Browsing by Author "Dada, Ashraf"

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    Active viral shedding in a vaccinated hospitalized patient infected with the delta variant (B.1.617.2) of SARS-CoV-2 and challenges of de-isolation
    (Elsevier, 2022) Alshukairi, Abeer N.; Al-Omari, Awad; Al-Tawfiq, Jaffar A.; El-Kafrawy, Sherif A.; El-Daly, Mai M.; Hassan, Ahmed M.; Faizo, Arwa A.; Alandijany, Thamir A.; Dada, Ashraf; Saeedi, Mohammed F.; Alhamlan, Fatma S.; Al Hroub, Mohammad K.; Qushmaq, Ismael; Azhar, Esam I.; Medicine, School of Medicine
    In the era of SARS-CoV-2 variants and COVID-19 vaccination, the duration of infectious viral shedding and isolation in post vaccine breakthrough infections is challenging and depends on disease severity. The current study described a case of SARS-CoV-2 Delta variant pneumonia requiring hospitalization. The patient received two doses of BNT162b2 COVID-19 vaccines, and he had positive SARS-CoV-2 viral cultures 12 days post symptom onset. The time between the second dose of vaccine and the breakthrough infection was 6 months. While immunosuppression is a known risk factor for prolonged infectious viral shedding, age and time between vaccination and breakthrough infection are important risk factors that warrant further studies.
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    De-isolation of vaccinated COVID-19 health care workers using rapid antigen detection test
    (Elsevier, 2022) Alshukairi, Abeer N.; Al-Omari, Awad; Al Hroub, Mohammad K.; Al-Tawfiq, Jaffar A.; Qutub, Mohammed; Shaikh, Samaher; Allali, Khalid; Saeedi, Mohammed F.; Alosaimi, Roaa S.; Alamoudi, Elaf; Hefni, Lama K.; El-Saed, Aiman; Alhamlan, Fatma S.; Dada, Ashraf; Wali, Ghassan Y.; Medicine, School of Medicine
    Background: COVID-19 de-isolation guidelines of health care workers (HCW) were formulated based on evidence describing the duration of infectious viral shedding of the wild SARS-CoV-2 virus. During the periods of COVID-19 vaccination and variants, a test-based approach was recommended to end isolation of HCW, based on emerging data describing the viral kinetics of COVID-19 variants. While Rapid antigen detection tests (RADT) are increasingly used in the diagnosis of COVID-19, their use is limited in de-isolation. Methods: We described the use of RADT in the de-isolation of COVID-19 vaccinated HCW with mild infection who were asymptomatic on day 7 post diagnosis in a single center retrospective cohort study during the Omicron surge. Results: Of the 480 HCWs, 173 (36%) had positive RADT. The positivity rate of RADT was not different in HCW who received two doses versus three doses of vaccine (34.4% versus 40.3%, p = 0.239). Conclusions: A symptom based, test-based approach using RADT is a useful tool in the de-isolation of HCW, with mild disease, in the era of Omicron. Further studies are required to evaluate the role of RADT in de-isolation of patients with severe COVID-19 disease.
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    Outcome of SARS-CoV-2 variant breakthrough infection in fully immunized solid organ transplant recipients
    (Elsevier, 2022) Almaghrabi, Reem S.; Alhamlan, Fatimah S.; Dada, Ashraf; Al-Tawfiq, Jaffar A.; Al Hroub, Mohammad K.; Saeedi, Mohammed F.; Alamri, Maha; Alhothaly, Bushra; Alqasabi, Abdulmohsin; Al-Qahtani, Ahmed A.; Al-Omari, Awad; Alshukairi, Abeer N.; Medicine, School of Medicine
    SARS-CoV-2 vaccination in solid organ transplant recipients is associated with suboptimal immune response and risk for breakthrough infection. It is not known whether they are at risk of severe post-vaccine breakthrough infections in the presence of SARSCoV-2 variant of concern. We describe a case series of four fully vaccinated solid organ transplant recipients who developed SARS-CoV-2 variants of concern breakthrough infections. Three patients received BNT162b2 mRNA (Pfizer-BioNTech) and one patient received ChAdOx1 (AZD12220) COVID-19 vaccines. The patients were infected with SARS-CoV-2 variants circulating in Saudi Arabia. Two patients were infected with Alpha variant and had severe pneumonia requiring intensive care admission and ventilatory support and subsequently died. The other two patients recovered; one patient was infected with Beta variant required low supplemental oxygen via nasal flow and the other patient was infected with Delta variant and required high supplemental oxygen nasal flow. Younger patients had a better outcome than older patients. Future large studies are required to confirm our observations and to compare the different vaccine efficacy among solid organ transplants in the era of SARS-CoV-2 variants of concern.
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    Re-infection with different SARS-CoV-2 clade and prolonged viral shedding in a patient with hematopoietic stem cell transplantation: SARS-CoV-2 Re-infection with different clade
    (Elsevier, 2021-07-18) Alshukairi, Abeer N.; El-Kafrawy, Sherif A.; Dada, Ashraf; Yasir, Mohamed; Yamani, Amani H.; Saeedi, Mohammed F.; Aljohaney, Ahmed; AlJohani, Naif I.; Bahaudden, Husam A.; Alam, Intikhab; Gojobori, Takashi; Radovanovic, Aleksandar; Alandijany, Thamir A.; Othman, Norah A.; Alsubhi, Tagreed L.; Hassan, Ahmed M.; Tolah, Ahmed M.; Al-Tawfiq, Jaffar A.; Zumla, Alimuddin; Azhar, Esam I.; Medicine, School of Medicine
    Immunocompromised patients who have SARS-CoV-2 infection pose many clinical and public health challenges. We describe a patient with hematopoietic stem cell transplantation and lymphoma with protracted illness requiring 3 consecutive hospital admissions. Whole genome sequencing confirmed two different SARS-CoV-2 clades. Clinical management issues, and unanswered questions arising are discussed.
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    Test-based De-isolation in COVID-19 Immunocompromised patients: Ct value versus SARS-CoV-2 viral cultures
    (Elsevier, 2021-05) Alshukairi, Abeer N.; Tolah, Ahmed M.; Dada, Ashraf; Al-Tawfiq, Jaffar A.; Almagharbi, Reem S.; Saeedi, Mohammed F.; Al-Hamzi, Mohammed A.; El-Kafrawy, Sherif A.; Bahaudden, Husam A.; El-Saeed, Aiman; Al-Mozaini, Maha A.; Khalid, Imran; Hefni, Lama K.; Hassan, Ahmed M.; Alandijany, Thamir A.; Bajrai, Leena H.; Bayumi, Daniyah T.; Albishi, Ghadeer E.; Althawadi, Sahar I.; Zabani, Najla A.; Perlman, Stanley; Azhar, Esam I.; Medicine, School of Medicine
    Background Immunocompromised patients with coronavirus disease 2019 (COVID-19) have prolonged infectious viral shedding for more than 20 days. A test-based approach is suggested for de-isolation of these patients. Methods The strategy was evaluated by comparing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load (cycle threshold (Ct) values) and viral culture at the time of hospital discharge in a series of 13 COVID-19 patients: six immunocompetent and seven immunocompromised (five solid organ transplant patients, one lymphoma patient, and one hepatocellular carcinoma patient). Results Three of the 13 (23%) patients had positive viral cultures: one patient with lymphoma (on day 16) and two immunocompetent patients (on day 7 and day 11). Eighty percent of the patients had negative viral cultures and had a mean Ct value of 20.5. None of the solid organ transplant recipients had positive viral cultures. Conclusions The mean Ct value for negative viral cultures was 20.5 in this case series of immunocompromised patients. Unlike those with hematological malignancies, none of the solid organ transplant patients had positive viral cultures. Adopting the test-based approach for all immunocompromised patients may lead to prolonged quarantine. Large-scale studies in disease-specific populations are needed to determine whether a test-based approach versus a symptom-based approach or a combination is applicable for the de-isolation of various immunocompromised patients.