Background Chronic smokers are at risk of premature death associated with underlying pulmonary or cardiovascular diseases. Dual influenza and pneumococcal vaccination has been shown to prevent death and hospitalization secondary to pulmonary or cardiovascular diseases in elderly persons. Its effect in chronic smokers remained unknown. Methods This is a prospective randomized open-labeled trial conducted from April 2010 to March 2013, comprising adult patients aged less than 50 years who were chronic smokers. Subjects were randomly assigned into 4 groups. Group 1 (study group) patients received both trivalent influenza vaccine (TIV) and the 23-valent polysaccharide pneumococcal vaccine (PPV). There were 3 control groups: Group 2 patients received the TIV only. Group 3 patients received the PPV only and Group 4 patients did not receive any vaccines. The TIV used was the Vaxigrip® (Sanofi Pasteur, France) and the PPV used was the Pneumovax®23 (Merck, USA). All enrolled patients were follow-up for 24 months post vaccination. Patient details, Charlson comorbidity index, medications, subsequent hospitalization, diagnosis and mortality were recorded and analyzed. Results A total of 1006 subjects were enrolled and completed the study (Group PPV+TIV: 250; Group TIV: 254, Group PPV: 250 and Group None: 259). The baseline demographics and Charlson comorbidity index were similar among subjects in the 4 groups. The median age was 48 years and 85.9% were male patients. Significantly fewer subjects who received the dual vaccination (Group PPV+TIV) were hospitalized (p<0.001), with shorter mean length of stay (p<0.001), and less frequent hospitalization (p<0.001) for cardiovascular or respiratory diseases than no vaccination (Group None) or single vaccination (Group TIV and Group PPV). Multivariate analysis demonstrated that dual vaccination with PPV + TIV was the only independent factor associated with reduced risk of hospitalization (p<0.001; relative risk 0.288; 95% CI 0.101-0.154). There was no difference in mortality rate among the groups. Both vaccinations were well tolerated and no serious adverse events were reported. Conclusion Dual influenza and pneumococcal vaccinations prevented chronic smokers against hospitalization secondary to pulmonary or cardiovascular causes. Annual influenza and a single pneumococcal vaccination should be promoted among chronic smokers. / published_or_final_version / Microbiology / Master / Master of Medical Sciences

The aim of this study was to investigate the vitamin B-6 status of Saudi adult males and compare the status between rural and urban subjects. Fifty-one adult male subjects were recruited from urban (n=31) and rural (n=20) populations of Riyadh. These subjects were reclassified to cigarette smokers (n=19), water pipe smokers (n=5) and non-smokers (n=27). The study also investigated the intake of macronutrients and selected micronutrients. In addition, the study investigated other health indicators including Body Mass Index (BMI), hematocrit, hemoglobin, plasma alkaline phosphatase activity and albumin concentration, urinary creatinine and urea nitrogen excretion. The mean of vitamin B-6 intake, B-6 to protein ratio, plasma pyridoxal phosphate (PLP) concentration and urinary 4-PA excretion in urban group were 2.18 ± 0.62 mg/day, 0.022 ± 0.008 mg/g, 39.3 ± 18.0 nmol/L and 4.6 ± 2.3 μmol/day, respectively. In rural group, these measures were 2.15 ± 0.65 mg/day, 0.021 ± 0.004 mg/g, 40.5 ± 14.6 nmol/L and 4.4 ± 2.3 (μmol/day, respectively. These measures indicated adequate status with no significant difference between the two groups. The mean intake of calcium, folate, vitamin D, zinc and dietary fiber was lower than recommendation of the Dietary Reference Intakes (DRI) in both groups. Health indicators were within normal range except for BMI, which indicated a prevalence of overweight and obesity in both urban (27.1 ± 5.5 Kg/m²) and rural (28.2 ± 6.0 Kg/m²) subjects. Comparison of the three smoking groups showed that the water pipe smokers compared to cigarette smokers and non-smokers groups had significantly higher mean intake of vitamin B-6 (2.51 ± 0.73 mg/day), which resulted in higher concentrations of plasma PLP, pyridoxal (PL), red blood cells PLP and urinary 4-PA (54.9 ± 23.1 nmol/L, 21.5 ± 10.0 nmol/L, 33.7 ± 8.5 nmol/L and 6.9 ± 4.7 μmol/day, respectively). Cigarette smokers had significantly lower concentration of plasma PLP (30.9 ± 12.5 nmol/L) compared to non-smokers (40.0 ± 12.9 nmol/L) without a significant difference in vitamin B-6 intake. Hematocrit and hemoglobin were significantly higher in smokers (50 ± 3% and 167 ± 11 g/L, respectively) compared to non-smokers (48 ± 3% and 160 ± 9 g/L, respectively). The results of this study suggest that vitamin B-6 status of adult males in Riyadh is adequate with no urban vs. rural variation. / Graduation date: 2004