Letters to the EditorReply Souheil M. Shabib, MD Haysam Tufenkeji, and FAAP Jerome B. ZeldisMD, PhD Souheil M. Shabib Search for more papers by this author , Haysam Tufenkeji Search for more papers by this author , and Jerome B. Zeldis Search for more papers by this author Published Online::1 Sep 1995https://doi.org/10.5144/0256-4947.1995.545SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionTo the Editor: We very much appreciate Dr. Arya’s thoughtful comments regarding viral hepatitis as it pertains to Saudi Arabia.We agree with him that as a result of marked improvements in public health measures in the Kingdom, the percentage of Saudis in metropolitan areas who have not been infected with hepatitis A virus (HAV) is rising. This could result in more Saudis becoming infected (from a variety of potential exposures) later in life when symptoms of infection are usually more severe. Fortunately, the hepatitis A vaccine is now available from at least two reputable manufacturers. These vaccines are already approved by the regulatory authorities in the US, Canada, and a number of European countries. We hope that if the cost is not prohibitive, and is documented with solid data, the vaccine will soon be offered to the many anti-HAV-negative Saudis who are susceptible to this infection.We also agree with Dr. Arya that only a few specialized centers in the Middle East are capable of performing in a reliable and reproducible manner the sophisticated tests for the detection of viral nucleic acids. Furthermore, for both PCR and in situ hybridization to be performed reliably, the specimens must be carefully prepared and stored. In Saudi Arabia, a few centers have this capability, including King Faisal Specialist Hospital and Research Centre. The routine use of nucleic acid assays is mainly relevant for the antiviral treatment of hepatitis B and C. These types of therapies should only be attempted in specialized centers where there is sophisticated technological support. Thus, for the present, the greatest impact on viral hepatitis in Saudi Arabia that we, as physicians, can accomplish is in the area of diagnosis and prevention.Fortunately for the vast majority of patients, simple-to-perform commercial kits are available that allow a laboratory to perform serological assays for hepatitis A, B, C, D and E. These assays include IgM assays for anti-HAC and for anti-HBc. These tests should not be beyond the capability of a local clinical laboratory. Certainly, serological assays alone will not identify all cases of viral hepatitis and will not make our blood supply absolutely safe. However, cases of hepatitis B virus transmission from serologically negative blood are rare. Universal serological screening of all sources of blood products for hepatitis A, B and C would, however, reduce this source of hepatitis propagation in Saudi Arabia by over 90%. Evidence for this assertion is the remarkable decline in post-transfusion hepatitis B and C observed with the adoption of HBsAg, anti-HBc, ALT and anti-HCV screening in a number of countries. In a two-year period after second-generation anti-HCV screening was used, the National Institutes of Health Blood Bank did not record a single case of post-transfusion hepatitis C (Harvey Alter, personal communication). Previous article FiguresReferencesRelatedDetails Volume 15, Issue 5September-October 1995 Metrics History Published online1 September 1995 InformationCopyright © 1995, Annals of Saudi MedicineThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.PDF download