internal Medicine, and Quality and Patient Safety Department, Johns Hopkins Aramco Healthcare, Dhahran, Eastern Province, Saudi Arabia.,Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Infectious Disease Division, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mohammed Ghamdi
- Population Health Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Amani Babgi
- Clinical Practice Education & Research, Johns Hopkins Aramco Healthcare, Dhahran, Eastern Province, Saudi Arabia
| | - Abdulrazack Amir
- Office of Academic Affairs, Johns Hopkins Aramco Healthcare, Dhahran, Eastern Province, Saudi Arabia
| | - Salwa S Sheikh
- Pathology Department, Johns Hopkins Aramco Healthcare, Dhahran, Eastern Province, Saudi Arabia
| | - Adel Darwisheh
- Laboratory Services Department, Johns Hopkins Aramco Healthcare, Dhahran, Eastern Province, Saudi Arabia
| | - Abrar Alobaid
- Laboratory Services Department, Johns Hopkins Aramco Healthcare, Dhahran, Eastern Province, Saudi Arabia
| | - Arulanantham Zechariah Jebakumar
- Vice Deanship of Postgraduate Studies Research, Prince Sultan Military College of Health Sciences, Dhahran, Eastern Province, Saudi Arabia
| | - Saeed Qahtani
- Wellness Institute, Johns Hopkins Aramco Healthcare, Dhahran, Eastern Province, Saudi Arabia
| | - Ahmed Al Sagheir
- Research Office, Johns Hopkins Aramco Healthcare, Dhahran, Eastern Province, Saudi Arabia
| |
Collapse
|
5
|
Pitak-Arnnop P, Sirintawat N, Tangmanee C, Sukphopetch P, Meningaud JP, Neff A. Inanimate surface contamination of SARS-CoV-2 during midfacial fracture repair in asymptomatic COVID-19 patients. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e233-e240. [PMID: 35063683 PMCID: PMC8767911 DOI: 10.1016/j.jormas.2022.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 01/11/2022] [Accepted: 01/15/2022] [Indexed: 12/24/2022]
Abstract
Purposes To evaluate inanimate surface contamination of SARS-CoV-2 during midfacial fracture repair (MFR) and to identify relevant aggregating factors. Methods Using a prospective non-randomised comparative study design, we enrolled a cohort of asymptomatic COVID-19 patients undergoing MFR. The predictor variables were osteofixation system (conventional titanium plates [CTiP] vs. ultrasound-assisted resorbable plates [USaRP]). The main outcomes were the presence of SARS-CoV-2 on four different surfaces. Other study variables were categorised into demographic, anatomical, and operative. Descriptive, bi- and multivariate statistics were computed. Results The sample consisted of 11 patients (27.3% females, 63.6% right side, 72.7% displaced fractures) with a mean age of 52.7 ± 20.1 years (range, 19–85). Viral spread was, on average, 1.9 ± 0.4 m. from the operative field, including most oral and orbital retractors’ tips (81.8% and 72.7%) and no virus was found at 3 m from the operative field, but no significant difference was found between 2 osteofixation types. On binary adjustments, significantly broader contamination was linked to centrolateral MFR (P = 0.034; 95% confidence interval [CI], 0.05 to 1.02), and displaced MFR > 45 min (P = 0.022; 95% CI, 0.1 to 1.03). Conclusions USaRP, albeit presumably heavily aerosol-producing, cause similar SARS-CoV-2 distribution to CTiP. Non-surgical operating room (OR) staff should stay ≥ 3 m from the operative field, if the patient is SARS-CoV-2-positive. Enoral and orbital instruments are a potential virus source, especially during displaced MFR > 45 min and/or centrolateral MFR, emphasising an importance of appropriate patient screening and OR organisation.
Collapse
Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Maxillofacial Surgery, UKGM GmbH, Campus Marburg, Faculty of Medicine, University Hospital of Giessen and Marburg, Philipps-University of Marburg, Baldingerstr, Marburg 35043, Germany.
| | - Nattapong Sirintawat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Chatpong Tangmanee
- Department of Statistics, Chulalongkorn Business School, Bangkok, Thailand
| | - Passanesh Sukphopetch
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Thailand
| | - Jean-Paul Meningaud
- Department of Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery, AP-HP, Faculty of Medicine, Henri Mondor University Hospital, University Paris-Est Créteil Val de Marne (Paris XII), Créteil, France
| | - Andreas Neff
- Department of Oral and Maxillofacial Surgery, UKGM GmbH, Campus Marburg, Faculty of Medicine, University Hospital of Giessen and Marburg, Philipps-University of Marburg, Baldingerstr, Marburg 35043, Germany
| |
Collapse
|
6
|
Alandijany TA, Faizo AA. Development of Serological Assays and Seroprevalence Studies of the New Coronavirus 2019 (COVID-19): Reports from Saudi Arabia. Healthcare (Basel) 2021; 9:healthcare9121730. [PMID: 34946456 PMCID: PMC8701666 DOI: 10.3390/healthcare9121730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 12/30/2022] Open
Abstract
Serological assays are valuable tools for tracking COVID-19 spread, estimation of herd immunity, and evaluation of vaccine effectiveness. Several reports from Saudi Arabia describe optimized in-house protocols that enable detection of SARS-CoV-2 specific antibodies and measurement of their neutralizing activity. Notably, there were variations in the approaches utilized to develop and validate these immunoassays in term of sample size, validation methodologies, and statistical analyses. The developed enzyme-linked immunoassays (ELISAs) were based on the viral full-length spike (S), S1 subunit, and nucleocapsid (NP), and enabled detection of IgM and/or IgG. ELISAs were evaluated and validated against a microneutralization assay utilizing a local SARS-CoV-2 clinical isolate, FDA-approved commercially available immunoassays, and/or real-time polymerase chain reaction (RT-PCR). Overall, the performance of the described assays was high, reaching up to 100% sensitivity and 98.9% specificity with no cross-reactivity with other coronaviruses. In-house immunoassays, along with commercially available kits, were subsequently applied in a number of sero-epidemiological studies aiming to estimate sero-positivity status among local populations including healthcare workers, COVID-19 patients, non-COVID-19 patients, and healthy blood donors. The reported seroprevalence rates differed widely among these studies, ranging from 0.00% to 32.2%. These variations are probably due to study period, targeted population, sample size, and performance of the immunoassays utilized. Indeed, lack of sero-positive cases were reported among healthy blood donors during the lockdown, while the highest rates were reported when the number of COVID-19 cases peaked in the country, particularly among healthcare workers working in referral hospitals and quarantine sites. In this review, we aim to (1) provide a critical discussion about the developed in-house immunoassays, and (2) summarize key findings of the sero-epidemiological studies and highlight strengths and weaknesses of each study.
Collapse
Affiliation(s)
- Thamir A. Alandijany
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, P.O. Box 128442, Jeddah 21362, Saudi Arabia
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, P.O. Box 80324, Jeddah 21589, Saudi Arabia
- Correspondence: (T.A.A.); (A.A.F.)
| | - Arwa A. Faizo
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, P.O. Box 128442, Jeddah 21362, Saudi Arabia
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, P.O. Box 80324, Jeddah 21589, Saudi Arabia
- Correspondence: (T.A.A.); (A.A.F.)
| |
Collapse
|
7
|
Alhasan K, Aljamaan F, Temsah MH, Alshahrani F, Bassrawi R, Alhaboob A, Assiri R, Alenezi S, Alaraj A, Alhomoudi RI, Batais MA, Al-Eyadhy L, Halwani R, AbdulMajeed N, Al-Jedai A, Senjab A, Memish ZA, Al-Subaie S, Barry M, Al-Tawfiq JA. COVID-19 Delta Variant: Perceptions, Worries, and Vaccine-Booster Acceptability among Healthcare Workers. Healthcare (Basel) 2021; 9:1566. [PMID: 34828612 PMCID: PMC8621199 DOI: 10.3390/healthcare9111566] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/23/2021] [Accepted: 11/11/2021] [Indexed: 12/23/2022] Open
Abstract
Background: As the COVID-19 Delta variant has spread across the globe, healthcare workers' (HCWs) knowledge, worries, and vaccine booster acceptance should be assessed. Methods: Online questionnaires aimed at HCWs in Saudi Arabia were distributed between 9 and 12 August 2021, aiming to evaluate HCWs' perceptions and worries about the Delta variant as well as their feelings about receiving a booster-vaccine. Results: A total of 1279 HCWs participated, with 51.1% being physicians and 41.7% nurses. 92.5% were aware of the emergence of the Delta variant. Still, only 28.7% were found to have sufficient knowledge of the variant, and their level of worry about it was higher than their level of worry about the Alpha variant (2.32/5 versus 1.79/5). The main information sources cited by the participants were social media (50.5%), while 30.5% used scientific journals. Overall, 55.3% were willing to receive a vaccine booster, while one third would have preferred to receive a new mRNA vaccine specifically developed for the Delta variant. Factors associated with vaccine booster acceptance were receiving both vaccination doses (p = 0.008), believing that the Pfizer-BioNTech BNT162b2 vaccine is effective against variants (p < 0.001), and agreement that mixing/matching vaccines is effective against variants (p < 0.001). Conclusions: A high percentage of HCWs were aware of the Delta variant, but only a small fraction had decent quality of knowledge about it. The participants exhibited high worry levels and showed a modest acceptance of receiving a vaccine booster dose. These results should encourage public health officials to scale up educational efforts to disseminate reliable information about the different variants and provide recommendations about receiving a vaccine booster. Further research on methods to alleviate HCWs' worries about emerging variants is warranted.
Collapse
Affiliation(s)
- Khalid Alhasan
- Pediatric Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia; (K.A.); (A.A.); (L.A.-E.); (S.A.-S.)
- Pediatric Department, King Saud University Medical City, Riyadh 11362, Saudi Arabia; (R.B.); (R.I.A.); (N.A.)
| | - Fadi Aljamaan
- Critical Care Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Mohamad-Hani Temsah
- Pediatric Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia; (K.A.); (A.A.); (L.A.-E.); (S.A.-S.)
- Pediatric Department, King Saud University Medical City, Riyadh 11362, Saudi Arabia; (R.B.); (R.I.A.); (N.A.)
- Prince Abdullah Ben Khaled Celiac Disease Research Chair, Department of Pediatrics, Faculty of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
| | - Fatimah Alshahrani
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh 11451, Saudi Arabia; (F.A.); (M.B.)
| | - Rolan Bassrawi
- Pediatric Department, King Saud University Medical City, Riyadh 11362, Saudi Arabia; (R.B.); (R.I.A.); (N.A.)
| | - Ali Alhaboob
- Pediatric Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia; (K.A.); (A.A.); (L.A.-E.); (S.A.-S.)
- Pediatric Department, King Saud University Medical City, Riyadh 11362, Saudi Arabia; (R.B.); (R.I.A.); (N.A.)
| | - Rasha Assiri
- Department of Basic Medical Sciences, College of Medicine, Princess Nourah Bent Abdulrahman University, Riyadh 11451, Saudi Arabia;
| | - Shuliweeh Alenezi
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Ali Alaraj
- Department of Medicine, College of Medicine, Qassim University, Buraydah 51452, Saudi Arabia;
- Department of Medicine, Doctor Sulaiman Al Habib Medical Group, Riyadh 11643, Saudi Arabia
| | - Reham I. Alhomoudi
- Pediatric Department, King Saud University Medical City, Riyadh 11362, Saudi Arabia; (R.B.); (R.I.A.); (N.A.)
| | - Mohammed A. Batais
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Lama Al-Eyadhy
- Pediatric Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia; (K.A.); (A.A.); (L.A.-E.); (S.A.-S.)
| | - Rabih Halwani
- Sharjah Institute of Medical Research, University of Sharjah, Sharjah 27272, United Arab Emirates;
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Naif AbdulMajeed
- Pediatric Department, King Saud University Medical City, Riyadh 11362, Saudi Arabia; (R.B.); (R.I.A.); (N.A.)
- Pediatric Nephrology Department, Prince Sultan Military Medical City, Riyadh 12233, Saudi Arabia
| | - Ahmed Al-Jedai
- Deputyship of Therapeutic Affairs, Ministry of Health, Riyadh 11176, Saudi Arabia;
- Colleges of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia;
| | | | - Ziad A. Memish
- King Saud Medical City, Ministry of Health & Alfaisal University, Riyadh 11533, Saudi Arabia;
- Hubert Department of Global Health, Emory University, Atlanta, GA 30322, USA
| | - Sarah Al-Subaie
- Pediatric Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia; (K.A.); (A.A.); (L.A.-E.); (S.A.-S.)
- Pediatric Department, King Saud University Medical City, Riyadh 11362, Saudi Arabia; (R.B.); (R.I.A.); (N.A.)
| | - Mazin Barry
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh 11451, Saudi Arabia; (F.A.); (M.B.)
| | - Jaffar A. Al-Tawfiq
- Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran 34465, Saudi Arabia;
- Department of Medicine, Infectious Disease Division, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Department of Medicine, Infectious Disease Division, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| |
Collapse
|