# pos

id: cord-259966-szkiilb1
pos: NNP
token:
  stillmed.olympic.org/media/Document%20Library/OlympicOrg/Games/Summer-Games/Games-Rio-2016-Olympic-Games/Media-Guide-for-Rio-2016/IOC-Marketing-Report-Rio-2016.pdf

lemma:
  stillmed.olympic.org/media/Document%20Library/OlympicOrg/Games/Summer-Games/Games-Rio-2016-Olympic-Games/Media-Guide-for-Rio-2016/IOC-Marketing-Report-Rio-2016.pdf


# ent

id: cord-258711-3fqxr2yz
type: TAXON
entity:
  rhinovirus enterovirus respiratory syncytial virus H influenzae K pneumoniae Moraxella catarrhalis Staphylococcus


id: cord-270408-4qqyb8sd
type: DISEASE
entity:
  cord_uid 4qqyb8sd BACKGROUND Indonesia provides the largest single source of pilgrims for the Hajj 10 In the last


id: cord-287159-bjccnp7u
type: ORG
entity:
  National Influenza Center Virology Department School of Public Health Tehran University of Medical Sciences


id: cord-261303-xjbz9fw9
type: CHEMICAL
entity:
  Lourdes World s largest mass bathing event influences the bacterial communities of Godavari a holy river of India Using mobile


id: cord-258611-uzzs8w1j
type: DNA
entity:
  human metapneumo virus hMPV human respiratory syncytial virus hRSV and human coronaviruses HKU1 229E


id: cord-258611-uzzs8w1j
type: DISEASE
entity:
  influenza B virus 4 for metapneumo virus 2 for respiratory syncytial virus and 3 for human coronavirus


id: cord-302784-jkjdglns
type: GGP
entity:
  TB 1 7 10 12 However the prevalence of coexisting chronic diseases 63 17 27 among TB patients especially diabetes was higher than that reported internationally as well


id: cord-255339-oudj079q
type: WORK_OF_ART
entity:
  Joint WHO FAO Expert Committee on Zoonoses Viral Zoonosis A Comprehensive Review Zoonotic Disease Programs for Enhancing Global Health Security Risk


id: cord-255339-oudj079q
type: ORG
entity:
  the European Union Camelid Infectious Disorders World Health Organization Hemorrhagic Fever Task Force


id: cord-305460-wln758og
type: ORG
entity:
  the Hajj Exploring Australian Hajj Tour Operators Knowledge and Practices Regarding Pilgrims Health Risks A Qualitative Study Hajj Research Team Influenza Vaccination


id: cord-305460-wln758og
type: ORG
entity:
  Abubakar Baaba A Assessment of Knowledge Attitude and Practice towards Prevention of Respiratory Tract Infections


id: cord-314607-bcocsjij
type: TAXON
entity:
  coronavirus NL63 coronavirus HKU1 parainfluenza 1 parainfluenza 2 parainfluenza 3 parainfluenza 4 human metapneumovirus rhinovirus adenovirus


id: cord-314607-bcocsjij
type: DISEASE
entity:
  influenza A H1N1 pandemic date 2011 12 23 journal Travel Med Infect Dis DOI 10 1016 j tmaid 2011 11 002 sha 75879ef509b26eff47fac73ec584ee98a22c46a5 doc_id 314607 cord_uid bcocsjij Despite the high risk of acquiring respiratory infections


id: cord-314607-bcocsjij
type: DISEASE
entity:
  influenza B respiratory syncytial virus other coronaviruses parainfluenza viruses human metapneumovirus adenovirus


id: cord-314607-bcocsjij
type: DISEASE
entity:
  coronavirus NL63 coronavirus HKU1 parainfluenza 1 parainfluenza 2 parainfluenza 3 parainfluenza 4 human metapneumovirus rhinovirus adenovirus and human bocavirus The xTAG


id: cord-314607-bcocsjij
type: DISEASE
entity:
  influenza A virus parainfluenza virus adenoviruses coronaviruses bocavirus metapneumovirus and RSV 29 Rhinovirus shedding is commonly limited to 10e14 days


id: cord-347907-0nrejsgr
type: GPE
entity:
  Alqahtani Amani S Wiley Kerrie E Tashani Mohamed Willaby Harold W Heywood Anita E BinDhim Nasser F Booy


id: cord-339124-m7choyr6
type: DISEASE
entity:
  influenza A H1N1 pdm09 among 305 returning Iranian pilgrims after the 2009 Hajj season was 1 6 26 Koul


id: cord-356048-nku844kt
type: DISEASE
entity:
  human coronavirus E229 HCoV E229 2 0 14 6 and influenza virus IAV 1 9 20 0 21 22 27 28 30 31 33 The most commonly acquired bacteria


# bib

id: cord-007030-mewo9w43
author: Hashim, Suhana
date: 2016-02-08
txt: ./txt/cord-007030-mewo9w43.txt
cache: ./cache/cord-007030-mewo9w43.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7107508/
doi: 10.1093/jtm/tav019
summary:
  The purpose of this study is to determine the prevalence of respiratory illness and its associated factors among Malaysian hajj pilgrims in 2013 and to describe its preventive measures. Malaysian hajj pilgrims with previous experience of hajj (OR 0.24; 95% CI 0.10–0.56) or umrah (OR 0.19; 95% CI 0.07–0.52) and those who have practiced good hand hygiene (OR 0.35; 95% CI 0.16–0.79) were found to be significantly associated with lower risk of having respiratory illness. All preventive measures which include hand hygiene, wearing face masks and influenza vaccination must be practiced together as bundle of care to reduce respiratory illness effectively. Data based on the social demographic, co-morbid illness, smoking habits, symptoms of respiratory illness, history of contact with respiratory ill patients, previous experience of hajj or umrah, the practice of preventive measures, influenza and pneumococcal vaccination and supplement intake against respiratory illness were obtained by a self-administered proforma.

title:
  The prevalence and preventive measures of the respiratory illness among Malaysian pilgrims in 2013 hajj season

abstract:
  Background. Respiratory illness continues to exert a burden on hajj pilgrims in Makkah. The purpose of this study is to determine the prevalence of respiratory illness and its associated factors among Malaysian hajj pilgrims in 2013 and to describe its preventive measures. Methods. A cross-sectional study was conducted in Makkah and Malaysia during the 2013 hajj season. A self-administered proforma on social demographics, previous experience of hajj or umrah, smoking habits, co-morbid illness and practices of preventive measures against respiratory illness were obtained. Results. A total of 468 proforma were analysed. The prevalence of the respiratory illness was 93.4% with a subset of 78.2% fulfilled the criteria for influenza-like illness (ILI). Most of them (77.8%) had a respiratory illness of <2 weeks duration. Approximately 61.8% were administered antibiotics but only 2.1% of them had been hospitalized. Most of them acquired the infection after a brief stay at Arafat (81.2%). Vaccination coverages for influenza virus and pneumococcal disease were quite high, 65.2% and 59.4%, respectively. For other preventive measures practices, only 31.8% of them practiced good hand hygiene, ∼82.9% of pilgrims used surgical face masks, N95 face masks, dry towels, wet towels or veils as their face masks. Nearly one-half of the respondents (44.4%) took vitamins as their food supplement. Malaysian hajj pilgrims with previous experience of hajj (OR 0.24; 95% CI 0.10–0.56) or umrah (OR 0.19; 95% CI 0.07–0.52) and those who have practiced good hand hygiene (OR 0.35; 95% CI 0.16–0.79) were found to be significantly associated with lower risk of having respiratory illness. Otherwise, pilgrims who had contact with those with respiratory illness (OR 2.61; 95% CI 1.12–6.09) was associated with higher risk. Conclusions. The prevalence of respiratory illness remains high among Malaysian hajj pilgrims despite having some practices of preventive measures. All preventive measures which include hand hygiene, wearing face masks and influenza vaccination must be practiced together as bundle of care to reduce respiratory illness effectively.


id: cord-255339-oudj079q
author: Al-Tayib, Omar A.
date: 2019-02-22
txt: ./txt/cord-255339-oudj079q.txt
cache: ./cache/cord-255339-oudj079q.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.3390/pathogens8010025
doi: 10.3390/pathogens8010025
summary:
  The most important zoonotic viral diseases of which eight were diagnosed (in dead or diseased animals or through antibody detection) on the Arabian Peninsula over the last years include rabies, Middle East Respiratory Syndrome (MERS-CoV), influenza virus (IFV), Alkhurma hemorrhagic fever, Crimean-Congo hemorrhagic fever (CCHF), Rift Valley fever (RVF), West Nile fever (WNV), and dengue fever virus. The same WHO epidemiological data suggest that in these 22 countries including Saudi Arabia, in recent years, there has been report of steadily increasing number of sporadic human cases, incidence, and outbreaks of the virus [122] . Surprisingly, the current review showed that during an outbreak, each of these eight most zoonotic viruses (rabies, MERS-CoV, influenza, AHFV, CCHFV, RVFV, DHFV, and WNV) which occurred and/or cases confirmed in Saudi Arabia particularly from (Jeddah and/or Makkah) areas with at least one or all of these eight zoonotic viral pathogenic diseases [33, 44, 46, 78, [96] [97] [98] [99] 121, 130, 156, 171] .

title:
  An Overview of the Most Significant Zoonotic Viral Pathogens Transmitted from Animal to Human in Saudi Arabia

abstract:
  Currently, there has been an increasing socioeconomic impact of zoonotic pathogens transmitted from animals to humans worldwide. Recently, in the Arabian Peninsula, including in Saudi Arabia, epidemiological data indicated an actual increase in the number of emerging and/or reemerging cases of several viral zoonotic diseases. Data presented in this review are very relevant because Saudi Arabia is considered the largest country in the Peninsula. We believe that zoonotic pathogens in Saudi Arabia remain an important public health problem; however, more than 10 million Muslim pilgrims from around 184 Islamic countries arrive yearly at Makkah for the Hajj season and/or for the Umrah. Therefore, for health reasons, several countries recommend vaccinations for various zoonotic diseases among preventive protocols that should be complied with before traveling to Saudi Arabia. However, there is a shortage of epidemiological data focusing on the emerging and reemerging of zoonotic pathogens transmitted from animal to humans in different densely populated cities and/or localities in Saudi Arabia. Therefore, further efforts might be needed to control the increasing impacts of zoonotic viral disease. Also, there is a need for a high collaboration to enhance the detection and determination of the prevalence, diagnosis, control, and prevention as well as intervention and reduction in outbreaks of these diseases in Saudi Arabia, particularly those from other countries. Persons in the health field including physicians and veterinarians, pet owners, pet store owners, exporters, border guards, and people involved in businesses related to animal products have adopted various preventive strategies. Some of these measures might pave the way to highly successful prevention and control results on the different transmission routes of these viral zoonotic diseases from or to Saudi Arabia. Moreover, the prevention of these viral pathogens depends on socioeconomic impacts, available data, improved diagnosis, and highly effective therapeutics or prophylaxis.


id: cord-255901-nl9k8uwd
author: Barasheed, Osamah
date: 2016-03-29
txt: ./txt/cord-255901-nl9k8uwd.txt
cache: ./cache/cord-255901-nl9k8uwd.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S1201971216310104
doi: 10.1016/j.ijid.2016.03.023
summary:
  Studies conducted in community or health care settings found facemasks to be generally effective against influenza-like illness (ILI) or even against severe acute respiratory syndrome (SARS) but its effectiveness against respiratory infections at MGs remains unknown. 15, 17 A review of non-pharmaceutical interventions against respiratory tract infections among Hajj pilgrims presented data on the uptake of facemask and acknowledged that compliance was generally poor, but did not evaluate its effectiveness during Hajj. A few studies showed that providing educational session on protective measures against respiratory infections (including facemask) before Hajj was associated with significantly higher uptake of facemasks among pilgrims. 68 Focused studies are required to investigate factors influencing facemask compliance among attendees of Hajj and other MGs. In this systematic review, pooled data of facemask effectiveness showed that participants who used facemask during Hajj are about 20% less likely to suffer from respiratory infections compared to those who do not use it.

title:
  Uptake and effectiveness of facemask against respiratory infections at mass gatherings: a systematic review

abstract:
  OBJECTIVES: The risk of acquisition and transmission of respiratory infections is high among attendees of mass gatherings (MGs). Currently used interventions have limitations yet the role of facemask in preventing those infections at MG has not been systematically reviewed. We have conducted a systematic review to synthesise evidence about the uptake and effectiveness of facemask against respiratory infections in MGs. METHODS: A comprehensive literature search was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines using major electronic databases such as, Medline, EMBASE, SCOPUS and CINAHL. RESULTS: Of 25 studies included, the pooled sample size was 12710 participants from 55 countries aged 11 to 89 years, 37% were female. The overall uptake of facemask ranged from 0.02% to 92.8% with an average of about 50%. Only 13 studies examined the effectiveness of facemask, and their pooled estimate revealed significant protectiveness against respiratory infections (relative risk [RR] = 0.89, 95% CI: 0.84-0.94, p < 0.01), but the study end points varied widely. CONCLUSION: A modest proportion of attendees of MGs use facemask, the practice is more widespread among health care workers. Facemask use seems to be beneficial against certain respiratory infections at MGs but its effectiveness against specific infection remains unproven.


id: cord-257200-q0vqlerz
author: Zumla, A.
date: 2016-06-15
txt: ./txt/cord-257200-q0vqlerz.txt
cache: ./cache/cord-257200-q0vqlerz.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S1201971216310943
doi: 10.1016/j.ijid.2016.06.010
summary:
  5 All previous experiences from different mass gathering show that vaccine preventable diseases is the most important infections like influenza, hepatitis A, polio and meningitis. 5 All previous experiences from different mass gathering show that vaccine preventable diseases is the most important infections like influenza, hepatitis A, polio and meningitis. The spread of severe acute respiratory syndrome coronavirus (SARS-CoV) from China to Hong Kong and further to Canada was not due to a mass gathering, but to infected individuals travelling late in the incubation period or just after the onset of symptoms. A review in this issue discusses the need for vaccines for mass gatherings and draws attention to immunization against pneumococcal infections in elderly pilgrims and highlights that polio may be a risk. Communicable diseases as health risks at mass gatherings other than Hajj: what is the evidence?

title:
  What is the experience from previous mass gathering events? Lessons for Zika virus and the Olympics 2016

abstract:
  All previous experiences from different mass gathering show that vaccine preventable diseases is the most important infections like influenza, hepatitis A, polio and meningitis. Three mass gathering held in Africa during the Ebola outbreak accepted participants from West Africa and was able to handle the theoretical risk without any incident. Therefore we believe that the Olympic games in Rio de Janeiro should not be cancelled. The number of visitors to the games is a tiny fraction (1%) of other visitors to Zika endemic countries and it will have no measurable effect on the risk of spreading Zika virus, if the games was cancelled.


id: cord-258611-uzzs8w1j
title: No MERS-CoV but positive influenza viruses in returning Hajj pilgrims, China, 2013–2015
author: Ma, Xuezheng
date: 2017-11-10
txt: ./txt/cord-258611-uzzs8w1j.txt
cache: ./cache/cord-258611-uzzs8w1j.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/29126397/
doi: 10.1186/s12879-017-2791-0
summary:
  BACKGROUND: There is global health concern that the mass movement of pilgrims to and from Mecca annually could contribute to the international spread of Middle East Respiratory Syndrome Coronavirus (MERS-CoV). DISCUSSION AND CONCLUSION: The MERS-CoV and respiratory viruses detection results at points of entry in China from 2013 to 2015 indicated that there were no MERS-CoV infection but a 5.7% positive influenza viruses in returning Chinese pilgrims. As of November 2015, there had been 1618 laboratoryconfirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection reported to the World Health Organization, and at least 579 cases had died [1, 2] . Two hypotheses were tested: (1) There is a significant difference in the positive and negative rates of influenza virus detection between Hajj pilgrims with symptoms and those without. In this study, we did not detect any cases of MERS-CoV infection but respiratory virus infections including influenza A and B, hMPV, hRSV, and human coronavirus were detected among Hajj pilgrims returning to China.

abstract:
  BACKGROUND: There is global health concern that the mass movement of pilgrims to and from Mecca annually could contribute to the international spread of Middle East Respiratory Syndrome Coronavirus (MERS-CoV). In China, about 11,000 Muslim pilgrims participate in the Hajj gathering in Mecca annually. This is the first report of MERS-CoV and respiratory virus molecular screening of returning pilgrims at points of entry in China from 2013 to 2015. METHODS AND RESULTS: A total of 847 returning Hajj pilgrims participated in this study. The test results indicated that of the travelers, 34 tested positive for influenza A virus, 14 for influenza B virus, 4 for metapneumo virus, 2 for respiratory syncytial virus, and 3 for human coronavirus. There was a significant difference in the rates of positive and negative influenza virus tests between Hajj pilgrims with symptoms and those without. The detection rates of influenza virus were not significantly different among the three years studied, at 5.3, 6.0 and 6.3% for 2013, 2014 and 2015, respectively. DISCUSSION AND CONCLUSION: The MERS-CoV and respiratory viruses detection results at points of entry in China from 2013 to 2015 indicated that there were no MERS-CoV infection but a 5.7% positive influenza viruses in returning Chinese pilgrims.


id: cord-258711-3fqxr2yz
author: Yezli, Saber
date: 2019-09-30
txt: ./txt/cord-258711-3fqxr2yz.txt
cache: ./cache/cord-258711-3fqxr2yz.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0196655319301506
doi: 10.1016/j.ajic.2019.02.033
summary:
  Methods Two cohorts of HCWs, the first serving Hajj pilgrims in Mecca and the second serving patients in Al-Ahsa, were investigated for respiratory and gastrointestinal symptoms and pathogen carriage using multiplex polymerase chain reaction before and after the 2015 Hajj. 12 In a study conducted among 120 HCWs from the Saudi Ministry of Health (MOH) and other Hajj medical missions during the 2009 season, 10.6% reported respiratory symptoms during the Hajj, and 12.5% were found infected by at least 1 virus post-Hajj comparing to 7.5% pre-Hajj using a PCR assay. [13] [14] [15] Further studies are needed for a better understanding of the impact of Hajj-related illness among HCWs. Although no correlation was observed between clinical symptoms and detection of respiratory pathogens, we report that HCWs exposed to ill pilgrims carried and acquired a number of respiratory pathogens including acquisition of rhinovirus, enterovirus, respiratory syncytial virus, H influenzae, K pneumoniae, Moraxella catarrhalis, Staphylococcus aureus, and Streptococcus pneumoniae.

title:
  Acquisition of respiratory and gastrointestinal pathogens among health care workers during the 2015 Hajj season

abstract:
  Background Data on the risk of transmission of infection to health care workers (HCWs) serving ill pilgrims during the Hajj is scarce. Methods Two cohorts of HCWs, the first serving Hajj pilgrims in Mecca and the second serving patients in Al-Ahsa, were investigated for respiratory and gastrointestinal symptoms and pathogen carriage using multiplex polymerase chain reaction before and after the 2015 Hajj. Results A total of 211 HCWs were enrolled of whom 92 were exposed to pilgrims (Mecca cohort), whereas 119 were not exposed (Al-Ahsa cohort). Symptoms were observed only in HCWs from the Mecca cohort, with 29.3% experiencing respiratory symptoms during the Hajj period or in the subsequent days and 3.3% having gastrointestinal symptoms. Acquisition rates of at least 1 respiratory virus were 14.7% in the Mecca cohort and 3.4% in the Al-Ahsa cohort (P = .003). Acquisition rates of at least 1 respiratory bacterium were 11.8% and 18.6% in the Mecca and Al-Ahsa cohorts, respectively (P = .09). Gastrointestinal pathogens were rarely isolated in both cohorts of HCWs and acquisition of pathogens after the Hajj was documented in only a few individuals. Conclusions HCWs providing care for pilgrims both acquire pathogens and present symptoms (especially respiratory symptoms) more frequently than those not working during Hajj.


id: cord-258781-peppszqx
author: Ishola, David A.
date: 2011-08-18
txt: ./txt/cord-258781-peppszqx.txt
cache: ./cache/cord-258781-peppszqx.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S2210600611000062
doi: 10.1016/j.jegh.2011.06.004
summary:
  The findings of the review may be able to help inform policy statements on the effectiveness of mass gathering restriction interventions that may be deployed to help reduce influenza virus spread during a pandemic. The other five observational studies were similarly designed, involving groups of intending Hajj pilgrims who were recruited in their home regions or countries prior to the event, and then re-assessed This was a well-organized systematic prospective influenza surveillance program, described by the authors as the first of its type at a large Games event Limitations include: A number of studies [18] [19] [20] [21] [22] have consistently demonstrated, over a number of years, that respiratory virus transmission occurs amongst pilgrims attending the annual Hajj in Saudi Arabia, and it is recognized as an issue of international public health significance [43] [44] [45] [46] that could be particularly important in a pandemic situation.

title:
  Could influenza transmission be reduced by restricting mass gatherings? Towards an evidence-based policy framework

abstract:
  INTRODUCTION: Mass gatherings (MG) may provide ideal conditions for influenza transmission. The evidence for an association between MG and influenza transmission is reviewed to assess whether restricting MG may reduce transmission. METHODS: Major databases were searched (Pubmed, EMBASE, Scopus, CINAHL), producing 1706 articles that were sifted by title, abstract, and full-text. A narrative approach was adopted for data synthesis. RESULTS: Twenty-four papers met the inclusion criteria, covering MG of varying sizes and settings, and including 9 observational studies, 10 outbreak reports, 4 event reports, and a quasi-experimental study. There is some evidence that certain types of MG may be associated with increased risk of influenza transmission. MG may also “seed” new strains into an area, and may instigate community transmission in a pandemic. Restricting MGs, in combination with other social distancing interventions, may help reduce transmission, but it was not possible to identify conclusive evidence on the individual effect of MG restriction alone. Evidence suggests that event duration and crowdedness may be the key factors that determine the risk of influenza transmission, and possibly the type of venue (indoor/outdoor). CONCLUSION: These factors potentially represent a basis for a policy-making framework for MG restrictions in the event of a severe pandemic.


id: cord-259111-hffy6xtm
title: The Hajj in The Time of an Ebola outbreak in West Africa
author: Memish, Ziad A.
date: 2014-10-31
txt: ./txt/cord-259111-hffy6xtm.txt
cache: ./cache/cord-259111-hffy6xtm.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S147789391400163X
doi: 10.1016/j.tmaid.2014.09.003
abstract: nan
summary:
  This issue of Travel Medicine and Infectious Disease has a number of papers pertinent to infectious disease risks for pilgrims attending Hajj, one of the largest annual recurring mass gathering events that takes place in the Kingdom of Saudi Arabia (KSA). The number of Muslims and the average number of pilgrims from the four countries in West Africa involved in the current Ebola Virus Disease (EVD) outbreak are shown in Table 1 . And long before the WHO announcement about PHEIC, the Saudi MOH after careful review by its national infectious diseases committee had asked in April 2014 that the respective authorities to suspend issuing the Hajj and Umrah''s visas for the people of Guinea, Sierra Leone and Liberia [2, 7] . Based on risk assessment in 2012, the Saudi Ministry of Health excluded pilgrims from Uganda and the Democratic Republic of the Congo due to the occurrence of an Ebola outbreak at that time [8] .


id: cord-259966-szkiilb1
author: Gautret, Philippe
date: 2019-11-09
txt: ./txt/cord-259966-szkiilb1.txt
cache: ./cache/cord-259966-szkiilb1.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S147789391930208X
doi: 10.1016/j.tmaid.2019.101504
summary:
  METHODS: Investigators evaluated ill travelers returning from a mass gathering, and presenting to a GeoSentinel site between August 2015 and April 2019, and collected data on the nature of the event and the relation between final diagnoses and the mass gathering. CONCLUSIONS: Despite this surveillance being limited to patients presenting to GeoSentinel sites, our findings highlight the importance of respiratory diseases at mass gatherings, the need for pre-travel consultations before mass gatherings, and consideration of vaccination against influenza and pneumococcal disease. Diagnoses related to attendance at the three most common MGs -Umrah or Hajj, World Scout Jamboree, and Olympics -are presented in Table 1 . Ill MG attendees seen at a GeoSentinel site most frequently attended Umrah or Hajj, likely due to the large number of travelers to these pilgrimages.

title:
  International mass gatherings and travel-associated illness: A GeoSentinel cross-sectional, observational study

abstract:
  BACKGROUND: Travelers to international mass gatherings may be exposed to conditions which increase their risk of acquiring infectious diseases. Most existing data come from single clinical sites seeing returning travelers, or relate to single events. METHODS: Investigators evaluated ill travelers returning from a mass gathering, and presenting to a GeoSentinel site between August 2015 and April 2019, and collected data on the nature of the event and the relation between final diagnoses and the mass gathering. RESULTS: Of 296 ill travelers, 51% were female and the median age was 54 years (range: 1–88). Over 82% returned from a religious mass gathering, most frequently Umrah or Hajj. Only 3% returned from the Olympics in Brazil or South Korea. Other mass gatherings included other sporting events, cultural or entertainment events, and conferences. Respiratory diseases accounted for almost 80% of all diagnoses, with vaccine preventable illnesses such as influenza and pneumonia accounting for 26% and 20% of all diagnoses respectively. This was followed by gastrointestinal illnesses, accounting for 4.5%. Sixty-three percent of travelers reported having a pre-travel encounter with a healthcare provider. CONCLUSIONS: Despite this surveillance being limited to patients presenting to GeoSentinel sites, our findings highlight the importance of respiratory diseases at mass gatherings, the need for pre-travel consultations before mass gatherings, and consideration of vaccination against influenza and pneumococcal disease.


id: cord-261303-xjbz9fw9
title: From the “Madding Crowd” to mass gatherings-religion, sport, culture and public health
author: Ahmed, Qanta A.
date: 2018-06-04
txt: ./txt/cord-261303-xjbz9fw9.txt
cache: ./cache/cord-261303-xjbz9fw9.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S1477893918301315
doi: 10.1016/j.tmaid.2018.06.001
summary:
  Today Mass Gathering Medicine focuses on the public health challenges to hosting events attended by a large enough number of people, at a specific site, for a defined period of time, likely to strain both the planning and response to the mass gathering of a community, state, or nation. Today mass gathering medicine focuses on the public health challenges to hosting events attended by a large enough number of people at a specific site for a defined period of time to strain the planning and response of a community, state, or nation. But it is useful to consider the World Cup as a sporting event on a par with the Summer Olympics and the more recently developed Para-Olympics while the Hajj as a mass gathering centering on Islamic belief is better understood within the context of other mass gatherings centered on other theist belief systems including the Hindu Kumbh Mehla, World Youth Day and other pilgrimages [8] [9] [10] .

abstract:
  Human behavior has long engaged in collective behavior assembling in crowds. The Christian pilgrimage to the Holy Land has been recorded since the 4th century, while the Hajj, Islam's great pilgrimage, has existed for fourteen centuries, of which a body of literature devoted to the travelogues of the Hajj has been recorded for over ten centuries. Football is a sport played worldwide by more than 1.5 million teams and in 300,000 clubs. Most however play outside of the officially organized sphere: more than 4 percent of the global population plays football, including 270 million amateur players. Assembling for specific events is a uniquely human behavior, though the formal study of crowds did not begin until the mid-Twentieth Century. Today Mass Gathering Medicine focuses on the public health challenges to hosting events attended by a large enough number of people, at a specific site, for a defined period of time, likely to strain both the planning and response to the mass gathering of a community, state, or nation. All of us can recall attending a mass gathering, whether it be watching one's favorite rock group in performance or assembling for religious pilgrimage. Certainly, the event itself is transporting and transforming and the unison of behaviors and activities can be enormously enriching, uplifting and overwhelming, just as much as they may be at times dangerous and high risk. This review seeks to draw contrasts and comparisons between sporting gatherings and religious gatherings with a chief focus on Hajj, among the largest of all mass gatherings today. We will find there are some powerful similarities as well as stark differences. Each bequeaths a legacy which can inform the other and, as we make our observations, we join with you and the legions of other investigators who continue to remain fascinated and enthralled by mass gatherings which are among the most beloved and beholden events of modern humanity.


id: cord-265363-xw56intn
author: Gautret, P.
date: 2014-12-12
txt: ./txt/cord-265363-xw56intn.txt
cache: ./cache/cord-265363-xw56intn.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1111/j.1469-0691.2009.02816.x
doi: 10.1111/j.1469-0691.2009.02816.x
summary:
  A prospective epidemiological study was conducted to evaluate the incidence of febrile cough episodes among adult Muslims travelling from Marseille to Saudi Arabia during the Hajj pilgrimage and to assess if use of statin had an influence on this incidence. This result suggests that while treatment with a statin has been demonstrated to reduce the mortality from severe sepsis associated with respiratory tract infections, it probably does not play a role in the outcome of regular febrile cough episodes as observed in the cohort studied here. The pre-travel questionnaire included demographic factors (age, gender, location of residence), indicators of immigration status (country of birth and duration of stay in France), socio-economic indicators (level of education, employment, type of housing, rooms per person and household, complementary health insurance modalities), health status indicators (diabetes, hypertension, chronic respiratory diseases, statin use, vaccination coverage against influenza) and number of previous travels to Saudi Arabia.

title:
  Incidence of Hajj-associated febrile cough episodes among French pilgrims: a prospective cohort study on the influence of statin use and risk factors

abstract:
  A prospective epidemiological study was conducted to evaluate the incidence of febrile cough episodes among adult Muslims travelling from Marseille to Saudi Arabia during the Hajj pilgrimage and to assess if use of statin had an influence on this incidence. In total, 580 individuals were presented with a questionnaire. A significant proportion of individuals had chronic medical disorders, e.g. diabetes mellitus (132, 22.8%) and hypertension (147, 25.3%). Pilgrims had a low level of education and a low employment rate. Sixty (10.3%) were treated with statins for hypercholesterolemia. Four hundred and fourty-seven pilgrims were presented a questionnaire on returning home. A total of 74 travellers (16.6%) experienced fever during their stay in Saudi Arabia (67 attended a doctor) and 271 (60.6%) had cough (259 attended a doctor); 70 travellers with cough were febrile (25.9%). Seventy per cent of the travellers who suffered cough episodes developed their first symptoms within 3 days, suggesting a human to human transmission of the responsible pathogen, with short incubation time as evidenced by a bimodal distribution of cough in two peaks at a 24 h interval. None of demographical and socioeconomic characteristics, underlying diseases or vaccination against influenza significantly affected the occurrence of cough. Diabetes correlated with an increased risk of febrile cough (OR = 2.02 (1.05–3.89)) as well as unemployment (OR = 2.22 (0.91–5.53)). Use of statins had no significant influence on the occurrence of cough and/or fever during the pilgrimage. This result suggests that while treatment with a statin has been demonstrated to reduce the mortality from severe sepsis associated with respiratory tract infections, it probably does not play a role in the outcome of regular febrile cough episodes as observed in the cohort studied here.


id: cord-267427-kg84j802
title: Epidemiology of human common coronavirus acquisition in pilgrims
author: Dao, Thi Loi
date: 2020-08-14
txt: ./txt/cord-267427-kg84j802.txt
cache: ./cache/cord-267427-kg84j802.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S1477893920303410
doi: 10.1016/j.tmaid.2020.101845
abstract: nan
summary:
  We revisited our data by investigating the prevalence of common HCoVs in the Hajj and Grand Magal pilgrims and studying the potential risk factors for HCoV acquisition in a large number of individuals. Symptoms were more frequent in Hajj pilgrims as compared to Grand Magal pilgrims (Supplementary Table 1) . In univariate analysis, acquisition of HCoVs was higher in Hajj pilgrims than in Grand Magal pilgrims. In addition, HCoVs acquisition was more frequent in pilgrims reporting respiratory symptoms, although this was not significant in univariate analysis. This report reveals the role of participation in a large gathering in common HCoVs acquisition and related infections. Significant acquisition of HCoVs following participation in the Hajj pilgrimage has been reported by several authors due to overcrowded conditions encouraging the person-to-person spread of respiratory viruses including HCoVs [3] .


id: cord-268105-617qcgpe
author: Refaey, Samir
date: 2016-11-11
txt: ./txt/cord-268105-617qcgpe.txt
cache: ./cache/cord-268105-617qcgpe.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/27603034/
doi: 10.1111/irv.12429
summary:
  title: Cross‐sectional survey and surveillance for influenza viruses and MERS‐CoV among Egyptian pilgrims returning from Hajj during 2012‐2015 The purpose of this study was to estimate influenza virus and MERS‐CoV prevalence among Egyptian pilgrims returning from Hajj. The MOHP has additionally conducted an annual survey among pilgrims returning from Hajj to explore the risk of influenza virus transmission to the broader community. T A B L E 1 The distribution of Egyptian pilgrims surveyed by season according to gender, age group, presence of influenza-like illness (ILI), vaccination status and influenza laboratory test result Middle East respiratory syndrome coronavirus (MERS-CoV) -Saudi Arabia Risk factors for primary middle east respiratory syndrome coronavirus illness in humans, Saudi Arabia High prevalence of common respiratory viruses and no evidence of Middle East respiratory syndrome coronavirus in Hajj pilgrims returning to Ghana Cross-sectional survey and surveillance for influenza viruses and MERS-CoV among Egyptian pilgrims returning from Hajj during 2012-2015

title:
  Cross‐sectional survey and surveillance for influenza viruses and MERS‐CoV among Egyptian pilgrims returning from Hajj during 2012‐2015

abstract:
  BACKGROUND: Approximately 80 000 Egyptians participate in Hajj pilgrimage annually. The purpose of this study was to estimate influenza virus and MERS‐CoV prevalence among Egyptian pilgrims returning from Hajj. STUDY: A cross‐sectional survey among 3 364 returning Egyptian pilgrims from 2012 to 2015 was conducted. Nasopharyngeal (NP) and oropharyngeal (OP) swabs were collected from all participants. Sputum specimens were collected from participants with respiratory symptoms and productive cough at the time of their interview. Specimens were tested for influenza viruses, and a convenience sample of NP/OP specimens was tested for MERS‐CoV. Thirty percent of participants met the case definition for influenza‐like illness (ILI), 14% tested positive for influenza viruses, and none tested positive for MERS‐CoV. Self‐reported influenza vaccination was 20%. CONCLUSIONS: High prevalence of reported ILI during pilgrimage and confirmed influenza virus on return from pilgrimage suggest a continued need for influenza prevention strategies for Egyptian Hajj pilgrims. An evaluation of the Ministry of Health and Population's current risk communication campaigns to increase influenza vaccine use among pilgrims may help identify strategies to improve vaccine coverage.


id: cord-270408-4qqyb8sd
author: Pane, Masdalina
date: 2013-08-21
txt: ./txt/cord-270408-4qqyb8sd.txt
cache: ./cache/cord-270408-4qqyb8sd.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1371/journal.pone.0073243
doi: 10.1371/journal.pone.0073243
summary:
  title: Causes of Mortality for Indonesian Hajj Pilgrims: Comparison between Routine Death Certificate and Verbal Autopsy Findings This study presents the patterns and causes of death for Indonesian pilgrims, and compares routine death certificates to verbal autopsy findings. In the last two decades, the mortality rate of Indonesian pilgrims, excluding years in which disasters such as stampedes occurred, fluctuated between 200-380 deaths per 100,000 persons during the ten-week Hajj period [5] . The cause of death based on this verbal autopsy method was then recorded in the database and compared to that reported by the hospital or flight doctor death certificate. A greater proportion of deaths were attributed to cardiovascular disease by the flight doctor or hospital death certificate (66%) compared to the cause of death ascertained using the verbal autopsy method (49%, p<0.001). Based on both the death certificates and verbal autopsy categories, cardiovascular disease was the leading cause of Indonesian pilgrim mortality in 2008.

title:
  Causes of Mortality for Indonesian Hajj Pilgrims: Comparison between Routine Death Certificate and Verbal Autopsy Findings

abstract:
  BACKGROUND: Indonesia provides the largest single source of pilgrims for the Hajj (10%). In the last two decades, mortality rates for Indonesian pilgrims ranged between 200–380 deaths per 100,000 pilgrims over the 10-week Hajj period. Reasons for high mortality are not well understood. In 2008, verbal autopsy was introduced to complement routine death certificates to explore cause of death diagnoses. This study presents the patterns and causes of death for Indonesian pilgrims, and compares routine death certificates to verbal autopsy findings. METHODS: Public health surveillance was conducted by Indonesian public health authorities accompanying pilgrims to Saudi Arabia, with daily reporting of hospitalizations and deaths. Surveillance data from 2008 were analyzed for timing, geographic location and site of death. Percentages for each cause of death category from death certificates were compared to that from verbal autopsy. RESULTS: In 2008, 206,831 Indonesian undertook the Hajj. There were 446 deaths, equivalent to 1,968 deaths per 100,000 pilgrim years. Most pilgrims died in Mecca (68%) and Medinah (24%). There was no statistically discernible difference in the total mortality risk for the two pilgrimage routes (Mecca or Medinah first), but the number of deaths peaked earlier for those traveling to Mecca first (p=0.002). Most deaths were due to cardiovascular (66%) and respiratory (28%) diseases. A greater proportion of deaths were attributed to cardiovascular disease by death certificate compared to the verbal autopsy method (p<0.001). Significantly more deaths had ill-defined cause based on verbal autopsy method (p<0.001). CONCLUSIONS: Despite pre-departure health screening and other medical services, Indonesian pilgrim mortality rates were very high. Correct classification of cause of death is critical for the development of risk mitigation strategies. Since verbal autopsy classified causes of death differently to death certificates, further studies are needed to assess the method’s utility in this setting.


id: cord-275605-mbiojk39
title: Clinical respiratory infections and pneumonia during the Hajj pilgrimage: A systematic review
author: Benkouiten, Samir
date: 2018-12-04
txt: ./txt/cord-275605-mbiojk39.txt
cache: ./cache/cord-275605-mbiojk39.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.tmaid.2018.12.002
doi: 10.1016/j.tmaid.2018.12.002
summary:
  METHOD: The MEDLINE/PubMed and Scopus databases were searched for all relevant papers published prior to February 2018 that evaluated the prevalence of clinical symptoms of respiratory infections, including pneumonia, among Hajj pilgrims, as well as their influenza and pneumococcal vaccination status. We carried out a systematic review of cohort and hospital studies that reported the prevalence of clinical symptoms of respiratory infections and pneumonia among pilgrims during the Hajj, and both their influenza and pneumococcal vaccination status, with the aim to provide data allowing the investigation of the impact of this large mass-gathering event on public health policies and services and to identify potential targets for preventive measures. For inclusion, the article had to meet the following criteria: (1) Original study involving Hajj pilgrims; (2) detailed description of the study population, including influenza and pneumococcal vaccination status when available; (3) clinical or self-reported respiratory symptoms and diseases.

abstract:
  BACKGROUND: The Islamic Hajj pilgrimage to Mecca is one of the world's largest annual mass gatherings. Inevitable overcrowding during the pilgrims' stay greatly increases the risk of acquiring and spreading infectious diseases, especially respiratory diseases. METHOD: The MEDLINE/PubMed and Scopus databases were searched for all relevant papers published prior to February 2018 that evaluated the prevalence of clinical symptoms of respiratory infections, including pneumonia, among Hajj pilgrims, as well as their influenza and pneumococcal vaccination status. RESULTS: A total of 61 papers were included in the review. Both cohort- and hospital-based studies provide complementary data, and both are therefore necessary to provide a complete picture of the total burden of respiratory diseases during the Hajj. Respiratory symptoms have been common among Hajj pilgrims over the last 15 years. In cohorts of pilgrims, cough ranged from 1.9% to 91.5%. However, the prevalence rates of the most common symptoms (cough, sore throat, and subjective fever) of influenza-like illness (ILI) varied widely across the included studies. These studies have shown variable results, with overall rates of ILI ranging from 8% to 78.2%. These differences might result from differences in study design, study period, and rates of vaccination against seasonal influenza that ranged from 1.1% to 100% among study participants. Moreover, the definition of ILI was inconsistent across studies. In hospitalized Hajj pilgrims, the prevalence of pneumonia, that remains a major concern in critically ill patients, ranged from 0.2% to 54.8%. CONCLUSIONS: Large multinational follow-up studies are recommended for clinic-based syndromic surveillance, in conjunction with microbiological surveillance. Matched cohorts ensure better comparability across studies. However, study design and data collection procedures should be standardized to facilitate reporting and to achieve comparability between studies. Furthermore, the definition of ILI, and of most common symptoms used to define respiratory infections (e.g., upper respiratory tract infection), need to be precisely defined and consistently used. Future studies need to address potential effect of influenza and pneumococcal vaccine in the context of the Hajj pilgrimage.


id: cord-286654-sox98pp3
title: The inevitable Hajj cough: Surveillance data in French pilgrims, 2012–2014
author: Gautret, Philippe
date: 2015-10-03
txt: ./txt/cord-286654-sox98pp3.txt
cache: ./cache/cord-286654-sox98pp3.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S1477893915001519
doi: 10.1016/j.tmaid.2015.09.008
summary:
  To better characterize the "Hajj cough" symptoms and its outcome, this study provides a clinical description of respiratory symptoms experienced by a cohort of French Hajj pilgrims during three consecutive Hajj seasons. The "Hajj cough" affected all individuals independently on their age, comorbidities, vaccination status and use of individual non-pharmaceutical preventive measures against respiratory tract infections. At the moment, none of the usual preventive measures against respiratory tract infection have been proven effective, including vaccination against influenza which is recommended for all Hajj pilgrims by French authorities and vaccination against pneumococcal infections which is recommended for at risk pilgrims suffering chronic conditions and or for those aged 60 years and over [27] . Nevertheless, prescription of antibiotics to Hajj pilgrims suffering mild respiratory symptoms is frequent in local health care structures: 95-99% patients consulting at the Ear, Nose and Throat clinic of a Hospital in Mecca were prescribed antibiotics while 85-92% presented with upper tract respiratory infection including pharyngitis and tonsillitis [28, 29] .

abstract:
  BACKGROUND: Respiratory tract infections are the most common infection affecting Hajj pilgrims, and the ‘‘Hajj cough’’ is considered by pilgrims almost de rigueur. METHODS: French pilgrims were recruited between January 2012–December 2014 and information on demographics, medical history, compliance with preventive measures and health problems during travel were collected. RESULTS: A total of 382 pilgrims were included with 39.3% aged ≥65 years and 55.1% suffering from a chronic disease, most frequently hypertension and diabetes. The prevalence of cough was 80.9% and a high proportion presented with associated sore throat (91.0%), rhinitis (78.7%) and hoarseness (63.0%). Myalgia was reported in 48.3% of cases and subjective fever in 47.3%. The incubation time of respiratory symptoms was 7.7 days (range 0–25 days) and 51.9% of pilgrims presenting with a cough during their stay were still symptomatic on return. Among pilgrims with a cough, 69.4% took antibiotics. The prevalence of cough was significantly higher among females than men, but age, chronic conditions and preventive measures had no significant effect. CONCLUSIONS: The Hajj cough is highly common, likely a result of crowded conditions at religious places. Pilgrims should be advised to carry symptomatic relief for the Hajj cough such as cough suppressant, soothing throat lozenges and paracetamol. Use of antibiotics should be discouraged.


id: cord-287159-bjccnp7u
author: Yavarian, Jila
date: 2017-10-12
txt: ./txt/cord-287159-bjccnp7u.txt
cache: ./cache/cord-287159-bjccnp7u.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/29031546/
doi: 10.1016/j.tmaid.2017.10.007
summary:
  The aim of this study was to determine and compare the prevalence of Middle East respiratory syndrome coronavirus (MERS-CoV) and influenza virus infections among Iranian general population and pilgrims with severe acute respiratory infections (SARI) returning from Mecca and Karbala during 2013–2016. METHODS: During 2013–2016, a total of 42351 throat swabs were examined for presence of influenza viruses and MERS-CoV in Iranian general population and pilgrims returning from Mecca and Karbala with SARI by using one step RT-PCR kit. CONCLUSION: This study showed the prevalence of influenza infections among Iranian pilgrims and general population and suggests continuing surveillance, infection control and appropriate vaccination especially nowadays that the risk of influenza pandemic threatens the world, meanwhile accurate screening for MERS-CoV is also recommended. The National Influenza Center (NIC) in Iran, located at Virology Department, School of Public Health, Tehran University of Medical Sciences, examines clinical samples from patients with severe acute respiratory infections (SARI) for influenza virus surveillance throughout the year in general population and/or pilgrims.

title:
  Influenza virus but not MERS coronavirus circulation in Iran, 2013–2016: Comparison between pilgrims and general population

abstract:
  BACKGROUND: The pilgrimage to Mecca and Karbala bring many Muslims to a confined area. Respiratory tract infections are the most common diseases transmitted during mass gatherings in Hajj, Umrah and Karbala. The aim of this study was to determine and compare the prevalence of Middle East respiratory syndrome coronavirus (MERS-CoV) and influenza virus infections among Iranian general population and pilgrims with severe acute respiratory infections (SARI) returning from Mecca and Karbala during 2013–2016. METHODS: During 2013–2016, a total of 42351 throat swabs were examined for presence of influenza viruses and MERS-CoV in Iranian general population and pilgrims returning from Mecca and Karbala with SARI by using one step RT-PCR kit. RESULTS: None of the patients had MERS-CoV but influenza viruses were detected in 12.7% with high circulation of influenza A/H1N1 (47.1%). CONCLUSION: This study showed the prevalence of influenza infections among Iranian pilgrims and general population and suggests continuing surveillance, infection control and appropriate vaccination especially nowadays that the risk of influenza pandemic threatens the world, meanwhile accurate screening for MERS-CoV is also recommended.


id: cord-291821-ovfqfurf
title: Emergence of medicine for mass gatherings: lessons from the Hajj
author: Memish, Ziad A
date: 2011-12-19
txt: ./txt/cord-291821-ovfqfurf.txt
cache: ./cache/cord-291821-ovfqfurf.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S1473309911703371
doi: 10.1016/s1473-3099(11)70337-1
summary:
  Among all MGs, the public health issues, associated with the Hajj (an annual pilgrimage to Mecca, Saudi Arabia) is clearly the best reported—probably because of its international or even intercontinental implications in terms of the spread of infectious disease. Imperial organisations linked cholera morbus, a non-epidemic diarrhoea, to Hajj, allowing a public health industry to develop that used health concerns to control immigration, pilgrim passports, proof of suffi cient funds to allow return travel, maritime regulation, and vessel quarantine procedures. Effi cient reorganization of the pilgrimage in every direction is needed and should be facilitated by the governments of the large number of the countries involved." 34 By the early 20th century, non-Muslim European powers were heavily engaged in the management of the Hajj and would remain so until modern Saudi Arabia came into existence and acquired fi nancial independence through petrochemical wealth.

abstract:
  Although definitions of mass gatherings (MG) vary greatly, they consist of large numbers of people attending an event at a specific site for a finite time. Examples of MGs include World Youth Day, the summer and winter Olympics, rock concerts, and political rallies. Some of the largest MGs are spiritual in nature. Among all MGs, the public health issues, associated with the Hajj (an annual pilgrimage to Mecca, Saudi Arabia) is clearly the best reported—probably because of its international or even intercontinental implications in terms of the spread of infectious disease. Hajj routinely attracts 2·5 million Muslims for worship. WHO's global health initiatives have converged with Saudi Arabia's efforts to ensure the wellbeing of pilgrims, contain infectious diseases, and reinforce global health security through the management of the Hajj. Both initiatives emphasise the importance of MG health policies guided by sound evidence and based on experience and the timeliness of calls for a new academic science-based specialty of MG medicine.


id: cord-293247-ltxt2dfv
author: Elachola, Habida
date: 2015-10-09
txt: ./txt/cord-293247-ltxt2dfv.txt
cache: ./cache/cord-293247-ltxt2dfv.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S1201971215002374
doi: 10.1016/j.ijid.2015.10.003
abstract: nan
summary:
  title: Advancing the global health security agenda in light of the 2015 annual Hajj pilgrimage and other mass gatherings Although current GHSA is yet to specifically highlight mass gathering preparedness as a strategic priority even in countries with high participant contribution to mass gatherings, the 12 Global Health Security Agenda action packages and the strategies to minimize the implications of mass gathering on public health are similar. Given that two-thirds of the emerging diseases are zoonotic, human-animal interaction during some mass gatherings such as the Hajj further increases the risk, and Saudi Arabia imports sacrifice animals from 6 countries. Mass gatherings offer opportunities to implement, test, and assess GHSA objectives in its entirety and can contribute significantly to health security of individuals, nations, and the world. Mass gatherings medicine and global health security

title:
  Advancing the global health security agenda in light of the 2015 annual Hajj pilgrimage and other mass gatherings


id: cord-299440-y6o5e2k5
title: A crucial time for public health preparedness: Zika virus and the 2016 Olympics, Umrah, and Hajj
author: Elachola, Habida
date: 2016-02-07
txt: ./txt/cord-299440-y6o5e2k5.txt
cache: ./cache/cord-299440-y6o5e2k5.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0140673616002749
doi: 10.1016/s0140-6736(16)00274-9
abstract: nan
summary:
  Although winter temperatures mean that mosquito density is expected to be low in Brazil at the time of the Olympics, given the summer time mosquito density in the northern hemisphere, including in Saudi Arabia, the introduction of a few infections to the mosquito population might be suffi cient to cause outbreaks of Zika virus in other countries. 11 Although both countries may have robust vector control eff orts, no single approach is adequate to prevent mosquito bites and non-vector modes of Zika virus transmission; a combination of measures is needed at personal, community, and policy levels. Given that pilgrim fl ow to Saudi Arabia is continuous, these eff orts will help minimise current transmission of Zika virus as well. 4, 13 Lessons from Saudi Arabia''s success with hosting Hajj during declared pandemics can be helpful to Brazil and the Olympics organisers. Liraglutide safety and effi cacy in patients with non-alcoholic steatohepatitis (LEAN): a multicentre, double-blind, randomised, placebo-controlled phase 2 study


id: cord-302784-jkjdglns
author: Alotaibi, Badriah
date: 2019-07-13
txt: ./txt/cord-302784-jkjdglns.txt
cache: ./cache/cord-302784-jkjdglns.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.tmaid.2019.07.007
doi: 10.1016/j.tmaid.2019.07.007
summary:
  title: Management of hospitalized drug sensitive pulmonary tuberculosis patients during the Hajj mass gathering: A cross sectional study This study documents the management of drug-sensitive TB patients during Hajj and explores the compliance of healthcare providers with the KSA TB management guidelines in the Ministry of Health (MOH) hospitals in Makkah during the mass gathering. The management of TB patients was documented using a specifically designed data collection form which included patients'' demographics data, underlying health conditions and TB risk factors as well as clinical data including various aspects of TB management such as patients'' screening, infection prevention and control (IPC), TB diagnosis and treatment and case notification and outcome. The result showed high level of compliance with the assessed TB management guidelines indices for systematic screening of TB suspects as well as IPC and surveillance, but low compliance scores were obtained for prompt TB diagnosis and use of standardized treatment regimen for drug-susceptible TB.

title:
  Management of hospitalized drug sensitive pulmonary tuberculosis patients during the Hajj mass gathering: A cross sectional study

abstract:
  BACKGROUND: To document the management of drug-sensitive TB patients during the Hajj and assess compliance with the Saudi TB management guidelines. METHOD: The study was conducted in hospitals in Makkah during the 2016 and 2017 Hajj seasons. Structured questionnaire was used to collect data on relevant indices on TB management and a scoring system was developed to assess compliance with guidelines. RESULTS: Data was collected from 31 TB cases, 65.4% (17/26) were Saudi residents. Sputum culture was the only diagnostic test applied in 67.7% (21/31) of patients. Most (96.8%, 30/31) confirmed TB cases were isolated, but only 12.9% (4/28) were tested for HIV and merely 37% (10/27) received the recommended four 1st-line anti-TB drugs. Guideline compliance scores were highest for infection prevention and control and surveillance (9.6/10) and identifying TB suspects (7.2/10). The least scores were obtained for treating TB (5.0/10) and diagnosing TB (3.0/10). CONCLUSIONS: Healthcare providers training and supervision are paramount to improve their knowledge and skill and ensure their compliance with existing TB management guidelines. However, there may be a need for the introduction of an international policy/guideline for TB control and management during mass gatherings such as the Hajj to guide providers’ choices and facilitate monitoring.


id: cord-305460-wln758og
author: Alqahtani, Amani Salem
date: 2020-05-04
txt: ./txt/cord-305460-wln758og.txt
cache: ./cache/cord-305460-wln758og.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32375320/
doi: 10.3390/pharmacy8020078
summary:
  This study assessed Australian Hajj pilgrims'' knowledge, attitude and practices throughout their Hajj journey to understand their health behaviors, use of preventative measures and development of illness symptoms. Similarly, hand hygiene and other preventative practices also vary among pilgrims, making it more difficult for researchers to ascertain whether vaccine uptake and health behaviors overall have improved in comparison to previous years or studies [5] [6] [7] . To address these research gaps, we conducted a cohort study to explore Australian Hajj pilgrims'' knowledge about the risk of diseases during Hajj, assess their preparedness and use of preventive measures at three times points (before, during and after Hajj) , investigate the factors affecting their preventive health behavior, and determine the number of reported infections during and after Hajj. This cohort study captured and compared the health behavior, knowledge, attitudes and practices of Australian Hajj pilgrims regarding preventative measures against communicable diseases throughout the course of Hajj travel (before, during and after the journey).

title:
  Tracking Australian Hajj Pilgrims’ Health Behavior before, during and after Hajj, and the Effective Use of Preventive Measures in Reducing Hajj-Related Illness: A Cohort Study

abstract:
  This study assessed Australian Hajj pilgrims’ knowledge, attitude and practices throughout their Hajj journey to understand their health behaviors, use of preventative measures and development of illness symptoms. A prospective cohort study with data collection at three phases (before, during and after Hajj) was conducted among Australian pilgrims between August and December 2015. Baseline data were collected from 421 pilgrims before Hajj, with 391 providing follow-up data during Hajj and 300 after their home return. Most participants (78% [329/421]) received one or more recommended vaccines; travel agents’ advice was the main factor affecting vaccination uptake. Most participants (69% [270/391]) practiced hand hygiene with soap and sanitizers frequently, followed by disposable handkerchief use (36% [139/391]) and washing hands with water only (28% [111/391]). During Hajj 74% (288/391) of participants reported one or more illness symptoms, 86% (248/288) of these symptoms were respiratory. Cough was less often reported among pilgrims who received vaccinations, cleaned their hands with soap or alcoholic hand rubs, while a runny nose was less common among those who frequently washed their hands with plain water but was more common among those who used facemasks. This study reveals that most Australian Hajj pilgrims complied with key preventative measures, and that tour group operators’ advice played an important role in compliance. Pilgrims who were vaccinated and practiced hand hygiene were less likely to report infection symptoms.


id: cord-310557-d33ll0ka
author: Alotaibi, Badriah M.
date: 2017-02-26
txt: ./txt/cord-310557-d33ll0ka.txt
cache: ./cache/cord-310557-d33ll0ka.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1093/jtm/taw087
doi: 10.1093/jtm/taw087
summary:
  Method: We reviewed documents, including guidelines and reports from the Saudi Ministry of Health''s database, to describe the characteristics of the infectious diseases surveillance systems that were operational during the 2015 Hajj, highlighting best practices and gaps and proposing strategies for strengthening and improvement. During Hajj, enhanced indicator-based notifiable diseases surveillance systems complement the existing surveillance tool to ensure timely reporting of event information for appropriate action by public health officials. 10 The use of appropriate surveillance systems during mass gatherings ensures the timely collection, analysis and interpretation of health data for effective planning and response to infectious diseases threats. 14 Furthermore, there is need to sustain the enhanced surveillance system and other public health interventions at key locations in the Kingdom, including the points of entry, after the Hajj, as a prevention and control strategy for the international spread of diseases during other mass gatherings with international dimensions, principally the Umrah pilgrimage.

title:
  Strengthening health security at the Hajj mass gatherings: characteristics of the infectious diseases surveillance systems operational during the 2015 Hajj

abstract:
  Background: Hajj is one of the largest and the most ethnically and culturally diverse mass gatherings worldwide. The use of appropriate surveillance systems ensures timely information management for effective planning and response to infectious diseases threats during the pilgrimage. The literature describes infectious diseases prevention and control strategies for Hajj but with limited information on the operations and characteristics of the existing Hajj infectious diseases surveillance systems. Method: We reviewed documents, including guidelines and reports from the Saudi Ministry of Health’s database, to describe the characteristics of the infectious diseases surveillance systems that were operational during the 2015 Hajj, highlighting best practices and gaps and proposing strategies for strengthening and improvement. Using Pubmed and Embase online search engines and a combination of search terms including, ‘mass gatherings’ ‘Olympics’ ‘surveillance’ ‘Hajj’ ‘health security’, we explored the existing literature and highlighted some lessons learnt from other international mass gatherings. Results: A regular indicator-based infectious disease surveillance system generates routine reports from health facilities within the Kingdom to the regional and central public health directorates all year round. During Hajj, enhanced indicator-based notifiable diseases surveillance systems complement the existing surveillance tool to ensure timely reporting of event information for appropriate action by public health officials. Conclusion: There is need to integrate the existing Hajj surveillance data management systems and to implement syndromic surveillance as an early warning system for infectious disease control during Hajj. International engagement is important to strengthen Hajj infectious diseases surveillance and to prevent disease transmission and globalization of infectious agents which could undermine global health security.


id: cord-311654-ixn65hxb
author: Zumla, Alimuddin
date: 2020-08-08
txt: ./txt/cord-311654-ixn65hxb.txt
cache: ./cache/cord-311654-ixn65hxb.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S1201971220306433
doi: 10.1016/j.ijid.2020.08.014
abstract: nan
summary:
  Apart from generic prevention and control issues of public health and lockdown measures to limit epidemic spread, specific issues of Mass Gathering (MG) sporting and religious events came under specific spotlight (Alzahrani et al, 2020; Baloch et al, 2020; McCloskey et al, 2020; . WHO with global MG partners, developed comprehensive key recommendations for COVID-19, and since end of February, 2020, there was a stepwise increase in cancellation, temporary suspension or postponement of international and national religious, sporting, musical, and other MGs, as countries worldwide took public health and other measures (WHO, 2020b; McCloskey et al, 2020; Petersen, McCloskey et al, 2020) . The successful completion of the 2020 Hajj is a major tribute to the leadership and commitment of the Saudi authorities, and it reflects their extensive experience of organising the annual Hajj pilgrimage, and continued commitment to improvement public health issues related to mass gatherings events.

title:
  COVID-19 and the scaled-down 2020 Hajj Pilgrimage - Decisive, logical and prudent decision making by Saudi authorities overcomes pre-Hajj public health concerns


id: cord-314421-j5psma9i
title: The cancellation of mass gatherings (MGs)? Decision making in the time of COVID-19
author: Ahmed, Qanta A.
date: 2020-03-14
txt: ./txt/cord-314421-j5psma9i.txt
cache: ./cache/cord-314421-j5psma9i.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S1477893920300995
doi: 10.1016/j.tmaid.2020.101631
summary:
  While health care workers (HCWs) will be familiar with these measures, and Hajj pilgrims are always escorted by Hajj tour agencies who also provide basic education in infection control, the Umrah pilgrim (the traveler making the mini-pilgrimage to Mecca sometimes on the spur of the moment and at any time of the year) and the general public will not have experience in hand hygiene education. Similarly when KSA has faced the extremely delicate balance of welcoming religious pilgrims for both Hajj and Umrah this year many of whom have waited a life time to enact their religious rites, and weighing the impact of propagating outbreaks, difficult and unpopular decisions have to be made to safeguard not only the mass gathering but also the wider global community.

abstract:
  Our recommendation, as experts who have monitored health hazards at the Hajj for over 15 years, especially if the situation with COVID-19 continues to escalate globally is that Hajj 2020 will be at risk of being suspended and a means for Muslims to fulfill their rights in the future either personally or even by proxy need to be announced. The same holds true for the Summer 2020 Olympics in Japan and for many other MGs and large gatherings. Decisions in the time of COVID-19 will be closely followed and will be a blueprint for other mass gatherings.


id: cord-314607-bcocsjij
author: Memish, Ziad A.
date: 2011-12-23
txt: ./txt/cord-314607-bcocsjij.txt
cache: ./cache/cord-314607-bcocsjij.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/22197024/
doi: 10.1016/j.tmaid.2011.11.002
summary:
  The prevalance of respiratory viruses among healthcare workers serving pilgrims in Makkah during the 2009 influenza A (H1N1) pandemic KEYWORDS Hajj; Viral; Respiratory; Healthcare workers; H1N1 Summary Despite the high risk of acquiring respiratory infections, healthcare workers who treat pilgrims at Hajj have not been studied in previous research on respiratory diseases during Hajj. The objective of this study was to determine the prevalence of different respiratory viruses among healthcare workers who treated pilgrims during Hajj 2009, the year of the influenza A H1N1 pandemic. The objective of this study was to determine the prevalence of different respiratory viruses among healthcare workers who treated pilgrims during Hajj 2009, the year of the influenza A H1N1 pandemic. Among the 18 circulating respiratory virus types and subtypes, only two were detected in the healthcare workers in the pre-and post-Hajj period: rhinovirus (N Z 21, 12.6%) and coronavirus 229E (N Z 1, 0.6%) .

title:
  The prevalance of respiratory viruses among healthcare workers serving pilgrims in Makkah during the 2009 influenza A (H1N1) pandemic

abstract:
  Despite the high risk of acquiring respiratory infections, healthcare workers who treat pilgrims at Hajj have not been studied in previous research on respiratory diseases during Hajj. The objective of this study was to determine the prevalence of different respiratory viruses among healthcare workers who treated pilgrims during Hajj 2009, the year of the influenza A H1N1 pandemic. A cross-sectional study was performed just before and after Hajj (25–29 November, 2009). Nasal and throat swabs were tested for 18 respiratory virus types and subtypes. A total of 184 healthcare workers were examined. Most were men (85%) with an average age of 41 years. Before the Hajj, rates of seasonal influenza vaccination were higher (51%) than rates of pandemic influenza A H1N1 vaccination (22%). After the Hajj, participants reported high rates of maintaining hand hygiene (98%), cough etiquette (89%), and wearing a face mask (90%). Among all the viruses tested, only two were detected: rhinovirus was detected in 12.6% and Coronavirus 229E in 0.6%. Rhinovirus was detected in 21% of those who had respiratory symptoms during Hajj. Influenza A (including H1N1), influenza B. respiratory syncytial virus, other coronaviruses, parainfluenza viruses, human metapneumovirus, adenovirus, and human bocavirus were not detected. The finding of high rates of rhinovirus infection corresponds to their frequent occurrence in adults. None of the participants had influenza A H1N1 2009, possibly because it was also infrequent among the 2009 pilgrims.


id: cord-316727-ktrlohm9
author: Razavi, Seyed Mansour
date: 2014-05-10
txt: ./txt/cord-316727-ktrlohm9.txt
cache: ./cache/cord-316727-ktrlohm9.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/25250272/
doi: nan
summary:
  title: Treatment and prevention of acute respiratory infections among Iranian hajj pilgrims: a 5-year follow up study and review of the literature Background Respiratory diseases/syndromes are the most common causes of referring to physicians among pilgrims in Hajj. The main aim of our study was to determine types, frequencies, etiologies, and epidemiologic factors of respiratory diseases among Iranian Hajj pilgrims and to suggest some preventive and treatment strategies. The aim of our study was to determine types, frequencies, etiologies, and some of other epidemiologic factors of respiratory diseases among Iranian Hajj pilgrims and to suggest some preventive and treatment strategies based on our 10 years of experience and literature review. We used the results of above mentioned studies and reviewed the literature, and offered a guideline for the treatment and prevention of acute respiratory infections (ARIs) in Hajj.  Significant difference values of NBT test before and after travel showed that respiratory diseases of pilgrims might have infectious origins.

title:
  Treatment and prevention of acute respiratory infections among Iranian hajj pilgrims: a 5-year follow up study and review of the literature

abstract:
  Background Respiratory diseases/syndromes are the most common causes of referring to physicians among pilgrims in Hajj. They lead to high morbidity, impose high costs on the health system and are among the major obstacles for pilgrims to perform Hajj duties. The main aim of our study was to determine types, frequencies, etiologies, and epidemiologic factors of respiratory diseases among Iranian Hajj pilgrims and to suggest some preventive and treatment strategies. Methods: To determine the types and frequencies of respiratory syndromes, we implemented a syndromic surveillance method in Iranian health care system for Hajj during 5 consecutive years. To achieve the etiology of these diseases, we performed 4 concurrent before and after studies. We also evaluated efficacy of the flu and pneumovax vaccines among Iranian Hajj pilgrims in 2 studies. To determine some other epidemiological factors, we conducted 4 additional studies. Results: The most common problem was common cold like syndrome. Origins of the most upper respiratory problems were infections, and allergies were less involved. Among infectious agents, viruses were the most common agents and their frequencies were as follows respectively: Adenoviruses 38 (36.2 %), Rhinoviruses 31 (30%), Influenza type B virus 21 (20%). Bacteria were often the secondary causes and their frequencies were as follows respectively: Intestine bacillus 69 (19.4%), Chlamydia pneumonia 20(15.8%), Haemophiluses 32 (9.1%) and Streptococcus (A,C and G) 30 ( 8.5%). We introduced some epidemiological factors as effective in creating respiratory diseases. Conclusion: In this paper, we suggested some applied points for prevention, treatment, and correction of common malpractices in the treatment of respiratory diseases of the pilgrims.


id: cord-318315-r6wqywwe
author: Memish, Ziad A.
date: 2014-06-23
txt: ./txt/cord-318315-r6wqywwe.txt
cache: ./cache/cord-318315-r6wqywwe.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/24970703/
doi: 10.1016/j.ijid.2014.06.003
summary:
  We aimed to screen Hajj pilgrims admitted to healthcare facilities in 2013 with severe community-acquired pneumonia (CAP) for MERS-CoV and to determine other etiologies. METHODS: Sputum samples were collected from all pilgrims admitted to 15 healthcare facilities in the cities of Makkah and Medina, Saudi Arabia, who were diagnosed with severe CAP on admission, presenting with bilateral pneumonia. 7, 10 In recent years, the Middle East respiratory syndrome coronavirus (MERS-CoV) has also emerged as a cause of serious illness including severe pneumonia. Respiratory tract infections are common illnesses during the Hajj, 15 and pneumonia is the leading cause of hospital admission, including admission to the ICU, during the pilgrimage. 16 In the current study, as part of the Saudi MoH MERS-CoV surveillance, we investigated the etiology of severe CAP in pilgrims attending the 2013 Hajj requiring hospitalization. 7,10 Studies performed during previous Hajj seasons have reported the organism as a cause of respiratory tract infections including penumonia.

title:
  Etiology of severe community-acquired pneumonia during the 2013 Hajj—part of the MERS-CoV surveillance program

abstract:
  BACKGROUND: Pneumonia is the leading cause of hospital admission during the annual Islamic pilgrimage (Hajj). The etiology of severe pneumonia is complex and includes the newly emerged Middle East respiratory syndrome coronavirus (MERS-CoV). Since 2012, the Saudi Ministry of Health (MoH) has required screening for MERS-CoV for all cases of severe pneumonia requiring hospitalization. We aimed to screen Hajj pilgrims admitted to healthcare facilities in 2013 with severe community-acquired pneumonia (CAP) for MERS-CoV and to determine other etiologies. METHODS: Sputum samples were collected from all pilgrims admitted to 15 healthcare facilities in the cities of Makkah and Medina, Saudi Arabia, who were diagnosed with severe CAP on admission, presenting with bilateral pneumonia. The medical records were reviewed to collect information on age, gender, nationality, and patient outcome. Samples were screened for MERS-CoV by PCR, and a respiratory multiplex array was used to detect up to 22 other viral and bacterial respiratory pathogens. RESULTS: Thirty-eight patients met the inclusion criteria; they were predominantly elderly (mean age 58.6 years, range 25–83 years) and male (68.4%), and all were from developing countries. Fourteen of the 38 patients died (36.8%). MERS-CoV was not detected in any of the samples. Other respiratory pathogens were detected in 26 (68.4%) samples. Of these, bacterial pathogens were detected in 84.6% (22/26) and viruses in 80.7% (21/26). Twenty-one (80.7%) samples were positive for more than one respiratory pathogen and 17 (65.3%) were positive for both bacteria and viruses. The most common respiratory virus was human rhinovirus, detected in 57.7% of the positive samples, followed by influenza A virus (23.1%) and human coronaviruses (19.2%). Haemophilus influenzae and Streptococcus pneumoniae were the predominant bacteria, detected in 57.7% and 53.8%, respectively, of the positive samples, followed by Moraxella catarrhalis (36.4%). CONCLUSIONS: MERS-CoV was not the cause of severe CAP in any of the hospitalized pilgrims investigated. However we identified a variety of other respiratory pathogens in the sputum of this small number of patients. This indicates that the etiology of severe CAP in Hajj is complex with implications regarding its management.


id: cord-319784-lpmsalux
author: Alqahtani, Amani S.
date: 2015-08-13
txt: ./txt/cord-319784-lpmsalux.txt
cache: ./cache/cord-319784-lpmsalux.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S2210600615000866
doi: 10.1016/j.jegh.2015.07.005
summary:
  title: Pilot use of a novel smartphone application to track traveller health behaviour and collect infectious disease data during a mass gathering: Hajj pilgrimage 2014 Pilot use of a novel smartphone application to track traveller health behaviour and collect infectious disease data during a mass gathering: Hajj pilgrimage 2014 1 Therefore, we conducted a pilot study using a smartphone app to examine its feasibility to track not only Hajj pilgrim KAP regarding preventive measures, but also symptom onset and participation in high-risk activities before, during, and after Hajj 2014. The first screen (first phase) is the pre-Hajj questionnaire, including data on participant demographics, pre-existing chronic diseases, vaccinations received before travel, factors influencing vaccination decision and uptake, perception of the risk of respiratory infection during Hajj, willingness to participate in highrisk activities, such as drinking unpasteurised milk, and awareness of official health recommendations provided by Saudi Arabian authorities.

title:
  Pilot use of a novel smartphone application to track traveller health behaviour and collect infectious disease data during a mass gathering: Hajj pilgrimage 2014

abstract:
  This study examines the feasibility of using a smartphone application (app) to conduct surveys among travellers during the Hajj pilgrimage, where the use of apps has not been evaluated for infectious disease surveillance. A longitudinal study was conducted among pilgrims at the Hajj 2014 using an iPhone app with separate questionnaires for three study phases covering before, during, and after Hajj. Forty-eight pilgrims from 13 countries downloaded the app. Respondents were aged between 21 and 61 (median 36) years and 58.5% (24/41) were male. Of these, 85% (41/48) completed the first phase, 52% (25/41) completed both the second and third phases, and 25 of these reported meningococcal vaccination, with 36% (9/25) receiving other vaccines. All (25) reported hand hygiene use and 64% (16/25) wore a facemask at some point during the pilgrimage. Four (6%) reported close contact with camels. Respiratory symptoms commenced from the 4th day of Hajj, with sore throat (20%) and cough (12%) being the most common. Three participants (12%) reported respiratory symptoms after returning home. Conducting a prospective survey using a smartphone app to collect data on travel-associated infections and traveller compliance to prevention is feasible at mass gatherings and can provide useful data associated with health-related behaviour.


id: cord-323455-26xi2lqf
author: AlBarrak, Ali
date: 2018-02-21
txt: ./txt/cord-323455-26xi2lqf.txt
cache: ./cache/cord-323455-26xi2lqf.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.ijid.2018.02.008
doi: 10.1016/j.ijid.2018.02.008
summary:
  This study was performed to evaluate the proportion of adult community-acquired pneumonia (CAP) cases attributable to Streptococcus pneumoniae among Hajj pilgrims in 2016. METHODS: Adult subjects hospitalized with X-ray-confirmed CAP were enrolled prospectively from all general hospitals designated to treat Hajj pilgrims in the holy cities of Mecca and Medina. RESULTS: From August 23 to September 23, 2016, a total of 266 patients with CAP were enrolled in the study, 70.6% of whom were admitted to hospitals in Mecca; 53% of the cases were admitted after the peak of Hajj. pneumoniae among adult Hajj pilgrims in 2016, using the urine antigen test as well as standard culture-based tests, in order to determine the clinical burden of disease associated with Hajj and inform vaccination policy-making. General pattern of community-acquired pneumonia (CAP) case admissions to hospitals during the study period. It was aimed to systematically enroll all hospitalized X-ray-confirmed CAP cases among Hajj pilgrims during the study period.

title:
  Proportion of adult community-acquired pneumonia cases attributable to Streptococcus pneumoniae among Hajj pilgrims in 2016

abstract:
  BACKGROUND: The Hajj mass gathering is a risk for pneumococcal disease. This study was performed to evaluate the proportion of adult community-acquired pneumonia (CAP) cases attributable to Streptococcus pneumoniae among Hajj pilgrims in 2016. To add sensitivity to etiological attribution, a urine antigen test was used in addition to culture-based methods. METHODS: Adult subjects hospitalized with X-ray-confirmed CAP were enrolled prospectively from all general hospitals designated to treat Hajj pilgrims in the holy cities of Mecca and Medina. Patients were treated according to local standard of care and administered the BinaxNow S. pneumoniae urine antigen test. RESULTS: From August 23 to September 23, 2016, a total of 266 patients with CAP were enrolled in the study, 70.6% of whom were admitted to hospitals in Mecca; 53% of the cases were admitted after the peak of Hajj. Patients originated from 43 countries. Their mean age was 65.3 years and the male to female ratio was 2:1. Just over 36% of the cases had diabetes, 10% declared that they were smokers, and 45.4% of cases were treated in the intensive care unit (ICU). The overall case-fatality rate was 10.1%, but was higher among those treated in the ICU and in those with invasive disease. The proportion of CAP cases positive for S. pneumoniae, based on culture or urine antigen test, was 18.0% (95% confidence interval 13.9–23.1%). CONCLUSIONS: CAP during Hajj has an important clinical impact. A proportion of CAP cases among Hajj pilgrims were attributable to S. pneumoniae, a pathogen for which vaccines are available. Additional studies to determine the serotypes causing pneumococcal disease could further inform vaccine policy for Hajj pilgrims.


id: cord-324215-1tzbvgyr
title: Indonesian Hajj Cohorts and Mortality in Saudi Arabia from 2004 to 2011
author: Pane, Masdalina
date: 2019-03-17
txt: ./txt/cord-324215-1tzbvgyr.txt
cache: ./cache/cord-324215-1tzbvgyr.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.2991/jegh.k.181231.001
doi: 10.2991/jegh.k.181231.001
summary:
  This report uses data extracted from the Indonesian Hajj surveillance to provide a descriptive overview of mortality patterns in each cohort of pilgrims from 2004 to 2011 (winter Hajj season) to identify health issues of pilgrims for further research planning. Demographic variables collected include name, age, sex, home address, employment, flight group, travel route, date of arrival into Saudi Arabia, and cause of death (if any), according to the hospital medical record or flight doctor death certificate. Public health surveillance was conducted as the morbidity and mortality surveillance in Hajj by the Indonesian public health authorities accompanying pilgrims to Saudi Arabia with daily reporting of hospitalizations and deaths. Database variables included name, age, sex, home address, employment, flight group, travel route, date of arrival into Saudi Arabia, and cause of death as obtained from the hospital medical record or flight doctor''s death certificate.

abstract:
  The Hajj is an annual pilgrimage that 1–2 million Muslims undertake in the Kingdom of Saudi Arabia (KSA), which is the largest mass gathering event in the world, as the world’s most populous Muslim nation, Indonesia holds the largest visa quota for the Hajj. All Hajj pilgrims under the quota system are registered in the Indonesian government’s Hajj surveillance database to ensure adherence to the KSA authorities’ health requirements. Performance of the Hajj and its rites are physically demanding, which may present health risks. This report provides a descriptive overview of mortality in Indonesian pilgrims from 2004 to 2011. The mortality rate from 2004 to 2011 ranged from 149 to 337 per 100,000 Hajj pilgrims, equivalent to the actual number of deaths ranging between 501 and 531 cases. The top two mortality causes were attributable to diseases of the circulatory and respiratory systems. Older pilgrims or pilgrims with comorbidities should be encouraged to take a less physically demanding route in the Hajj. All pilgrims should be educated on health risks and seek early health advice from the mobile medical teams provided.


id: cord-326768-uo6482ah
author: Hashem, Anwar M.
date: 2019-02-20
txt: ./txt/cord-326768-uo6482ah.txt
cache: ./cache/cord-326768-uo6482ah.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/30729547/
doi: 10.1002/jmv.25424
summary:
  The aim here was to screen symptomatic pilgrims for Middle East respiratory syndrome coronavirus (MERS‐CoV) and other viral etiologies. 2, [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] The emergence of the novel Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia, its endemicity, and high mortality rates (35%-40%) clearly represent another major public health concern, especially during Hajj. High prevalence of common respiratory viruses and no evidence of Middle East respiratory syndrome coronavirus in Hajj pilgrims returning to Ghana Detection of respiratory viruses among pilgrims in Saudi Arabia during the time of a declared influenza A(H1N1) pandemic MERS-CoV but positive influenza viruses in returning Hajj pilgrims, China Cross-sectional survey and surveillance for influenza viruses and MERS-CoV among Egyptian pilgrims returning from Hajj during 2012-2015. Middle east respiratory syndrome coronavirus (MERS-CoV) infections in two returning travellers in the Netherlands MERS-CoV, influenza and other respiratory viruses among symptomatic pilgrims during 2014 Hajj season

title:
  MERS‐CoV, influenza and other respiratory viruses among symptomatic pilgrims during 2014 Hajj season

abstract:
  More than two million Muslims visit Makkah, Saudi Arabia, annually to perform the religious rituals of Hajj where the risk of spreading respiratory infections is very common. The aim here was to screen symptomatic pilgrims for Middle East respiratory syndrome coronavirus (MERS‐CoV) and other viral etiologies. Thus, 132 nasopharyngeal samples were collected from pilgrims presenting with acute respiratory symptoms at the healthcare facilities in the holy sites during the 5 days of the 2014 Hajj season. Samples were tested using real‐time reverse transcription polymerase chain reactions and microarray. Demographic data including age, sex, and country of origin were obtained for all participants. While we did not detect MERS‐CoV in any of the samples, several other viruses were detected in 50.8% of the cases. Among the detected viruses, 64.2% of the cases were due to a single‐virus infection and 35.8% were due to the coinfections with up to four viruses. The most common respiratory virus was influenza A, followed by non‐MERS human coronaviruses, rhinoviruses, and influenza B. Together, we found that it was not MERS‐CoV but other respiratory viruses that caused acute respiratory symptoms among pilgrims. The observed high prevalence of influenza viruses underscores the need for more effective surveillance during the Hajj and adoption of stringent vaccination requirements from all pilgrims.


id: cord-329275-cd71wttk
title: Respiratory Viruses and Bacteria among Pilgrims during the 2013 Hajj
author: Benkouiten, Samir
date: 2014-11-17
txt: ./txt/cord-329275-cd71wttk.txt
cache: ./cache/cord-329275-cd71wttk.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.3201/eid2011.140600
doi: 10.3201/eid2011.140600
summary:
  Nasal swab samples were independently tested as described (5) for influenza virus A/H3N2 (16), influenza B virus (16), influenza C virus (17) , and A(H1N1)pdm09 virus (18) ; human adenovirus (19) ; human bocavirus (20) , human cytomegalovirus (21) ; human coronaviruses (HCoVs); human enterovirus (22) ; human metapneumovirus (23); human parainfluenza viruses (HPIVs); human parechovirus (24); human respiratory syncytial virus (25) ; and human rhinovirus (HRV) (26) by using real-time reverse transcription PCRs. HCoVs and human HPIVs were detected by using an HCoV/HPIV R-Gene Kit (Argene/bioMérieux, Marcy l''Etoile, France) (27) . Of 19 participants whose post-Hajj specimens were positive for HRV, 17 (89.5%) had acquired the infection during their stay in Saudi Arabia (Figure 1 ). Of 50 participants whose post-Hajj specimens were positive for ≥1 respiratory virus, 43 (86.0%) reported ≥1 respiratory symptom during their stay in Saudi Arabia, of whom 37 (86.0%) still had respiratory symptoms at the time of sampling. Also, of 79 participants whose post-Hajj specimens were negative for respiratory viruses, 74 (93.7%) reported ≥1 respiratory symptom during their stay Saudi Arabia, of whom 53 (71.6%) still had respiratory symptoms at the time of sampling.

abstract:
  Pilgrims returning from the Hajj might contribute to international spreading of respiratory pathogens. Nasal and throat swab specimens were obtained from 129 pilgrims in 2013 before they departed from France and before they left Saudi Arabia, and tested by PCR for respiratory viruses and bacteria. Overall, 21.5% and 38.8% of pre-Hajj and post-Hajj specimens, respectively, were positive for ≥1 virus (p = 0.003). One third (29.8%) of the participants acquired ≥1 virus, particularly rhinovirus (14.0%), coronavirus E229 (12.4%), and influenza A(H3N2) virus (6.2%) while in Saudi Arabia. None of the participants were positive for the Middle East respiratory syndrome coronavirus. In addition, 50.0% and 62.0% of pre-Hajj and post-Hajj specimens, respectively, were positive for Streptococcus pneumoniae (p = 0.053). One third (36.3%) of the participants had acquired S. pneumoniae during their stay. Our results confirm high acquisition rates of rhinovirus and S. pneumoniae in pilgrims and highlight the acquisition of coronavirus E229.


id: cord-331980-m6dflwmm
author: Alqahtani, Amani S.
date: 2016-07-18
txt: ./txt/cord-331980-m6dflwmm.txt
cache: ./cache/cord-331980-m6dflwmm.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1093/jtm/taw046
doi: 10.1093/jtm/taw046
summary:
  title: Association between Australian Hajj Pilgrims'' awareness of MERS-CoV, and their compliance with preventive measures and exposure to camels Through a prospective cohort study the relationship between travellers'' awareness of MERS-CoV, and compliance with preventive measures and exposure to camels was evaluated among Australian Hajj pilgrims who attended Hajj in 2015. [7] [8] [9] However, no study has attempted to investigate the association between Hajj pilgrims'' awareness of MERS-CoV, and their compliance with preventive measures and exposure to camels. This study shows that only 28% of Australian pilgrims were aware of MERS-CoV before attending the Hajj 2015, with some engaging in high risk behaviours such as exposure to camels (2%), and non-compliance with preventive measures. 8, 9 Importantly, this study showed that pilgrims who were aware of MERS-CoV were twice more likely to intend to avoid contact with camels and consume their raw products during Hajj than those who were unaware.

title:
  Association between Australian Hajj Pilgrims’ awareness of MERS-CoV, and their compliance with preventive measures and exposure to camels

abstract:
  Through a prospective cohort study the relationship between travellers’ awareness of MERS-CoV, and compliance with preventive measures and exposure to camels was evaluated among Australian Hajj pilgrims who attended Hajj in 2015. Only 28% of Australian Hajj pilgrims were aware of MERS-CoV in Saudi Arabia. Those who were aware of MERS-CoV were more likely to receive recommended vaccines [odds ratio (OR) 3.1, 95% confidence interval (CI): 1.5–5.9, P < 0.01], but there was no significant difference in avoiding camels or their raw products during Hajj between those who were aware of MERS-CoV and those who were not (OR 1.2, 95% CI: 0.3–5.2, P = 0.7). Hajj pilgrims’ awareness is reflected in some of their practices but not in all.


id: cord-339124-m7choyr6
title: Hajj and Umrah Mass Gatherings and COVID-19 Infection
author: Hoang, Van-Thuan
date: 2020-11-03
txt: ./txt/cord-339124-m7choyr6.txt
cache: ./cache/cord-339124-m7choyr6.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33169095/
doi: 10.1007/s40475-020-00218-x
summary:
  In order to avoid a COVID-19 outbreak with potential spreading to many countries through returning pilgrims, Saudi Arabia suspended the Umrah, and access to the 2020 Hajj was very limited. The KSA Ministry of Health recommends individual preventive measures such as use of face mask and disposable handkerchiefs and hand hygiene to mitigate the risk of RTIs. However, the efficacy of these measures against RTIs is debated [35] , and there have been no reliable controlled studies investigating their efficacy on the incidence of Hajj-related RTIs. The use of face masks may not provide optimal protection from infection, but that may reduce the spread of smallsized saliva droplets around when coughing or sneezing which is the main mode of transmission of most RTIs. Mandatory use of face mask in public places is considered one of the effective measures in controlling the COVID-19 pandemic [54] [55] [56] , but no investigation has been conducted in the context of MGs so far.

abstract:
  PURPOSE OF REVIEW: We discuss the risk of COVID-19 in religious mass gathering events including Hajj and Umrah pilgrimages. RECENT FINDINGS: The risk of transmission of respiratory viruses including COVID-19 is particularly high due to the overcrowding conditions at the Hajj and Umrah. The profile of the Hajj pilgrims who tend to be older and with multiple comorbidities corresponds to that of individuals at risk for severe COVID-19. In order to avoid a COVID-19 outbreak with potential spreading to many countries through returning pilgrims, Saudi Arabia suspended the Umrah, and access to the 2020 Hajj was very limited. SUMMARY: A clear relation between early suspension of religious mass gatherings and lower occurrence of COVID-19 transmission in countries that took such measures promptly was noticed. There are lessons to national and international health organizations for other mass gatherings in the context of the pandemic.


id: cord-341775-mucatzaa
author: Shafi, Shuja
date: 2016-06-22
txt: ./txt/cord-341775-mucatzaa.txt
cache: ./cache/cord-341775-mucatzaa.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.ijid.2016.06.013
doi: 10.1016/j.ijid.2016.06.013
summary:
  Mass gathering sporting and religious events pose important public health challenges, including the transmission of infectious diseases, exacerbation of non-communicable diseases, and disorders related to climate change. [1] [2] [3] [4] [5] Every year, the Kingdom of Saudi Arabia (KSA) hosts the Hajj pilgrimage, which is the largest mass gathering in the world held on a recurrent annual basis. Mass gatherings at religious events can pose major public health challenges, particularly the transmission of infectious diseases. Lethal infectious disease outbreaks were common during Hajj in the 19th and 20th centuries although they have now been controlled to a great extent by the huge investments made by the KSA into public health prevention and surveillance programs. Lethal infectious disease outbreaks were common during Hajj in the 19th and 20th centuries although they have now been controlled to a great extent by the huge investments made by the KSA into public health prevention and surveillance programs.

title:
  The annual Hajj pilgrimage—minimizing the risk of ill health in pilgrims from Europe and opportunity for driving the best prevention and health promotion guidelines

abstract:
  Mass gatherings at religious events can pose major public health challenges, particularly the transmission of infectious diseases. Every year the Kingdom of Saudi Arabia (KSA) hosts the Hajj pilgrimage, the largest gathering held on an annual basis where over 2 million people come to KSA from over 180 countries. Living together in crowded conditions exposes the pilgrims and the local population to a range infectious diseases. Respiratory and gastrointestinal tract bacterial and viral infections can spread rapidly and affect attendees of mass gatherings. Lethal infectious disease outbreaks were common during Hajj in the 19th and 20th centuries although they have now been controlled to a great extent by the huge investments made by the KSA into public health prevention and surveillance programs. The KSA provides regular updated Hajj travel advice and health regulations through international public health agencies such as the WHO, Public Health England, the Centers for Disease Control and Prevention, and Hajj travel agencies. During the Hajj, an additional 25 000 health workers are deployed; there are eight hospitals in Makkah and Mina complete with state-of-the-art surgical wards and intensive care units made specifically available for pilgrims. All medical facilities offer high quality of care, and services are offered free to Hajj pilgrims to ensure the risks of ill health to all pilgrims and KSA residents are minimal. A summary of the key health issues that arise in pilgrims from Europe during Hajj and of the KSA Hajj guidelines, together with other factors that may play a role in reducing the risks to pilgrims and to wider global health security, is provided herein.


id: cord-347907-0nrejsgr
author: Alqahtani, Amani S.
date: 2016-02-10
txt: ./txt/cord-347907-0nrejsgr.txt
cache: ./cache/cord-347907-0nrejsgr.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.ijid.2016.02.005
doi: 10.1016/j.ijid.2016.02.005
summary:
  1, 2 Hajj presents a public health challenge for Saudi Arabia, as the authorities need to cater for an increasing number of pilgrims and respond to emerging infections such as the Middle East respiratory syndrome coronavirus (MERS-CoV). In an effort to reduce the risk of infectious diseases at Hajj, an array of preventive measures have been recommended by the Saudi Arabian Ministry of Health (MoH), which include vaccination and hygiene measures (Table 1) . 8 A French study demonstrated that less than half of pilgrims were aware of social distancing and facemask use as precautions against respiratory infections, 9 but no study has explored the barriers to and facilitators of the uptake of preventive measures. To address these questions, two cross-sectional surveys were conducted among Australian pilgrims, one before and one after the Hajj 2014, to identify what preventive advice and interventions pilgrims received before travel, and what factors influenced their compliance with these measures while they were there.

title:
  Exploring barriers to and facilitators of preventive measures against infectious diseases among Australian Hajj pilgrims: cross-sectional studies before and after Hajj

abstract:
  OBJECTIVE: For reasons that have yet to be elucidated, the uptake of preventive measures against infectious diseases by Hajj pilgrims is variable. The aim of this study was to identify the preventive advice and interventions received by Australian pilgrims before Hajj, and the barriers to and facilitators of their use during Hajj. METHODS: Two cross-sectional surveys of Australians pilgrims aged ≥18 years were undertaken, one before and one after the Hajj 2014. RESULTS: Of 356 pilgrims who completed the survey (response rate 94%), 80% had the influenza vaccine, 30% the pneumococcal vaccine, and 30% the pertussis vaccine. Concern about contracting disease at Hajj was the most cited reason for vaccination (73.4%), and not being aware of vaccine availability was the main reason for non-receipt (56%). Those who obtained pre-travel advice were twice as likely to be vaccinated as those who did not seek advice. Of 150 pilgrims surveyed upon return, 94% reported practicing hand hygiene during Hajj, citing ease of use (67%) and belief in its effectiveness (62.4%) as the main reasons for compliance; university education was a significant predictor of hand hygiene adherence. Fifty-three percent used facemasks, with breathing discomfort (76%) and a feeling of suffocation (40%) being the main obstacles to compliance. CONCLUSION: This study indicates that there are significant opportunities to improve awareness among Australian Hajj pilgrims about the importance of using preventive health measures.


id: cord-349956-h4i2t2cr
author: Hoang, Van-Thuan
date: 2019-11-21
txt: ./txt/cord-349956-h4i2t2cr.txt
cache: ./cache/cord-349956-h4i2t2cr.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/31749410/
doi: 10.1080/22221751.2019.1693247
summary:
  We conducted this study to describe the dynamics of the acquisition of respiratory pathogens, their potential interactions and risk factors for possible lower respiratory tract infection symptoms (LRTI) among French pilgrims during the 2018 Hajj. showed that human rhinovirus (HRV) and influenza viruses were the most common viral respiratory pathogens isolated from ill Hajj pilgrims [6] . Unadjusted associations between respiratory pathogen carriage with multiples factors: sociodemographic characteristics (gender, ≥60 years), chronic respiratory disease, BMI classification, smoking status; individual preventive measures (vaccination against influenza, vaccination against IPD, use of a face mask, hand washing, disinfectant gel and disposable handkerchiefs); antibiotic intake 10 days before each sample; respiratory virus or bacteria and dual carriage were analysed by univariable analysis. aureus carriage increase and the initial wave of respiratory symptoms, suggests that this pathogen association was responsible for the RTIs that affected most pilgrims soon after arriving in Mecca.

title:
  The dynamics and interactions of respiratory pathogen carriage among French pilgrims during the 2018 Hajj

abstract:
  We conducted this study to describe the dynamics of the acquisition of respiratory pathogens, their potential interactions and risk factors for possible lower respiratory tract infection symptoms (LRTI) among French pilgrims during the 2018 Hajj. Each participant underwent four successive systematic nasopharyngeal swabs before and during their stay in Saudi Arabia. Carriage of the main respiratory pathogens was assessed by PCR. 121 pilgrims were included and 93.4% reported respiratory symptoms during the study period. The acquisition of rhinovirus, coronaviruses and Staphylococcus aureus occurred soon after arrival in Saudi Arabia and rates decreased gradually after days 5 and 6. In contrast, Streptococcus pneumoniae and Klebsiella pneumoniae carriage increased progressively until the end of the stay in Saudi Arabia. Haemophilus influenzae and Moraxella catarrhalis carriage increased starting around days 12 and 13, following an initial clearance. Influenza viruses were rarely isolated. We observed an independent positive mutual association between S. aureus and rhinovirus carriage and between H. influenzae and M. catarrhalis carriage. Dual carriage of H. influenzae and M. catarrhalis was strongly associated with S. pneumoniae carriage (OR = 6.22). Finally, our model showed that M. catarrhalis carriage was negatively associated with K. pneumoniae carriage. Chronic respiratory disease was associated with symptoms of LRTI. K. pneumoniae, M. catarrhalis-S. aureus and H. influenzae-rhinovirus dual carriage was associated with LRTI symptoms. Our data suggest that RTIs at the Hajj are a result of complex interactions between a number of respiratory viruses and bacteria.


id: cord-354011-v9t2b2ca
title: Circulation of Respiratory Viruses Among Pilgrims During the 2012 Hajj Pilgrimage
author: Benkouiten, Samir
date: 2013-10-01
txt: ./txt/cord-354011-v9t2b2ca.txt
cache: ./cache/cord-354011-v9t2b2ca.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/23839997/
doi: 10.1093/cid/cit446
summary:
  We performed a prospective survey among a cohort of pilgrims departing from Marseille, France, to Mecca in the Kingdom of Saudi Arabia (KSA) for the 2012 Hajj season. This study suggests a rapid acquisition of respiratory viruses among pilgrims during their stay in the KSA, most notably rhinovirus, and highlights the potential of spreading these infections in the pilgrims'' home countries upon their return. This study, including sample collection and laboratory methods, was conducted among a cohort of pilgrims departing from Marseille, France, to Mecca in the KSA for the 2012 Hajj season. Each sample was tested for the following viruses by real-time reverse transcription polymerase chain reaction (rRT-PCR): influenza A (FLUA) [11] , influenza B (FLUB) [11] , influenza C (FLUC), and A/2009/H1N1 [12] viruses; human respiratory syncytial virus A and B (RSVB) [13] ; human metapneumovirus (HMPV) [14] ; human rhinovirus (HRV) [15] ; MS2 bacteriophage; human adenovirus (HAdV) [16] ; and human enterovirus (HEV) [17] .

abstract:
  Background. The Hajj is the oldest and largest annual mass gathering in the world and may increase the risk of spread of respiratory viruses. Methods. We performed a prospective survey among a cohort of pilgrims departing from Marseille, France, to Mecca in the Kingdom of Saudi Arabia (KSA) for the 2012 Hajj season. Nasal swabs were collected from participants and tested for 11 respiratory viruses by real-time reverse transcription polymerase chain reaction. Results. Of 165 participants sampled before departing to the KSA, 8 (4.8%) were positive for at least 1 virus (5 rhinovirus, 1 influenza C, 1 adenovirus, and 1 enterovirus). Seventy symptomatic pilgrims underwent additional nasal swabs during their pilgrimage in the KSA, of which 27 (38.6%) were positive for at least 1 virus (19 rhinovirus, 6 influenza A, 1 influenza C, 1 respiratory syncytial virus B, 1 metapneumovirus, 1 adenovirus, and 1 enterovirus). This was significantly higher than the 4.8% who were positive before departing for the KSA (P < .001). Of 154 pilgrims sampled before leaving the KSA, 17 (11%) were positive for at least 1 virus (13 rhinovirus, 3 adenovirus, 2 influenza B, and 1 enterovirus), which was also significantly higher than the percentage of positive pilgrims (4.8%), before departing for the KSA (P = .040). Conclusions. This study suggests a rapid acquisition of respiratory viruses among pilgrims during their stay in the KSA, most notably rhinovirus, and highlights the potential of spreading these infections in the pilgrims' home countries upon their return.


id: cord-356048-nku844kt
title: Infectious Diseases and Mass Gatherings
author: Hoang, Van-Thuan
date: 2018-08-28
txt: ./txt/cord-356048-nku844kt.txt
cache: ./cache/cord-356048-nku844kt.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/30155747/
doi: 10.1007/s11908-018-0650-9
summary:
  RECENT FINDINGS: In the context of Hajj, one of the largest religious MGs at Mecca, Saudi Arabia, respiratory tract infections are the leading cause of infectious diseases in pilgrims with a prevalence of 50–93%. In this review, we summarize recent findings in the field of infectious diseases associated with international MGs. The Hajj (Table 1) The Hajj, an annual Muslim pilgrimage to Mecca, Saudi Arabia, is one of the largest religious MGs in the world with about two million pilgrims from 185 countries [4] . The predominance of bacterial pathogens in Hajj-related gastrointestinal infections poses a major risk to public health through the potential emergence and transmission of antimicrobial-resistant bacteria [53] . (Table 1) Although numerous gastrointestinal and respiratory outbreaks have been documented at large-scale open-air festivals, particularly music festivals, with thousands of participants, these events are probably neglected, in terms of public health attention, as well as surveillance and prevention of infectious disease strategies, compared to other categories of MGs [78] .

abstract:
  PURPOSE OF REVIEW: Mass gatherings (MGs) are characterized by a high concentration of people at a specific time and location. Infectious diseases are of particular concern at MGs. The aim of this review was to summarize findings in the field of infectious diseases with a variety of pathogens associated with international MGs in the last 5 years. RECENT FINDINGS: In the context of Hajj, one of the largest religious MGs at Mecca, Saudi Arabia, respiratory tract infections are the leading cause of infectious diseases in pilgrims with a prevalence of 50–93%. The most commonly acquired respiratory viruses were human rhinovirus, followed by human coronaviruses and influenza A virus, in decreasing order. Haemophilus influenzae, Staphylococcus aureus, and Streptococcus pneumoniae were the predominant bacteria. The prevalence of Hajj-related diarrhea ranged from 1.1 to 23.3% and etiologies included Salmonella spp., and Escherichia coli, with evidence of acquisition of antimicrobial-resistant bacteria. In other MGs such as Muslim, Christian, and Hindu religious events, sports events, and large-scale open-air festivals, outbreaks have been reported less frequently. The most common outbreaks at these events involved diseases preventable by vaccination, notably measles and influenza. Gastrointestinal infections caused by a variety of pathogens were also recorded. SUMMARY: Because social distancing and contact avoidance are difficult measures to implement in the context of many MGs, individual preventive measures including vaccination, use of face mask, disposable handkerchief and hand hygiene may be recommended. Nevertheless, the effectiveness of these measures has been poorly investigated in the context of MGs.


