Cholera is a secretory diarrhoeal disease caused by infection with Vibrio cholerae, primarily the V. cholerae O1 El Tor biotype. There are approximately 2.9 million cases in 69 endemic countries annually, resulting in 95 000 deaths. Cholera is associated with poor infrastructure and lack of access to sanitation and clean drinking water. The current cholera epidemic in Yemen, linked to spread of V. cholerae O1 (Ogawa serotype), is associated with the ongoing war. This has devastated infrastructure and health services. The World Health Organization had estimated that 172 286 suspected cases arose between 27th April and 19th June 2017, including 1170 deaths. While there are three oral cholera vaccines prequalified by the World Health Organization, there are issues surrounding vaccination campaigns in conflict situations, exacerbated by external factors such as a global vaccine shortage. Major movements of people complicates surveillance and administration of double doses of vaccines. Cholera therapy mainly depends on rehydration, with use of antibiotics in more severe infections. Concerns have arisen about the rise of antibiotic resistance in cholera, due to mobile genetic elements. In this review, we give an overview of cholera epidemiology, virulence, antibiotic resistance, therapy and vaccines, in the light of the ongoing epidemic in Yemen.
Anti-Bacterial Agents ; therapeutic use ; Cholera ; drug therapy ; prevention & control ; Cholera Vaccines ; therapeutic use ; DNA, Bacterial ; genetics ; Disease Outbreaks ; Drug Resistance, Multiple, Bacterial ; Humans ; Microbial Sensitivity Tests ; Polymerase Chain Reaction ; Vibrio cholerae ; drug effects ; isolation & purification ; Virulence Factors ; genetics ; Yemen

OBJECTIVES: The cholera outbreak in Yemen has become the largest in the recent history of cholera records, having reached more than 1.4 million cases since it started in late 2016. This study aimed to identify risk factors for cholera in this outbreak. METHODS: A case-control study was conducted in Aden in 2018 to investigate risk factors for cholera in this still-ongoing outbreak. In total, 59 cholera cases and 118 community controls were studied. RESULTS: The following risk factors were associated with being a cholera case in the bivariate analysis: a history of travelling and having had visitors from outside Aden Province; eating outside the house; not washing fruit, vegetables, and khat (a local herbal stimulant) before consumption; using common-source water; and not using chlorine or soap in the household. In the multivariate analysis, not washing khat and the use of common-source water remained significant risk factors for being a cholera case. CONCLUSIONS: Behavioural factors and unsafe water appear to be the major risk factors in the recent cholera outbreak in Yemen. In order to reduce the risk of cholera, hygiene practices for washing khat and vegetables and the use and accessibility of safe drinking water should be promoted at the community level.
Case-Control Studies ; Catha ; Chlorine ; Cholera ; Drinking Water ; Eating ; Family Characteristics ; Fruit ; Hygiene ; Multivariate Analysis ; Risk Factors ; Soaps ; Vegetables ; Water ; Yemen

OBJECTIVES: The cholera outbreak in Yemen has become the largest in the recent history of cholera records, having reached more than 1.4 million cases since it started in late 2016. This study aimed to identify risk factors for cholera in this outbreak.METHODS: A case-control study was conducted in Aden in 2018 to investigate risk factors for cholera in this still-ongoing outbreak. In total, 59 cholera cases and 118 community controls were studied.RESULTS: The following risk factors were associated with being a cholera case in the bivariate analysis: a history of travelling and having had visitors from outside Aden Province; eating outside the house; not washing fruit, vegetables, and khat (a local herbal stimulant) before consumption; using common-source water; and not using chlorine or soap in the household. In the multivariate analysis, not washing khat and the use of common-source water remained significant risk factors for being a cholera case.CONCLUSIONS: Behavioural factors and unsafe water appear to be the major risk factors in the recent cholera outbreak in Yemen. In order to reduce the risk of cholera, hygiene practices for washing khat and vegetables and the use and accessibility of safe drinking water should be promoted at the community level.
Case-Control Studies ; Catha ; Chlorine ; Cholera ; Drinking Water ; Eating ; Family Characteristics ; Fruit ; Hygiene ; Multivariate Analysis ; Risk Factors ; Soaps ; Vegetables ; Water ; Yemen

PURPOSE: Periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome is a leading cause of periodic fever in children. This study describes the clinical characteristics of PFAPA syndrome in patients from a single center.METHODS: Thirteen children diagnosed with PFAPA syndrome at Seoul National University Children's Hospital were included in this study. Retrospective medical chart reviews were performed.RESULTS: Among the 13 patients, 8 (61.5%) were male. The median follow-up duration was 3.3 years (range, 10 months–8.3 years). The median age of periodic fever onset was 3 years (range, 1–6 years). All patients had at least 5 episodes of periodic fever and pharyngitis, managed with oral antibiotics, before diagnosis. The median occurrence of fever was every 3.9 weeks and lasted for 4.2 days. All patients had pharyngitis and 12 (92.3%) had cervical lymphadenitis. Blood tests were performed for 12 patients, and no patients had neutropenia. Both the C-reactive protein and erythrocyte sedimentation rate were elevated at medians of 4.5 mg/dL (range, 0.4–13.2 mg/dL) and 29 mm/hr (range, 16–49 mm/hr), respectively. Throat swab cultures and rapid streptococcal antigen tests were negative. Nine (69.2%) patients received oral prednisolone at a median dose of 0.8 mg/kg, and in 6 (66.7%) patients, fever resolved within a few hours. Three (23.1%) patients received tonsillectomy and adenoidectomy.CONCLUSIONS: PFAPA syndrome should be considered when a child presents with periodic fever along with aphthous stomatitis, pharyngitis, or cervical lymphadenitis. Glucocorticoid administration is effective for fever resolution and can reduce unnecessary use of antibiotics.
Adenoidectomy ; Anti-Bacterial Agents ; Blood Sedimentation ; C-Reactive Protein ; Child ; Diagnosis ; Fever ; Follow-Up Studies ; Hematologic Tests ; Humans ; Lymphadenitis ; Male ; Neutropenia ; Pharyngitis ; Pharynx ; Prednisolone ; Retrospective Studies ; Seoul ; Stomatitis, Aphthous ; Tonsillectomy ; Yemen

BACKGROUND: Leprosy is a contagious chronic granulomatous disease and is a disease that is associated with defects in cellular immunity. A high prevalence of hepatitis C virus infection in leprosy patients has been reported in several African countries, Yemen, Brazil and Japan. In Korea, it's seropositivity was reported as 8.33%(2001), 39.3%(2002), 35.1%(2009) and 16.0%(2009) on Korean Leprosy Bulletin. OBJECTIVE: In the meantime, the studies were limited to the subjects in a specific region, and the number of subjects was not enough, so it was not enough to evaluate the hepatitis C virus seropositivity of persons affected by leprosy in Korea. So this study was conducted to evaluate the it's seropositivity in settlement villages nationwide. METHOD: This study was conducted that the mobile team visited the resettlement villages nationwide from 2009 to 2017 and conducted on persons affected by leprosy and residents residing in resettlement village. Obtained serums were assayed by the ADVIA Centaur HVC(IgG antibodies to Hepatitis C Virus) reagent using a Siemens ADVIA Centaur CP instrument. The results of persons affected by leprosy and residents were compared, and the difference of seropositivity among the groups(male and female, multibacillary and paucibacillary, locations of resettlement villages) was evaluated. RESULT: The results of hepatitis C virus antibody positivity of 1669 persons affected by leprosy subjects and 185 residents of resettlement villages were 28.46% in persons affected by leprosy and 6.49% in residents(Pearson's Chi-Square test, P = 0.00). In persons affected by leprosy, that were 31.99%(male) and 26.84%(female)(Pearson's Chi-Square test, P = 0.06) and were 29.97%(multibacillary) and 25.36%(paucibacillary)(Pearson's Chi-Square test, P = 0.05). That of Seoul(48.28%), Busan(43.78%) and Chungbuk Province(35.94%) were highly positive and that of Gangwon Province(20.34%) was lowly positive(Fisher's Exact test P = 0.002). CONCLUSION: In this study, we found that hepatitis C virus antibody positivity rate was high in persons affected by leprosy in Korea. In order to explain the high positive rate, further studies will be needed. Also, through various approaches including assessment of HCV RNA to the subjects who were judged to be positive for antibody test in the future, a comprehensive evaluation of hepatitis C and its countermeasures are needed.
Antibodies ; Brazil ; Chungcheongbuk-do ; Female ; Gangwon-do ; Granulomatous Disease, Chronic ; Hepacivirus* ; Hepatitis C* ; Hepatitis* ; Humans ; Immunity, Cellular ; Japan ; Korea* ; Leprosy* ; Methods ; Prevalence ; RNA ; Yemen

Community pharmacists are expected to have the necessary knowledge to give advice on safe and appropriate drug use during self-medication. However, the profession of pharmacist in Yemen has become less trustworthy and less reliable. In addition, quality of medication has been raising a lot of questions among consumers and fake medications have been entering the country without quality control checks. The aim of this study was to determine the consumer perception of health care services provided and its impact on self-medication practice in Sana’a city, Yemen. A self-administered questionnaire containing open-ended and closed-ended questions was developed and distributed among 400 consumers attending 10 community pharmacies in Sana’a City. All data obtained from the questionnaires were coded, entered, and analysed using Chi-square test and multiple logistic regressions. Prevalence of self-medication was found to be 90.7 %. The majority of respondents stated that they do not trust the health care services provided by physician (68.8%), community drug dispensers (78.2%), Ministry of Health (70.5%) or the quality of medicine dispensed by community pharmacies (59.7%). The trust of health care services provided by physicians and community drug dispensers were found to be significant predictors of self-medication practice. Those who did not trust health care services provided by physicians were more likely to use self-medication compared to those who did not (OR= 21.212, CI 95% 2.678-168.001, p= 0.004). Those who did not trust health care services provided by community drug dispensers were more likely to use self-medication compared to those who did not (OR= 2.746, CI 95% 1.048-7.195, p= 0.04). Consumers in Sana’a City have a negative overall perception of the services provided by community drug dispensers, physician and Ministry of Health and the quality of medication. An urgent intervention from health care authorities to adopt and to implement a new national drug policy with necessary laws and regulations is needed
Self-medication ; Trust ; Health Care Providers ; Community Pharmacy consumers ; Sana&rsquo ; a City ; Yemen

The role of lactic acid bacteria (LAB) in honey as antifungal activity has received little attention and their mechanism of inhibitory of fungi is not fully understood. In this study, LAB were isolated from honey samples from Malaysia, Libya, Saudi Arabia, and Yemen. Twenty-five isolates were confirmed LAB by catalase test and Gram staining, and were screened for antifungal activity. Four LAB showed inhibitory activity against Candida spp. using the dual agar overlay method. And they were identified as Lactobacillus plantarum HS isolated from Al-Seder honey, Lactobacillus curvatus HH isolated from Al-Hanon honey, Pediococcus acidilactici HC isolated from Tualang honey and Pediococcus pentosaceus HM isolated from Al-Maray honey by the 16S rDNA sequence. The growth of Candida glabrata ATCC 2001 was strongly inhibited (>15.0 mm) and (10~15 mm) by the isolates of L. curvatus HH and P. pentosaceus HM, respectively. The antifungal activity of the crude supernatant (cell free supernatant, CFS) was evaluated using well diffusion method. The CFS showed high antifungal activity against Candida spp. especially The CFS of L. curvatus HH was significantly (p < 0.05) inhibited growth of C. glabrata ATCC 2001, C. parapsilosis ATCC 2201, and C. tropicalis ATCC 750 with inhibitory zone 22.0, 15.6, and 14.7 mm, respectively. While CFS of P. pentosaceus HM was significantly (p < 0.05) effective against C. krusei, C. glabrata, and C. albicans with inhibition zone 17.2, 16.0, and 13.3 mm, respectively. The results indicated that LAB isolated from honey produced compounds which can be used to inhibit the growth of the pathogenic Candida species.
Agar ; Bacteria* ; Candida glabrata ; Candida* ; Catalase ; Diffusion ; DNA, Ribosomal ; Fungi ; Honey* ; Lactic Acid* ; Lactobacillus ; Lactobacillus plantarum ; Libya ; Malaysia ; Methods ; Pediococcus ; Saudi Arabia ; Yemen

A "system integration country" is defined as the political unification to a single national system of a country divided for a certain period of time such as Germany, Yemen, and Vietnam. Vietnam is moving to adopt the South Korean health insurance system. The process by which the Vietnamese healthcare insurance system is introduced should be applied to establishing the North Korean healthcare system after the future unification of the Korean peninsula. Yemen's political instability has resulted in poor health care indicators. Before the unification of Germany, an agreement regarding healthcare was formed and vigorous mutual exchanges of health care issues occurred. Political unification is not in itself a perfect solution for health care issues. We must make thorough preparations and develop strategies for an upcoming integration of healthcare systems. Like the experience of the unified Germany, humanitarian exchanges and cooperation of public healthcare issues should continue. A unified Korea will be confronted with many hardships, especially in health care. Therefore, a practical plan for the healthcare system before and after the unification of the Korean peninsula is needed.
Asian Continental Ancestry Group ; Delivery of Health Care ; Germany ; Humans ; Insurance ; Insurance, Health ; Korea ; Vietnam ; Yemen

A two-year-old, castrated male Jindo dog presented with a three-week history of non-pruritic alopecia and scales on dorsum. The dermatologic lesions were progressive and did not respond to antibiotics and treatment for ectoparasite. Silver-white scales were adhered to the hair shafts and a follicular cast was marked on a trichogram. Findings on histopathologic examination of the skin lesions were consistent with sebaceous adenitis. Treatment with systemic cyclosporine and topical shampoo treatment was recommended for long term management. This case report is the first to describe a sebaceous adenitis in our country and suggests combination treatment approaches to long term management of this disease.
Alopecia ; Animals ; Anti-Bacterial Agents ; Cyclosporine ; Dogs* ; Hair ; Humans ; Lymphadenitis* ; Male ; Skin ; Weights and Measures ; Yemen*

This cross sectional study was conducted in the city of Taiz, Yemen, during the period from August 2006 to August 2007 in order to investigate the seroprevalence and incidence of toxoplasmosis among apparently healthy children (AHC) and visually and/or hearing disabled children (DC). The seroprevalence was 16.0% among AHC compared to 32.5% among DC. The effect of gender was clear as the seroprevalence rate was significantly higher among females (18.3 and 43.8% for AHC and DC, respectively) than males (13.8 and 25% for AHC and DC, respectively). The seroprevalence was proportionally increased with the age, and the highest rates (20.9 and 53.0%) were reported among the oldest age group (> 10-14 years) for AHC and DC groups, respectively. The incidence rate was also higher (4.2%) in DC group compared to AHC group (2.4%) during 1 year period. These data indicate that the seroprevalence and incidence of toxoplasmosis are significantly higher in DC group than those of AHC group. We need to check further relationship between toxoplasmosis and visual and/or hearing disability.
Adolescent ; Age Factors ; Animals ; Child ; Child, Preschool ; Cross-Sectional Studies ; Disabled Children ; Female ; *Hearing Impaired Persons ; Humans ; Incidence ; Infant ; Male ; Seroepidemiologic Studies ; Sex Factors ; Toxoplasma/*isolation & purification ; Toxoplasmosis/diagnosis/*epidemiology ; Urban Population ; *Visually Impaired Persons ; Yemen/epidemiology