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Alhumaid S, Al Mutared KM, Al Alawi Z, Sabr Z, Alkhars O, Alabdulqader M, Al Dossary N, ALShakhs FM, Majzoub RA, Alalawi YH, Al Noaim K, Alnaim AA, Al Ghamdi MA, Alahmari AA, Albattat SS, Almubarak YS, Al Abdulmohsen EM, Al Shaikh H, Alobaidan ME, Almusallam HH, Alhassan FM, Alamer MA, Al-Hajji JA, Al-Hajji DA, Alkadi AA, Al Mutair A, Rabaan AA. Severity of SARS-CoV-2 infection in children with inborn errors of immunity (primary immunodeficiencies): a systematic review. Allergy Asthma Clin Immunol 2023; 19:69. [PMID: 37559153 PMCID: PMC10413516 DOI: 10.1186/s13223-023-00831-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 07/30/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Inborn errors of immunity (IEIs) are considered significant challenges for children with IEIs, their families, and their medical providers. Infections are the most common complication of IEIs and children can acquire coronavirus disease 2019 (COVID-19) even when protective measures are taken. OBJECTIVES To estimate the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children with IEIs and analyse the demographic parameters, clinical characteristics and treatment outcomes in children with IEIs with COVID-19 illness. METHODS For this systematic review, we searched ProQuest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus and Nature through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guideline for studies on the development of COVID-19 in children with IEIs, published from December 1, 2019 to February 28, 2023, with English language restriction. RESULTS Of the 1095 papers that were identified, 116 articles were included in the systematic review (73 case report, 38 cohort 4 case-series and 1 case-control studies). Studies involving 710 children with IEIs with confirmed COVID-19 were analyzed. Among all 710 IEIs pediatric cases who acquired SARS-CoV-2, some children were documented to be admitted to the intensive care unit (ICU) (n = 119, 16.8%), intubated and placed on mechanical ventilation (n = 87, 12.2%), suffered acute respiratory distress syndrome (n = 98, 13.8%) or died (n = 60, 8.4%). Overall, COVID-19 in children with different IEIs patents resulted in no or low severity of disease in more than 76% of all included cases (COVID-19 severity: asymptomatic = 105, mild = 351, or moderate = 88). The majority of children with IEIs received treatment for COVID-19 (n = 579, 81.5%). Multisystem inflammatory syndrome in children (MIS-C) due to COVID-19 in children with IEIs occurred in 103 (14.5%). Fatality in children with IEIs with COVID-19 was reported in any of the included IEIs categories for cellular and humoral immunodeficiencies (n = 19, 18.6%), immune dysregulatory diseases (n = 17, 17.9%), innate immunodeficiencies (n = 5, 10%), bone marrow failure (n = 1, 14.3%), complement deficiencies (n = 1, 9.1%), combined immunodeficiencies with associated or syndromic features (n = 7, 5.5%), phagocytic diseases (n = 3, 5.5%), autoinflammatory diseases (n = 2, 3%) and predominantly antibody deficiencies (n = 5, 2.5%). Mortality was COVID-19-related in a considerable number of children with IEIs (29/60, 48.3%). The highest ICU admission and fatality rates were observed in cases belonging to cellular and humoral immunodeficiencies (26.5% and 18.6%) and immune dysregulatory diseases (35.8% and 17.9%) groups, especially in children infected with SARS-CoV-2 who suffered severe combined immunodeficiency (28.6% and 23.8%), combined immunodeficiency (25% and 15%), familial hemophagocytic lymphohistiocytosis (40% and 20%), X-linked lymphoproliferative diseases-1 (75% and 75%) and X-linked lymphoproliferative diseases-2 (50% and 50%) compared to the other IEIs cases. CONCLUSION Children with IEIs infected with SARS-CoV-2 may experience higher rates of ICU admission and mortality in comparison with the immunocompetent pediatric populations. Underlying immune defects does seem to be independent risk factors for severe SARS-CoV-2 infection in children with IEIs, a number of children with SCID and CID were reported to have prolonged infections-though the number of patients is small-but especially immune dysregulation diseases (XLP1 and XLP2) and innate immunodeficiencies impairing type I interferon signalling (IFNAR1, IFNAR2 and TBK1).
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Affiliation(s)
- Saad Alhumaid
- School of Pharmacy, University of Tasmania, Hobart, 7000, Australia.
| | - Koblan M Al Mutared
- Administration of Pharmaceutical Care, Ministry of Health, 66255, Najran, Saudi Arabia
| | - Zainab Al Alawi
- Division of Allergy and Immunology, College of Medicine, King Faisal University, 31982, Hofuf, Al-Ahsa, Saudi Arabia
| | - Zainah Sabr
- Division of Allergy and Immunology, Pediatric Department, College of Medicine, King Khalid University, 62529, Abha, Saudi Arabia
| | - Ola Alkhars
- Pediatric Department, King Faisal General Hospital, Ministry of Health, 36361, Hofuf, Al-Ahsa, Saudi Arabia
| | - Muneera Alabdulqader
- Pediatric Nephrology Specialty, Pediatric Department, Medical College, King Faisal University, 31982, Hofuf, Al-Ahsa, Saudi Arabia
| | - Nourah Al Dossary
- General Surgery Department, Alomran General Hospital, Ministry of Health, 36358, Hofuf, Al-Ahsa, Saudi Arabia
| | - Fatemah M ALShakhs
- Respiratory Therapy Department, Prince Saud Bin Jalawi Hospital, Ministry of Health, 36424, Al Mubarraz, Al-Ahsa, Saudi Arabia
| | - Rabab Abbas Majzoub
- Department of Pediatrics, College of Medicine, King Faisal University, 31982, Hofuf, Al-Ahsa, Saudi Arabia
| | - Yousef Hassan Alalawi
- Ear, Nose and Throat Department, Al Jabr Hospital for Eye, Ear, Nose and Throat, Ministry of Health, 36422, Al Mubarraz, Al-Ahsa, Saudi Arabia
| | - Khalid Al Noaim
- Department of Pediatrics, College of Medicine, King Faisal University, 31982, Hofuf, Al-Ahsa, Saudi Arabia
| | - Abdulrahman A Alnaim
- Department of Pediatrics, College of Medicine, King Faisal University, 31982, Hofuf, Al-Ahsa, Saudi Arabia
| | - Mohammed A Al Ghamdi
- Department of Pediatrics, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, 34212, Dammam, Saudi Arabia
| | - Abdulaziz A Alahmari
- Department of Pediatrics, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, 34212, Dammam, Saudi Arabia
| | - Sawsan Sami Albattat
- College of Medicine, King Faisal University, 31982, Hofuf, Al-Ahsa, Saudi Arabia
| | - Yasin S Almubarak
- Regional Medical Supply, Al-Ahsa Health Cluster, Ministry of Health, 36361, Hofuf, Al-Ahsa, Saudi Arabia
| | | | - Hanan Al Shaikh
- Infection Prevention and Control Department, Prince Saud Bin Jalawi Hospital, Ministry of Health, 36424, Al Mubarraz, Al-Ahsa, Saudi Arabia
| | - Mortadah Essa Alobaidan
- Pharmacy Department, King Faisal General Hospital, Ministry of Health, 36361, Hofuf, Al-Ahsa, Saudi Arabia
| | - Hadi Hassan Almusallam
- Pharmacy Department, King Faisal General Hospital, Ministry of Health, 36361, Hofuf, Al-Ahsa, Saudi Arabia
| | - Fatimah Mohammed Alhassan
- Pharmacy Department, King Faisal General Hospital, Ministry of Health, 36361, Hofuf, Al-Ahsa, Saudi Arabia
| | - Mohammed Abdulhadi Alamer
- Pharmacy Department, Prince Saud Bin Jalawi Hospital, Ministry of Health, 36424, Al Mubarraz, Al-Ahsa, Saudi Arabia
| | - Jawad Ali Al-Hajji
- Primary Care Medicine, Al-Ahsa Health Cluster, Ministry of Health, 24231, Hofuf, Al-Ahsa, Saudi Arabia
| | - Duaa Ali Al-Hajji
- Nursing Department, King Faisal General Hospital, Ministry of Health, 36361, Hofuf, Al-Ahsa, Saudi Arabia
| | - Anwar Ahmed Alkadi
- Nursing Department, Prince Saud Bin Jalawi Hospital, Ministry of Health, 36424, Al Mubarraz, Al-Ahsa, Saudi Arabia
| | - Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, 36342, Al Mubarraz, Al-Ahsa, Saudi Arabia
- College of Nursing, Princess Norah Bint Abdul Rahman University, 11564, Riyadh, Saudi Arabia
- School of Nursing, University of Wollongong, Wollongong, NSW, 2522, Australia
- Nursing Department, Prince Sultan Military College of Health Sciences, 33048, Dhahran, Saudi Arabia
| | - Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, 31311, Dhahran, Saudi Arabia
- College of Medicine, Alfaisal University, 11533, Riyadh, Saudi Arabia
- Department of Public Health/Nutrition, The University of Haripur, Haripur, 22620, Khyber Pakhtunkhwa, Pakistan
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Alhumaid S, Al Mutair A, Rabaan AA, ALShakhs FM, Choudhary OP, Yong SJ, Nainu F, Khan A, Muhammad J, Alhelal F, Al Khamees MH, Alsouaib HA, Al Majhad AS, Al-Tarfi HR, ALyasin AH, Alatiyyah YY, Alsultan AA, Alessa ME, Alessa ME, Alissa MA, Alsayegh EH, Alshakhs HN, Al Samaeel HA, AlShayeb RA, Alnami DA, Alhassan HA, Alabdullah AA, Alhmed AH, AlDera FH, Hajissa K, Al-Tawfiq JA, Al-Omari A. New-onset and relapsed liver diseases following COVID-19 vaccination: a systematic review. BMC Gastroenterol 2022; 22:433. [PMID: 36229799 PMCID: PMC9559550 DOI: 10.1186/s12876-022-02507-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 09/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Liver diseases post-COVID-19 vaccination is extremely rare but can occur. A growing body of evidence has indicated that portal vein thrombosis, autoimmune hepatitis, raised liver enzymes and liver injuries, etc., may be potential consequence of COVID-19 vaccines. OBJECTIVES To describe the results of a systematic review for new-onset and relapsed liver disease following COVID-19 vaccination. METHODS For this systematic review, we searched Proquest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus and Nature through the Preferred Reporting Items for Systematic Reviews and Meta Analyses PRISMA guideline for studies on the incidence of new onset or relapsed liver diseases post-COVID-19 vaccination, published from December 1, 2020 to July 31, 2022, with English language restriction. RESULTS Two hundred seventy-five cases from one hundred and eighteen articles were included in the qualitative synthesis of this systematic review. Autoimmune hepatitis (138 cases) was the most frequent pathology observed post-COVID-19 vaccination, followed by portal vein thrombosis (52 cases), raised liver enzymes (26 cases) and liver injury (21 cases). Other cases include splanchnic vein thrombosis, acute cellular rejection of the liver, jaundice, hepatomegaly, acute hepatic failure and hepatic porphyria. Mortality was reported in any of the included cases for acute hepatic failure (n = 4, 50%), portal vein thrombosis (n = 25, 48.1%), splanchnic vein thrombosis (n = 6, 42.8%), jaundice (n = 1, 12.5%), raised liver enzymes (n = 2, 7.7%), and autoimmune hepatitis (n = 3, 2.2%). Most patients were easily treated without any serious complications, recovered and did not require long-term hepatic therapy. CONCLUSION Reported evidence of liver diseases post-COIVD-19 vaccination should not discourage vaccination against this worldwide pandemic. The number of reported cases is relatively very small in relation to the hundreds of millions of vaccinations that have occurred and the protective benefits offered by COVID-19 vaccination far outweigh the risks.
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Affiliation(s)
- Saad Alhumaid
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Rashdiah Street, P. O. Box 12944, Al-Ahsa, 31982, Saudi Arabia.
| | - Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Al-Ahsa, Saudi Arabia.,College of Nursing, Princess Norah Bint Abdul Rahman University, Riyadh, Saudi Arabia.,School of Nursing, University of Wollongong, Wollongong, Australia
| | - Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, 11533, Saudi Arabia.,Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan
| | - Fatemah M ALShakhs
- Respiratory Therapy Department, Prince Saud Bin Jalawi Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Om Prakash Choudhary
- Department of Veterinary Anatomy and Histology, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University (I), Selesih, Aizawl, Mizoram, 796015, India
| | - Shin Jie Yong
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Subang Jaya, Malaysia
| | - Firzan Nainu
- Department of Pharmacy, Faculty of Pharmacy, Hasanuddin University, Makassar, 90245, Indonesia
| | - Amjad Khan
- Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan
| | - Javed Muhammad
- Department of Microbiology, The University of Haripur, Haripur, 22620, Khyber Pakhtunkhwa, Pakistan
| | - Fadil Alhelal
- Optometry Department, Dhahran Eye Specialist Hospital, Ministry of Health, Dhahran, Saudi Arabia
| | | | - Hussain Ahmed Alsouaib
- Medical Store Department, Maternity and Children Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Ahmed Salman Al Majhad
- Medical Store Department, Maternity and Children Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Hassan Redha Al-Tarfi
- Medical Store Department, Maternity and Children Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Ali Hussain ALyasin
- Medical Store Department, Maternity and Children Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | | | - Ali Ahmed Alsultan
- Medical Supply Store, Aloyoon General Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Mohammed Essa Alessa
- Inventory Control Unit, Aloyoon General Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Mustafa Essa Alessa
- Pharmacy Department, Aloyoon General Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Mohammed Ahmed Alissa
- Pharmacy Department, Aloyoon General Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Emad Hassan Alsayegh
- Pharmacy Department, Aloyoon General Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Hassan N Alshakhs
- Pharmacy Department, Aloyoon General Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | | | - Rugayah Ahmed AlShayeb
- Pharmacy Department, King Fahad Hofuf Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Dalal Ahmed Alnami
- Pharmacy Department, King Fahad Hofuf Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Hussain Ali Alhassan
- Pharmacy Department, Maternity and Children Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | | | - Ayat Hussain Alhmed
- Administration of Nursing Care, Maternity and Children Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Faisal Hussain AlDera
- General Surgery Department, King Fahad Hofuf Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Khalid Hajissa
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Awad Al-Omari
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
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Alhumaid S, Al Mutair A, Busubaih JS, Al Dossary N, Alsuliman M, Baltyour SA, Alissa I, Al Hassar HI, Al Aithan NA, Albassri HA, AlOmran SA, ALGhazal RM, Busbaih A, Alsalem NA, Alagnam W, Alyousef MY, Alseffay AU, Al Aish HA, Aldiaram A, Al Eissa HA, Alhumaid MA, Bukhamseen AN, Al Mutared KM, Aljwisim AH, Twibah AM, AlSaeed MM, Alkhalaf HA, ALShakhs FM, Koritala T, Al-Tawfiq JA, Dhama K, Rabaan AA, Al-Omari A. Colorectal cancer in patients with SARS-CoV-2: a systematic review and meta-analysis. Infect Agent Cancer 2022; 17:49. [PMID: 36096812 PMCID: PMC9466313 DOI: 10.1186/s13027-022-00459-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/23/2022] [Indexed: 11/11/2022] Open
Abstract
Background Patients with colorectal cancer (CRC) are more likely to develop severe course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and experience increased risk of mortality compared to SARS-CoV-2 patients without CRC. Objectives To estimate the prevalence of SARS-CoV-2 infection in CRC patients and analyse the demographic parameters, clinical characteristics and treatment outcomes in CRC patients with COVID-19 illness. Methods For this systematic review and meta-analysis, we searched Proquest, Medline, Embase, Pubmed, CINAHL, Wiley online library, Scopus and Nature for studies on the incidence of SARS-CoV-2 infection in CRC patients, published from December 1, 2019 to December 31, 2021, with English language restriction. Effect sizes of prevalence were pooled with 95% confidence intervals (CIs). Sub-group analyses were performed to minimize heterogeneity. Binary logistic regression model was used to explore the effect of various demographic and clinical characteristics on patient’s final treatment outcome (survival or death). Results Of the 472 papers that were identified, 69 articles were included in the systematic review and meta-analysis (41 cohort, 16 case-report, 9 case-series, 2 cross-sectional, and 1 case-control studies). Studies involving 3362 CRC patients with confirmed SARS-CoV-2 (all patients were adults) were analyzed. The overall pooled proportions of CRC patients who had laboratory-confirmed community-acquired and hospital-acquired SARS-CoV-2 infections were 8.1% (95% CI 6.1 to 10.1, n = 1308, 24 studies, I2 98%, p = 0.66), and 1.5% (95% CI 1.1 to 1.9, n = 472, 27 studies, I2 94%, p < 0.01). The median patient age ranged from 51.6 years to 80 years across studies. The majority of the patients were male (n = 2243, 66.7%) and belonged to White (Caucasian) (n = 262, 7.8%), Hispanic (n = 156, 4.6%) and Asian (n = 153, 4.4%) ethnicity. The main source of SARS-CoV-2 infection in CRC patients was community-acquired (n = 2882, 85.7%; p = 0.014). Most of those SARS-CoV-2 patients had stage III CRC (n = 725, 21.6%; p = 0.036) and were treated mainly with surgical resections (n = 304, 9%) and chemotherapies (n = 187, 5.6%), p = 0.008. The odd ratios of death were significantly high in patients with old age (≥ 60 years) (OR 1.96, 95% CI 0.94–0.96; p < 0.001), male gender (OR 1.44, 95% CI 0.41–0.47; p < 0.001) CRC stage III (OR 1.54, 95% CI 0.02–1.05; p = 0.041), CRC stage IV (OR 1.69, 95% CI 0.17–1.2; p = 0.009), recent active treatment with chemotherapies (OR 1.35, 95% CI 0.5–0.66; p = 0.023) or surgical resections (OR 1.4, 95% CI 0.8–0.73; p = 0.016) and admission to ICU (OR 1.88, 95% CI 0.85–1.12; p < 0.001) compared to those who survived. Conclusion SARS-CoV-2 infection in CRC patient is not uncommon and results in a mortality rate of 26.2%. Key determinants that lead to increased mortality in CRC patients infected with COVID-19 include older age (≥ 60 years old); male gender; Asian and Hispanic ethnicity; if SARS-CoV-2 was acquired from hospital source; advanced CRC (stage III and IV); if patient received chemotherapies or surgical treatment; and if patient was admitted to ICU, ventilated or experienced ARDS.
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Affiliation(s)
- Saad Alhumaid
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Rashdiah Street, P. O. Box 12944, Alahsa, 31982, Saudi Arabia.
| | - Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Al-Ahsa, Saudi Arabia.,College of Nursing, Princess Norah Bint Abdul Rahman University, Riyadh, Saudi Arabia.,School of Nursing, University of Wollongong, Wollongong, Australia
| | - Jawad S Busubaih
- Gastroenterology Department, King Fahad Hofuf Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Nourah Al Dossary
- General Surgery Department, Alomran General Hospital, Alahsa, Saudi Arabia
| | - Murtadha Alsuliman
- Department of Pharmacy, Hereditary Blood Diseases Centre, Al-Ahsa, Saudi Arabia
| | - Sarah A Baltyour
- Infection Prevention and Control Department, Alomran General Hospital, Alahsa, Saudi Arabia
| | - Ibrahim Alissa
- Pharmaceutical Care Department, Prince Sultan Cardiac Centre, Al-Ahsa, Saudi Arabia
| | | | - Noor A Al Aithan
- Intensive Care Unit, Omran General Hospital, Al-Ahsa, Saudi Arabia
| | - Hani A Albassri
- Pharmacy Department, Prince Saud Bin Jalawi Hospital, Al-Ahsa, Saudi Arabia
| | - Suliman A AlOmran
- Pharmacy Department, King Faisal General Hospital, Al-Ahsa, Saudi Arabia
| | - Raed M ALGhazal
- Department of Gastroenterology, King Fahad Hofuf Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Ahmed Busbaih
- Critical Care Medicine/Gastroenterology Department, King Fahad Hofuf Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Nasser A Alsalem
- Department of Critical Care, King Fahad Hofuf Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Waseem Alagnam
- Department of Critical Care, King Fahad Hofuf Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Mohammed Y Alyousef
- Administration of Academic Affairs and Research, Ministry of Health, Al-Ahsa, Saudi Arabia
| | | | | | - Ali Aldiaram
- Pharmaceutical Care Department, Prince Sultan Cardiac Centre, Al-Ahsa, Saudi Arabia
| | - Hisham A Al Eissa
- Medical Services Department, King Fahad Hofuf Hospital, Al-Ahsa, Saudi Arabia
| | | | - Ali N Bukhamseen
- Pharmacy Department, Maternity and Children Hospital, Al-Ahsa, Saudi Arabia
| | - Koblan M Al Mutared
- Administration of Pharmaceutical Care, Ministry of Health, Najran, Saudi Arabia
| | - Abdullah H Aljwisim
- Administration of Compliance, Al-Ahsa Health Affairs, Ministry of Health, Al‑Ahsa, Saudi Arabia
| | - Abdullah M Twibah
- Administration of Compliance, Al-Ahsa Health Affairs, Ministry of Health, Al‑Ahsa, Saudi Arabia
| | - Meteab M AlSaeed
- Regional Medical Supply, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Hussien A Alkhalaf
- Pharmacy Department, Al Jaber Hospital for Eye, Ear, Nose and Throat, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Fatemah M ALShakhs
- Respiratory Therapy Department, Prince Saud Bin Jalawi Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Thoyaja Koritala
- Department of Internal Medicine, Mayo Clinic Health System, Mankato, MN, USA
| | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Uttar Pradesh, Izatnagar, Bareilly, 243122, India
| | - Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, 11533, Saudi Arabia.,Department of Public Health and Nutrition, The University of Haripur, Haripur, 22610, Pakistan
| | - Awad Al-Omari
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
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