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Goumballa N, Hoang VT, Al-Tawfiq JA, Sokhna C, Gautret P. Evidence for transmission of SARS-CoV-2 at religious mass gatherings: A systematic review. New Microbes New Infect 2024; 60-61:101442. [PMID: 38978956 PMCID: PMC11228583 DOI: 10.1016/j.nmni.2024.101442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 06/04/2024] [Accepted: 06/08/2024] [Indexed: 07/10/2024] Open
Abstract
Background Transmission of SARS-CoV-2 at major mass gatherings (MGs) has been observed during the COVID-19 pandemic. Methods In this systematic review done according to the PRISMA guidelines, PubMed and Scopus databases were searched for relevant studies to describe the epidemiology of SARS-CoV-2 in relation to major religious MGs including the Grand Magal of Touba (GMT), Hajj, Umrah, Kumbh Mela, Arbaeen and Lourdes pilgrimage during the COVID-19 pandemic. Results Ten articles met the inclusion criteria and were included.No cases of SARS-CoV-2 were detected at 2020 and 2021 GMT or at the 2020 Hajj. In a small study, 7 % of tested individuals were positive after the 2022 GMT. SARS-CoV-2 prevalence during the 2021-2022 Hajj and Umrah seasons varied from 0 to 15 % in different studies. At the 2021 Kumbh Mela, 0.4 million COVID-19 cases were diagnosed among returning pilgrims across India and 1 % tested positive during a one-day survey conducted on participants. During the 2021 Arbaeen pilgrimage, 3 % pilgrims were tested positive. No relevant data were found in relation to SARS-CoV-2 transmission at the 2021 Arbaeen and Lourdes pilgrimages. Conclusion The transmission of the SARS-CoV-2 virus during religious MG events depends on many factors such as: the number and density of pilgrims, the intensity of circulation of the virus in the hosting country and in countries sending international participants at the time of the event, the transmissibility of virus variants at the time of the event, the various preventive measures adopted, and the immune status of the pilgrims.
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Affiliation(s)
- Ndiaw Goumballa
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, AP-HM, SSA, RITMES, Marseille, France
- MINES, Campus International IRD-UCAD de L'IRD, Dakar, Senegal
| | - Van Thuan Hoang
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - Jaffar A Al-Tawfiq
- Specialty Internal Medicine and Quality Patient Safety Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Infectious Diseases Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Infectious Diseases Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cheikh Sokhna
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, AP-HM, SSA, RITMES, Marseille, France
- MINES, Campus International IRD-UCAD de L'IRD, Dakar, Senegal
| | - Philippe Gautret
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, AP-HM, SSA, RITMES, Marseille, France
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2
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Sharma A, Gupta B, Petersen E, Lee SS, Zumla A. Enhancing preparedness for reducing transmission and globalisation of Antimicrobial Resistance at the Ardh Kumbh Mela 2025, the world's largest recurring religious mass gathering. Int J Infect Dis 2023; 137:79-81. [PMID: 37852598 DOI: 10.1016/j.ijid.2023.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Affiliation(s)
- Avinash Sharma
- DBT-National Centre for Cell Science, Pune, 411007, India.
| | - Bhavuk Gupta
- DBT-National Centre for Cell Science, Pune, 411007, India
| | - Eskild Petersen
- Institute for Clinical Medicine, Faculty of Health Sciences, University of Aarhus, Denmark; European Society for Clinical Microbiology and Infectious Diseases Task Force for Emerging Infections, Basel, Switzerland; International Society for Infectious Diseases
| | - Shui Shan Lee
- International Society for Infectious Diseases; International Society for Infectious Diseases; Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong; S.H. Ho Research Centre for Infectious Diseases
| | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, University College London; NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK
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Bhatt A, Dada AC, Prajapati SK, Arora P. Integrating life cycle assessment with quantitative microbial risk assessment for a holistic evaluation of sewage treatment plant. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 862:160842. [PMID: 36509266 DOI: 10.1016/j.scitotenv.2022.160842] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/12/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
An integrated approach was employed in the present study to combine life cycle assessment (LCA) with quantitative microbial risk assessment (QMRA) to assess an existing sewage treatment plant (STP) at Roorkee, India. The midpoint LCA modeling revealed that high electricity consumption (≈ 576 kWh.day-1) contributed to the maximum environmental burdens. The LCA endpoint result of 0.01 disability-adjusted life years per person per year (DALYs pppy) was obtained in terms of the impacts on human health. Further, a QMRA model was developed based on representative sewage pathogens, including E. coli O157:H7, Giardia sp., adenovirus, norovirus, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The public health risk associated with intake of pathogen-laden aerosols during treated water reuse in sprinkler irrigation was determined. A cumulative health risk of 0.07 DALYs pppy was obtained, where QMRA risks contributed 86 % of the total health impacts. The annual probability of illness per person was highest for adenovirus and norovirus, followed by SARS-CoV-2, E. coli O157:H7 and Giardia sp. Overall, the study provides a methodological framework for an integrated LCA-QMRA assessment which can be applied across any treatment process to identify the hotspots contributing maximum environmental burdens and microbial health risks. Furthermore, the integrated LCA-QMRA approach could support stakeholders in the water industry to select the most suitable wastewater treatment system and establish regulations regarding the safe reuse of treated water.
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Affiliation(s)
- Ankita Bhatt
- Department of Hydro and Renewable Energy, Indian Institute of Technology Roorkee, Uttarakhand, India
| | | | - Sanjeev Kumar Prajapati
- Department of Hydro and Renewable Energy, Indian Institute of Technology Roorkee, Uttarakhand, India
| | - Pratham Arora
- Department of Hydro and Renewable Energy, Indian Institute of Technology Roorkee, Uttarakhand, India.
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Diwan V, Sharma U, Ganeshkumar P, Thangaraj JWV, Muthappan S, Venkatasamy V, Parashar V, Soni P, Garg A, Pawar NS, Pathak A, Purohit MR, Madhanraj K, Hulth A, Ponnaiah M. Syndromic surveillance system during mass gathering of Panchkroshi Yatra festival, Ujjain, Madhya Pradesh, India. New Microbes New Infect 2023; 52:101097. [PMID: 36864894 PMCID: PMC9971318 DOI: 10.1016/j.nmni.2023.101097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 01/29/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
Background The health implications surrounding a mass gathering pose significant challenges to public health officials. The use of syndromic surveillance provides an ideal method for achieving the public health goals and objectives at such events. In the absence of published reports of systematic documentation of public health preparedness in mass gatherings in the local context, we describe the public health preparedness and demonstrate the operational feasibility of a tablet-based participatory syndromic surveillance among pilgrims during the annual ritual circumambulation- Panchkroshi Yatra. Methods A real-time surveillance system was established from 2017-2019 to capture all the health consultations done at the designated points (medical camps) in the Panchkroshi yatra area of the city Ujjain in Madhya Pradesh. We also surveyed a subset of pilgrims in 2017 to gauge satisfaction with the public health measures such as sanitation, water, safety, food, and cleanliness. Results In 2019, injuries were reported in the highest proportion (16.7%; 794/4744); most numbers of fever cases (10.6%; 598/5600) were reported in 2018, while 2017 saw the highest number of patient presentations of abdominal pain (7.73%; 498/6435). Conclusion Public health and safety measures were satisfactory except for the need for setting up urinals along the fixed route of the circumambulation. A systematic data collection of selected symptoms among yatris and their surveillance through tablet could be established during the panchkroshi yatra, which can complement the existing surveillance for detecting early warning signals. We recommend the implementation of such tablet-based surveillance during such mass gathering events.
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Affiliation(s)
- Vishal Diwan
- ICMR- National Institute for Research in Environmental Health, Bhopal, India,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden,Corresponding author. ICMR- National Institute for Research in Environmental Health, Bhopal, India.
| | - Upasana Sharma
- ICMR- National Institute of Epidemiology, Chennai, India
| | | | | | | | | | | | | | - Ankit Garg
- R.D Gardi Medical College, Ujjain, India
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5
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Almehmadi M, Alqahtani JS. Healthcare Research in Mass Religious Gatherings and Emergency Management: A Comprehensive Narrative Review. Healthcare (Basel) 2023; 11:healthcare11020244. [PMID: 36673612 PMCID: PMC9859393 DOI: 10.3390/healthcare11020244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/05/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
Religious mass gatherings, especially pilgrimages of various faiths, involve overcrowding and the international movement of people, exposing individuals to significant health risks, such as the spread of infectious diseases, crowds, exposure to bad weather, physical stress, or risks due to pre-existing medical conditions. This paper aims to review the literature related to health care research on religious mass gatherings, with special reference to the role of awareness creation, training, and risk awareness for individuals during Hajj. The results indicated that the research on health risks associated with large-scale gatherings showed that some countries (which witness religious gatherings) follow effective preventive measures to reduce health risks, while some countries did not (and linked this to its poor infrastructure and the low standard of living in it, such as India). It also showed that most studies overlooked identifying the causes of infectious diseases and determining the perceptions of participants in mass gatherings. While it showed that environmental factors strongly influence the emergence of infectious diseases among individuals, the results also showed the scarcity of research that revolves around the awareness of community members, the health risks of mass gatherings, preventive measures against diseases, and the main effects on individuals' perceptions of risks. The results also showed a lack of research evidence on how pilgrims perceive risks, adopt information, and interact with their willingness to be trained in preventive measures.
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Affiliation(s)
- Mater Almehmadi
- UCL Institute for Risk and Disaster, University College London, London WC1E 6BT, UK
- Correspondence:
| | - Jaber S. Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia
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6
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Patnaik I, Sane R, Shah A, Subramanian SV. Distribution of self-reported health in India: The role of income and geography. PLoS One 2023; 18:e0279999. [PMID: 36706087 PMCID: PMC9882784 DOI: 10.1371/journal.pone.0279999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 12/19/2022] [Indexed: 01/28/2023] Open
Abstract
An important new large-scale survey database is brought to bear on measuring and analysing self-reported health in India. The most important correlates are age, income and location. There is substantial variation of health across the 102 'homogeneous regions' within the country, after controlling for household and individual characteristics. Higher income is correlated with better health in only 40% of India. We create novel maps showing regions with poor health, that is attributable to the location, that diverge from the conventional wisdom. These results suggest the need for epidemiological studies in the hotspots of ill-health and in regions where higher income does not correlate with improved health.
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Affiliation(s)
- Ila Patnaik
- National Institute of Public Finance and Policy, Delhi, India
| | - Renuka Sane
- National Institute of Public Finance and Policy, Delhi, India
| | - Ajay Shah
- xKDR Forum, Mumbai, Maharashtra, India
- * E-mail:
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Dubey AP, Hazarika RD, Abitbol V, Kolhapure S, Agrawal S. Proceedings of the Expert Consensus Group meeting on meningococcal serogroup B disease burden and prevention in India. Hum Vaccin Immunother 2022; 18:2026712. [PMID: 35239455 PMCID: PMC8993054 DOI: 10.1080/21645515.2022.2026712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/20/2021] [Accepted: 01/05/2022] [Indexed: 12/03/2022] Open
Abstract
Meningococcal disease is highly transmissible, life-threatening and leaves significant sequelae in survivors. Every year, India, which has a plethora of risk factors for meningococcal disease, reports around 3000 endemic cases. However, the overall disease burden and serogroup distribution are unknown, creating a setting of general disease negligence and unawareness. Vaccination with quadrivalent meningococcal conjugate vaccine A, C, W, and Y is only recommended for high-risk children, and there is no overall guidance for meningococcal serogroup B (MenB) vaccination. MenB vaccines, which recently have been licensed in many countries but not in India, have significantly aided the fight against meningococcal disease. However, these MenB vaccines are not available in India. An Expert Consensus Group meeting was held with leading meningococcal disease experts to better understand the current disease epidemiology, particularly serogroup B, the prevalence gaps, and feasible ways to bridge them. The proceedings are presented in this paper.
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Affiliation(s)
- Anand P. Dubey
- Pediatrics, ESI-PGIMSR & Model Hospital, New Delhi, India
| | - Rashna Dass Hazarika
- Pediatrics, Nemcare Superspeciality Hospital, Bhangagarh, Guwahati, and RIGPA Childrenʻs Clinic, Guwahati, India
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8
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Skaria J, John TM, Varkey S, Kontoyiannis DP. Are Unique Regional Factors the Missing Link in India's COVID-19-Associated Mucormycosis Crisis? mBio 2022; 13:e0047322. [PMID: 35357212 PMCID: PMC9040830 DOI: 10.1128/mbio.00473-22] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The exact cause of the disproportionate increase in COVID-19-associated mucormycosis (CAM) cases in India remains unknown. Most researchers consider the major cause of India's CAM epidemic to be the conjunction of the COVID-19 pandemic and associated corticosteroid treatment with the enormous number of Indians with diabetes mellitus (DM). However, excess CAM cases were not seen to the same extent in the Western world, where diabetes is prevalent and corticosteroids are also used extensively for COVID-19 treatment. Herein, we hypothesize that previously overlooked environmental factors specific to India were important contributors to the country's CAM epidemic. Specifically, we propose that the spread of fungal spores, mainly through fumes generated from the burning of Mucorales-rich biomass, like cow dung and crop stubble, caused extensive environmental exposure in the context of a large population of highly vulnerable patients with DM and COVID-19. Testing this hypothesis with epidemiologic studies, phylogenetic analyses, and strategic environmental sampling may have implications for preventing future epidemics.
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Affiliation(s)
| | - Teny M. John
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shibu Varkey
- Maxivision Eye Hospitals, Trichy, Tamil Nadu, India
| | - Dimitrios P. Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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9
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Shukla S, Khan R, Ahmed Y, Memish ZA. Conducting mass gathering events during the COVID-19 pandemic: a case study of Kumbh Mela 2021 as a potential 'super spreader event'. J Travel Med 2021; 28:6381388. [PMID: 34609481 PMCID: PMC8500053 DOI: 10.1093/jtm/taab160] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND With the emergence of novel pathogens, there is a worldwide debate on the cancellation or conduction of mass gathering events. METHODS In the current coronavirus disease-2019 (COVID-19) pandemic situation, this study assesses the challenges in the conduction of the recently held Kumbh Mela mass gathering (MG), which took place from 14th January 2021 to 29th April 2021 at Haridwar, the capital city of the state of Uttarakhand, India. The correlation between increased cases of COVID-19 and the Kumbh Mela MG has been highlighted through statistical analysis and growth curves using the available data. RESULTS The Kumbh Mela-2021 emerged as a potential super spreader event with an increase of 37 cases per day to 144 cases per day (276%) in the COVID-19 cases in Haridwar. An increase from 138 to 480 cases per day (236%) and from 45 600 to 92 754 cases per day (92%) was noted in Uttarakhand and India respectively during this MG. A very strong correlation of 'more than 0.99' was seen between the number of cumulative cases of COVID-19 in Uttarakhand and Haridwar, and Haridwar and India during the Kumbh Mela in the third wave of the pandemic. CONCLUSIONS The direct influence of Kumbh Mela on the increase in the overall number of COVID-19 cases is observed. Although, the socio-cultural, psychological and economical advantages of MGs are considerable in a developing nation like India, but organization of such events can be a huge health hazard. The lack of efficient implementation and observance of COVID-19 guidelines elevates the necessity of cancellation of such MGs to prevent the outbreak of diseases. Thus, a well-conducted risk assessment prior to the hosting of a MG event during a pandemic is required with strict application of precautionary measures towards prevention of super-spreader events.
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Affiliation(s)
- Saurabh Shukla
- Faculty of Civil Engineering, Institute of Technology, Shri Ramswaroop Memorial University, Barabanki, India
| | - Ramsha Khan
- Faculty of Civil Engineering, Institute of Technology, Shri Ramswaroop Memorial University, Barabanki, India
| | - Yusuf Ahmed
- Department of Obstetrics and Gynecology, University Teaching Hospital, Lusaka, Zambia
| | - Ziad A Memish
- King Saud Medical City, Ministry of Health & Alfaisal University, Riyadh, Saudi Arabia.,Hubert Department of Global Health, Emory University Atlanta, Atlanta, Georgia, USA
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A Review of Infectious Diseases Associated with Religious and Nonreligious Rituals. Interdiscip Perspect Infect Dis 2021; 2021:1823957. [PMID: 34912451 PMCID: PMC8668350 DOI: 10.1155/2021/1823957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/25/2021] [Indexed: 11/18/2022] Open
Abstract
Rituals are an integral part of human life but a wide range of rituals (both religious and non-religious), from self-flagellation to blood brotherhood to ritual sprinkling of holy water, have been associated with transmission of infections. These infections include angiostrongyliasis, anthrax, brucellosis, cholera, COVID-19, cutaneous larva migrans, Ebola, hepatitis viruses, herpes simplex virus, HIV, human T-cell leukemia virus (HTLV), kuru, Mycobacterium bovis, Naegleria fowleri meningoencephalitis, orf, rift valley fever, and sporotrichosis. Education and community engagement are important cornerstones in mitigating infectious risks associated with rituals.
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11
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Bäckdahl T, Sharma M. Knowledge and transmission risk awareness of tuberculosis among the pilgrims attending a religious mass gathering in India: a cross-sectional study. BMC Public Health 2021; 21:2141. [PMID: 34809593 PMCID: PMC8607969 DOI: 10.1186/s12889-021-12192-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/03/2021] [Indexed: 11/23/2022] Open
Abstract
Background Tuberculosis infection accounts for more annual deaths than any other single infectious disease, except the Corona Virus infection. It is a significant global issue and India is one of the most affected countries. Religious mass gatherings congregate millions of pilgrims at one place. Over-crowding is a high-risk factor for the transmission of tuberculosis. Knowledge and awareness of the disease are proven prerequisites for the spread-prevention and early diagnosis of tuberculosis. The present study was designed to explore the knowledge of tuberculosis and awareness of disease transmission risk among pilgrims attending a religious mass gathering, the Kumbh Mela (2016) in Ujjain, India. Methods Self-reported data on the pilgrims’ tuberculosis-knowledge were collected using a cross-sectional study design. A contextual, pre-tested questionnaire was used, using the convenience sampling method. In addition to the anonymous descriptive analyses, a composite knowledge-score was developed to enable comparisons between demographic groups. Results In total, 1665 pilgrims participated in the study with 38.8 years of mean age and 59% literacy rate. The most recognized symptoms of tuberculosis were “Cough for more than 15 days with sputum” (94%) and “Blood in sputum” (81%). Most participants knew that tuberculosis is an infectious disease (93%) and not hereditary (91%). Additionally, 84% considered it is a potentially lethal disease that requires extensive treatment. However, vaccine awareness was poor (4%). “Direct contact with tuberculosis patient” (78%) and “To be in a crowded area” (4%) were considered as the most important risk factors for tuberculosis transmission. For the composite knowledge-score, a significantly higher mean score was seen among those with at least ten years of schooling compared with illiterates (p < 0.001). Occupation and residency also affected the mean score. Conclusion Most pilgrims attending the Kumbh Mela had basic knowledge of the characteristics of tuberculosis, but some important knowledge gaps concerning the transmission risks associated with crowded situations existed. These gaps need to be addressed in future policies to enable safer mass gatherings and to end the TB epidemic, globally.
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Affiliation(s)
- Tim Bäckdahl
- Department of Global Public Health- Health Systems and Policy (HSP): Medicines, focusing antibiotics, Karolinska Institutet, Stockholm, Sweden
| | - Megha Sharma
- Department of Global Public Health- Health Systems and Policy (HSP): Medicines, focusing antibiotics, Karolinska Institutet, Stockholm, Sweden. .,Department of Pharmacology, R. D. Gardi Medical College, Ujjain, Madhya Pradesh, India.
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12
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Tavan A, Tafti AD, Nekoie-Moghadam M, Ehrampoush M, Nasab MRV, Tavangar H. Public health risks threatening health of people participating in mass gatherings: A qualitative study. Indian J Public Health 2021; 64:242-247. [PMID: 32985424 DOI: 10.4103/ijph.ijph_305_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Mass gatherings (MGs) have made many problems for the health system and potentially threaten the health of those participated in these gatherings. MGs account for a range of public health risks including communicable diseases, waterborne diseases, water treatment, and outbreaks. Objectives The present study aimed to identify public health risks threatening the health of people participating in MGs in Iran. Methods A qualitative study was designed using a conventional qualitative content analysis approach. Participants were selected using a purposive sampling method among the managers and staff who have experiences in the field of health in MGs in Iran. Subjects were interviewed through individual in-depth interviews after obtaining informed consent. Semi-structured interviews were used to collect the data from December 2018 to February 2019. To analyze the data, the content of recorded interviews was written verbatim. Preliminary data were repeatedly and simultaneously retrieved to give a general understanding of them. Results The main theme emerged from data analysis on 16 interviews was related to public health risks involving the following categories: food hygiene deficiencies, communicable diseases risks, defects in health supervision, and the risk of environmental contamination. Conclusion It is of paramount importance to identify the risks threatening the health of people participating in MGs. In the present study, the main public health risks were detected.
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Affiliation(s)
- Asghar Tavan
- PhD Student, Department of Health in Disasters and Emergencies, International Campus, Shahid Sadoughi University of Medical Sciences, Kerman, Iran
| | - Abbasali Dehghani Tafti
- Associate Professor, Department of Health in Disasters and Emergencies, School of Public Health, Shahid Sadoughi University of Medical Sciences, Kerman, Iran
| | - Mahmood Nekoie-Moghadam
- Professor, Department of Health Services Management, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohmmadhasan Ehrampoush
- Professor, Department of Environmental Health Engineering, School of Public Health, Shahid Sadoughi University of Medical Sciences, Kerman, Iran
| | - Mohammad Reza Vafaei Nasab
- Associate Professor, Department of Physical Medicine and Rehabilitation, Shahid Sadoughi University of Medical Sciences, Kerman, Iran
| | - Hossein Tavangar
- Associate Professor, Department of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Kerman, Iran
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13
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Dubey AP, Hazarika RD, Abitbol V, Kolhapure S, Agrawal S. Mass gatherings: a review of the scope for meningococcal vaccination in the Indian context. Hum Vaccin Immunother 2021; 17:2216-2224. [PMID: 33605845 PMCID: PMC8189129 DOI: 10.1080/21645515.2020.1871572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/30/2020] [Indexed: 11/17/2022] Open
Abstract
The risk of meningococcal transmission is increased with crowding and prolonged close proximity between people. There have been numerous invasive meningococcal disease (IMD) outbreaks associated with mass gatherings and other overcrowded situations, including cramped accommodation, such as student and military housing, and refugee camps. In these conditions, IMD outbreaks predominantly affect adolescents and young adults. In this narrative review, we examine the situation in India, where the burden of IMD-related complications is significant but the reported background incidence of IMD is low. However, active surveillance for meningococcal disease is suboptimal and laboratory confirmation of meningococcal strain is near absent, especially in non-outbreak periods. IMD risk factors are prevalent, including frequent mass gatherings and overcrowding combined with a demographically young population. Since overcrowded situations are generally unavoidable, the way forward relies on preventive measures. More widespread meningococcal vaccination and strengthened disease surveillance are likely to be key to this approach.
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Affiliation(s)
- Anand P Dubey
- Pediatrics, ESI-PGIMSR & Model Hospital, New Delhi, India
| | - Rashna Dass Hazarika
- Pediatrics, Nemcare Superspeciality Hospital, Bhangagarh, Guwahati, and RIGPA Children’s Clinic, Guwahati, India
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Quadri SA, Padala PR. An Aspect of Kumbh Mela Massive Gathering and COVID-19. CURRENT TROPICAL MEDICINE REPORTS 2021; 8:225-230. [PMID: 33816058 PMCID: PMC8006868 DOI: 10.1007/s40475-021-00238-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 12/11/2022]
Abstract
Purpose of Review Kumbh Mela, a religious gathering of Hindus held in India, is the largest massive gathering event in the world. The COVID-19 pandemic is an unprecedented healthcare crisis in recent times with effects reverberating in all spheres of human lives. India has registered the second highest number of COVID-19 cases. This paper aims to dwell in the religious and social background of Kumbh Mela massive gathering, as well as the ritualistic practices that could potentially entail public health risks in the current situation. It also aims to identify possible preparatory and interventional measures to evade such risks. Recent Findings In recent years, the increase in the number of people attending the Kumbh Mela has been phenomenal. Congregants are put up at the holy sites for several days. The sheer number of people assembling at the religious venues poses a great challenge to manage the crowds, to cater to the requirements of basic amenities, and to meet their healthcare needs. Some of the ritualistic practices could heighten the risk for transmission of respiratory pathogens. The COVID-19 pandemic has escalated over the past few months in India. The pandemic is expected to sustain its tempo in India throughout the foreseeable future. Organization of the forthcoming Kumbh Mela needs meticulous planning. Summary Kumbh Mela is a Hindu religious gathering at the banks of India’s rivers, held periodically. It witnesses assembly of huge numbers of people and has the potential to amplify the COVID-19 pandemic in India; this could overwhelm the healthcare system.
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Affiliation(s)
- Sayed A Quadri
- Division of Microbiology and Immunology, Department of Biomedical Sciences, College of Medicine, King Faisal University, Al-Ahsa, Eastern Province Kingdom of Saudi Arabia
| | - Prasad R Padala
- Geriatric Research Education, and Clinical Center, Central Arkansas Veterans, Healthcare System (CAVHS), Little Rock, AR USA.,Department of Psychiatry, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR USA
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Gastrointestinal symptoms and the acquisition of enteric pathogens in Hajj pilgrims: a 3-year prospective cohort study. Eur J Clin Microbiol Infect Dis 2020; 40:315-323. [PMID: 32918166 DOI: 10.1007/s10096-020-04018-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
The acquisition of enteric pathogens and risk factors for Hajj-associated diarrhea in Hajj pilgrims is poorly documented. Pilgrims from Marseille participating in the Hajj in 2016-2018 underwent successive systematic rectal swabbing before and after their travel. Carriage of the main enteric pathogens was assessed by real-time PCR. Baseline demographics, adherence to individual preventive measures, gastrointestinal symptoms, and treatments were recorded. A total of 376 pilgrims were included. The median age was 62.0 years. During the Hajj, 18.6% presented at least one gastrointestinal symptom, 13.8% had diarrhea, and 36.4% had acquired at least one enteric pathogen. Enteropathogenic Escherichia coli (EPEC) and Enteroaggregative E. coli (EAEC) were the pathogens most frequently acquired by pilgrims (17.6% and 14.4%, respectively). Being female was associated with increased frequency of gastrointestinal symptoms during the pilgrimage (aOR = 2.38, p = 0.004). Enterohemorrhagic Escherichia coli (EHEC) acquisition was associated with a four-fold higher risk of reporting at least one gastrointestinal symptom and diarrhea (aOR = 3.68 and p = 0.01 and aOR = 3.96 and p = 0.01, respectively). Pilgrims who suffered from diarrhea were more likely to wash their hands more often (aOR = 2.07, p = 0.03) and to be either overweight (aOR = 2.71, p = 0.03) or obese (aOR = 2.51, p = 0.05). Enteric bacteria such as E. coli that are frequently associated with traveler's diarrhea due to the consumption of contaminated food and drink were frequently found in pilgrims. Respecting strict measures regarding food and water quality during the Hajj and adherence to preventive measures such as good personal hygiene and environmental management will help reduce the burden of gastrointestinal infections at the event.
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Aye AMM, Bai X, Borrow R, Bory S, Carlos J, Caugant DA, Chiou CS, Dai VTT, Dinleyici EC, Ghimire P, Handryastuti S, Heo JY, Jennison A, Kamiya H, Tonnii Sia L, Lucidarme J, Marshall H, Putri ND, Saha S, Shao Z, Sim JHC, Smith V, Taha MK, Van Thanh P, Thisyakorn U, Tshering K, Vázquez J, Veeraraghavan B, Yezli S, Zhu B. Meningococcal disease surveillance in the Asia-Pacific region (2020): The global meningococcal initiative. J Infect 2020; 81:698-711. [PMID: 32730999 DOI: 10.1016/j.jinf.2020.07.025] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/17/2020] [Accepted: 07/24/2020] [Indexed: 12/20/2022]
Abstract
The degree of surveillance data and control strategies for invasive meningococcal disease (IMD) varies across the Asia-Pacific region. IMD cases are often reported throughout the region, but the disease is not notifiable in some countries, including Myanmar, Bangladesh and Malaysia. Although there remains a paucity of data from many countries, specific nations have introduced additional surveillance measures. The incidence of IMD is low and similar across the represented countries (<0.2 cases per 100,000 persons per year), with the predominant serogroups of Neisseria meningitidis being B, W and Y, although serogroups A and X are present in some areas. Resistance to ciprofloxacin is also of concern, with the close monitoring of antibiotic-resistant clonal complexes (e.g., cc4821) being a priority. Meningococcal vaccination is only included in a few National Immunization Programs, but is recommended for high-risk groups, including travellers (such as pilgrims) and people with complement deficiencies or human immunodeficiency virus (HIV). Both polysaccharide and conjugate vaccines form part of recommendations. However, cost and misconceptions remain limiting factors in vaccine uptake, despite conjugate vaccines preventing the acquisition of carriage.
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Affiliation(s)
| | - Xilian Bai
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester M13 9WZ, UK.
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester M13 9WZ, UK.
| | | | - Josefina Carlos
- University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | | | | | - Vo Thi Trang Dai
- Department of Microbiology and Immunology, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | | | | | | | - Jung Yeon Heo
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, South Korea.
| | | | - Hajime Kamiya
- National Institute of Infectious Diseases, Tokyo, Japan
| | | | - Jay Lucidarme
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester M13 9WZ, UK.
| | - Helen Marshall
- Robinson Research Institute and department of Paediatrics, Adelaide Medical School, The University of Adelaide, Adelaide, Australia.
| | - Nina Dwi Putri
- Dr Cipto Mangunkusumo National Central Hospital, Jakarta, Indonesia
| | - Senjuti Saha
- Child Health Research Foundation, Mohammadpur, Dhaka1207, Bangladesh.
| | - Zhujun Shao
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
| | | | - Vinny Smith
- Meningitis Research Foundation, Bristol, UK.
| | | | - Phan Van Thanh
- Department of Microbiology and Immunology, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Usa Thisyakorn
- Tropical Medicine Cluster, Chulalongkorn University, Bangkok, Thailand
| | - Kinley Tshering
- Jigme Dorji Wangchuck National Referral Hospital, Thimpu, Bhutan
| | - Julio Vázquez
- National Reference Laboratory for Meningococci, Institute of Health Carlos III, Spain.
| | | | - Saber Yezli
- Global Center for Mass Gatherings Medicine, Saudi Arabia
| | - Bingqing Zhu
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Fouz N, Pangesti KNA, Yasir M, Al-Malki AL, Azhar EI, Hill-Cawthorne GA, Abd El Ghany M. The Contribution of Wastewater to the Transmission of Antimicrobial Resistance in the Environment: Implications of Mass Gathering Settings. Trop Med Infect Dis 2020; 5:tropicalmed5010033. [PMID: 32106595 PMCID: PMC7157536 DOI: 10.3390/tropicalmed5010033] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/30/2020] [Accepted: 02/15/2020] [Indexed: 12/11/2022] Open
Abstract
Antimicrobial resistance (AMR) is the major issue posing a serious global health threat. Low- and middle-income countries are likely to be the most affected, both in terms of impact on public health and economic burden. Recent studies highlighted the role of resistance networks on the transmission of AMR organisms, with this network being driven by complex interactions between clinical (e.g., human health, animal husbandry and veterinary medicine) and other components, including environmental factors (e.g., persistence of AMR in wastewater). Many studies have highlighted the role of wastewater as a significant environmental reservoir of AMR as it represents an ideal environment for AMR bacteria (ARB) and antimicrobial resistant genes (ARGs) to persist. Although the treatment process can help in removing or reducing the ARB load, it has limited impact on ARGs. ARGs are not degradable; therefore, they can be spread among microbial communities in the environment through horizontal gene transfer, which is the main resistance mechanism in most Gram-negative bacteria. Here we analysed the recent literature to highlight the contribution of wastewater to the emergence, persistence and transmission of AMR under different settings, particularly those associated with mass gathering events (e.g., Hajj and Kumbh Mela).
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Affiliation(s)
- Nour Fouz
- The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW 2145, Australia;
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Krisna N. A. Pangesti
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (K.N.A.P.); (G.A.H.-C.)
| | - Muhammad Yasir
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (M.Y.); (E.I.A.)
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Abdulrahman L. Al-Malki
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Esam I. Azhar
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (M.Y.); (E.I.A.)
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Grant A. Hill-Cawthorne
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (K.N.A.P.); (G.A.H.-C.)
| | - Moataz Abd El Ghany
- The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW 2145, Australia;
- The Marie Bashir Institute of Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW 2145, Australia
- The Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2145, Australia
- Correspondence: or
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Muttalif AR, Presa JV, Haridy H, Gamil A, Serra LC, Cané A. Incidence and Prevention of Invasive Meningococcal Disease in Global Mass Gathering Events. Infect Dis Ther 2019; 8:569-579. [PMID: 31471813 PMCID: PMC6856249 DOI: 10.1007/s40121-019-00262-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Mass gathering events involve close contact among large numbers of people in a specific location at the same time, an environment conducive to transmission of respiratory tract illnesses including invasive meningococcal disease (IMD). This report describes IMD incidence at mass gatherings over the past 10 years and discusses strategies to prevent IMD at such events. METHODS A PubMed search was conducted in December 2018 using a search string intended to identify articles describing IMD at mass gatherings, including religious pilgrimages, sports events, jamborees, and refugee camps. The search was limited to articles in English published from 2008 to 2018. Articles were included if they described IMD incidence at a mass gathering event. RESULTS A total of 127 articles were retrieved, of which 7 reported on IMD incidence at mass gatherings in the past 10 years. Specifically, in Saudi Arabia between 2002 and 2011, IMD occurred in 16 Hajj pilgrims and 1 Umrah pilgrim; serotypes involved were not reported. At a youth sports festival in Spain in 2008, 1 case of serogroup B IMD was reported among 1500 attendees. At the 2015 World Scout Jamboree in Japan, an outbreak of serogroup W IMD was identified in five scouts and one parent. At a refugee camp in Turkey, one case of serogroup B IMD was reported in a Syrian girl; four cases of serogroup X IMD occurred in an Italian refugee camp among refugees from Africa and Bangladesh. In 2017, a funeral in Liberia resulted in 13 identified cases of serogroup C IMD. Requiring meningococcal vaccination for mass gathering attendees and vaccinating refugees might have prevented these IMD cases. CONCLUSIONS Mass gathering events increase IMD risk among attendees and their close contacts. Vaccines preventing IMD caused by serogroups ACWY and B are available and should be recommended for mass gathering attendees. FUNDING Pfizer.
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Affiliation(s)
| | - Jessica V Presa
- Pfizer Vaccines, Pfizer Inc, 500 Arcola Road, Collegeville, PA, 19426, USA.
| | - Hammam Haridy
- Pfizer Vaccines, Pfizer Inc, Pfizer Building 6, Dubai Media City, Dubai, United Arab Emirates
| | - Amgad Gamil
- Pfizer Vaccines, Pfizer Inc, Pfizer Building 6, Dubai Media City, Dubai, United Arab Emirates
| | - Lidia C Serra
- Pfizer Vaccines, Pfizer Inc, 500 Arcola Road, Collegeville, PA, 19426, USA
| | - Alejandro Cané
- Pfizer Biopharmaceuticals Group, Complejo Thames Office Park, Colectora Panamericana 1804, 1 Piso Sector "B" Lado Sur, CP 1607EEV, Villa Adelina, Pcia Buenos Aires, Argentina
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Samson R, Shah M, Yadav R, Sarode P, Rajput V, Dastager SG, Dharne MS, Khairnar K. Metagenomic insights to understand transient influence of Yamuna River on taxonomic and functional aspects of bacterial and archaeal communities of River Ganges. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 674:288-299. [PMID: 31005831 DOI: 10.1016/j.scitotenv.2019.04.166] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/11/2019] [Accepted: 04/11/2019] [Indexed: 06/09/2023]
Abstract
River confluences are interesting ecosystems to investigate for their microbial community structure and functional potentials. River Ganges is one of the most important and holy river of India with great mythological history and religious significance. The Yamuna River meets Ganges at the Prayagraj (formerly known as Allahabad), India to form a unique confluence. The influence of Yamuna River on taxonomic and functional aspects of microbiome at this confluence and its downstream, remains unexplored. To unveil this dearth, whole metagenome sequencing of the microbial (bacterial and archaeal) community from the sediment samples of December 2017 sampling expedition was executed using high throughput MinION technology. Results revealed differences in the relative abundance of bacterial and archaeal communities across the confluence. Grouped by the confluence, a higher abundance of Proteobacteria and lower abundance of Bacteroidetes and Firmicutes was observed for Yamuna River (G15Y) and at immediate downstream of confluence of Ganges (G15DS), as compared to the upstream, confluence, and farther downstream of confluence. A similar trend was observed for archaeal communities with a higher abundance of Euryarchaeota in G15Y and G15DS, indicating Yamuna River's influence. Functional gene(s) analysis revealed the influence of Yamuna River on xenobiotic degradation, resistance to toxic compounds, and antibiotic resistance interceded by the autochthonous microbes at the confluence and succeeding downstream locations. Overall, similar taxonomic and functional profiles of microbial communities before confluence (upstream of Ganges) and farther downstream of confluence, suggested a transient influence of Yamuna River. Our study is significant since it may be foundational basis to understand impact of Yamuna River and also rare event of mass bathing on the microbiome of River Ganges. Further investigation would be required to understand, the underlying cause behind the restoration of microbial profiles post-confluence farther zone, to unravel the rejuvenation aspects of this unique ecosystem.
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Affiliation(s)
- Rachel Samson
- National Collection of Industrial Microorganisms (NCIM), Biochemical Sciences Division, CSIR-National Chemical Laboratory (NCL), Pune 411008, India
| | - Manan Shah
- National Collection of Industrial Microorganisms (NCIM), Biochemical Sciences Division, CSIR-National Chemical Laboratory (NCL), Pune 411008, India
| | - Rakeshkumar Yadav
- National Collection of Industrial Microorganisms (NCIM), Biochemical Sciences Division, CSIR-National Chemical Laboratory (NCL), Pune 411008, India; Academy of Scientific and Industrial Research (AcSIR), New Delhi, India
| | - Priyanka Sarode
- Environmental Virology Cell (EVC), CSIR-National Environmental Engineering Research Institute (NEERI), Nehru Marg, Nagpur 440020, India
| | - Vinay Rajput
- National Collection of Industrial Microorganisms (NCIM), Biochemical Sciences Division, CSIR-National Chemical Laboratory (NCL), Pune 411008, India
| | - Syed G Dastager
- National Collection of Industrial Microorganisms (NCIM), Biochemical Sciences Division, CSIR-National Chemical Laboratory (NCL), Pune 411008, India; Academy of Scientific and Industrial Research (AcSIR), New Delhi, India
| | - Mahesh S Dharne
- National Collection of Industrial Microorganisms (NCIM), Biochemical Sciences Division, CSIR-National Chemical Laboratory (NCL), Pune 411008, India; Academy of Scientific and Industrial Research (AcSIR), New Delhi, India.
| | - Krishna Khairnar
- Academy of Scientific and Industrial Research (AcSIR), New Delhi, India; Environmental Virology Cell (EVC), CSIR-National Environmental Engineering Research Institute (NEERI), Nehru Marg, Nagpur 440020, India.
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Memish ZA, Steffen R, White P, Dar O, Azhar EI, Sharma A, Zumla A. Mass gatherings medicine: public health issues arising from mass gathering religious and sporting events. Lancet 2019; 393:2073-2084. [PMID: 31106753 PMCID: PMC7159069 DOI: 10.1016/s0140-6736(19)30501-x] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 02/19/2019] [Accepted: 02/27/2019] [Indexed: 12/14/2022]
Abstract
Mass gathering events are associated with major public health challenges. The 2014 Lancet Series on the new discipline of mass gatherings medicine was launched at the World Health Assembly of Ministers of Health in Geneva in May, 2014. The Series covered the planning and surveillance systems used to monitor public health risks, public health threats, and experiences of health-care providers from mass gathering events in 2012 and 2013. This follow-up Review focuses on the main public health issues arising from planned mass gathering events held between 2013 and 2018. We highlight public health and research data on transmission of infectious diseases and antibiotic-resistant bacteria, mass casualty incidents, and non-communicable diseases, including thermal disorders. In the events discussed in this Review, the combination of a large influx of people, many from countries with outbreak-prone infectious diseases, with a high degree of crowd interactions imposed substantial burdens on host countries' health systems. The detection and transmission of antibiotic-resistant bacteria in pilgrims attending the Kumbh Mela and the Hajj raise concern of possible globalisation from mass-gathering religious events. Priorities for further investments and opportunities for research into prevention, surveillance, and management of these public health issues are discussed.
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Affiliation(s)
- Ziad A Memish
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Infectious Diseases Division, Department of Medicine and Research, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Robert Steffen
- Epidemiology, Biostatistics and Prevention Institute, WHO Collaborating Centre for Travellers' Health, University of Zurich, Zurich, Switzerland; Division of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas School of Public Health, Houston, TX, USA
| | - Paul White
- Commonwealth of the Northern Mariana Islands, Epidemiology and Laboratory Capacity Program, Public Health & Hospital Emergency Preparedness Program, Commonwealth Health Care Corporation, Saipan, Northern Mariana Islands, USA
| | - Osman Dar
- Public Health England and Chatham House Centre on Global Health Security, Royal Institute of International Affairs, London, UK
| | - Esam I Azhar
- Special Infectious Agents Unit, King Fahd Medical Research Center, Jeddah, Saudi Arabia; Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Avinash Sharma
- National Centre for Microbial Resource, Pune, Maharashtra, India; National Centre for Cell Science, Pune, Maharashtra, India
| | - Alimuddin Zumla
- Division of Infection, University College London, London, UK; NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.
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21
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Karampourian A, Ghomian Z, Khorasani-Zavareh D. Qualitative study of health system preparedness for traumatic incidents in a religious mass gathering. Injury 2019; 50:1097-1104. [PMID: 30595410 DOI: 10.1016/j.injury.2018.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/08/2018] [Accepted: 12/12/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Traumatic incidents may occur during religious mass gatherings. A lack of preparedness by the health system to respond to traumatic incidents may increase the mortality rate. This study investigated the factors that affect the preparedness of a health system to respond to traumatic incidents, and we provide appropriate suggestions for improving the response to such incidents during religious mass gatherings. METHODS A qualitative research method was used with a conventional content analysis approach. In total, 22 semi-structured interviews were conducted employing the content analysis method. The data were analyzed based on the means of the meaning units, condensed meaning units, sub-themes, themes, and codes. RESULTS Four main categories and nine sub-categories emerged from the data: factors that increased or decreased the occurrence of incidents (with three sub-categories comprising risk perception and fatalism, pilgrims' responses to incidents, and health system response to traumatic events); medical infrastructure (with two sub-categories comprising medical infrastructure in the host country and medical structures in border cities); organizational resource category (with two sub-categories comprising manpower, and equipment and facilities); and coordination of responsible organizations (with two sub-categories comprising inter-organizational coordination and inter-agency collaboration). All of the data were extracted from the experiences of the participants. CONCLUSION Similar to other mass gatherings, Arbaeen requires multi-sectoral and international planning, organizing, and management. The key factors that could improve the preparedness to respond to traumatic events in Arbaeen include training, increasing the perception of risk, changing the attitudes and behavior of pilgrims, developing a national strategic plan of the health system preparedness for policymakers, and implementing scenario-based exercises for executives.
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Affiliation(s)
- Arezou Karampourian
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Zohreh Ghomian
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Davoud Khorasani-Zavareh
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Neurobiology, Care Sciences and Society (NVS), H1, Division of Family Medicine and Primary Care, Alfred Nobels Allé 23 141 83 Huddinge, Sweden.
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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.
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Affiliation(s)
- Van-Thuan Hoang
- IRD, AP-HM, SSA, VITROME, Institut Hospitalo-Universitaire Méditerranée Infection, Aix Marseille University, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France.,Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Philippe Gautret
- IRD, AP-HM, SSA, VITROME, Institut Hospitalo-Universitaire Méditerranée Infection, Aix Marseille University, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France.
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Ahmed QA, Memish ZA. From the "Madding Crowd" to mass gatherings-religion, sport, culture and public health. Travel Med Infect Dis 2018; 28:91-97. [PMID: 29879514 PMCID: PMC7110704 DOI: 10.1016/j.tmaid.2018.06.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/31/2018] [Accepted: 06/02/2018] [Indexed: 02/03/2023]
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.
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Affiliation(s)
- Qanta A Ahmed
- Division of Pulmonary Disease and Critical Care Medicine, Department of Medicine, NYU Hospital, New York, USA; State University of New York (SUNY) at Stony Brook, New York, USA.
| | - Ziad A Memish
- Infectious Diseases Division, Department of Medicine and Research Department, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health & College of Medicine Alfaisal University, Riyadh, Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA.
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24
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Hopkins N, Reicher SD. Social identity and health at mass gatherings. EUROPEAN JOURNAL OF SOCIAL PSYCHOLOGY 2017. [DOI: 10.1002/ejsp.2288] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Nick Hopkins
- School of Social Sciences; University of Dundee; Dundee UK
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Gautret P, Steffen R. Communicable diseases as health risks at mass gatherings other than Hajj: what is the evidence? Int J Infect Dis 2016; 47:46-52. [PMID: 26987476 DOI: 10.1016/j.ijid.2016.03.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/07/2016] [Accepted: 03/09/2016] [Indexed: 01/06/2023] Open
Abstract
Mass gatherings are characterized by the concentration of people temporally and spatially, and may lead to the emergence of infectious diseases due to enhanced transmission between attendees. This is well-demonstrated in the context of the Hajj and Umrah pilgrimages in Saudi Arabia. The goal of this review was to present the available evidence on outbreaks associated with a variety of pathogens, or also the lack thereof, as assessed by thorough surveillance at any mass gatherings with the exception of those in Saudi Arabia. A systematic search for relevant articles in the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Sixty-eight studies were identified. Although outbreaks have not been reported frequently in or after mass gatherings outside the Hajj and Umrah pilgrimages, they have sometimes occurred at Muslim, Christian, and Hindu religious events, at sports events, and at large-scale open air festivals. In this review it was found that the most common outbreaks at these mass gatherings involved vaccine preventable diseases, mainly measles and influenza, but also mumps and hepatitis A. Meningococcal disease has rarely been recorded. Additionally it was found that the transmission of various communicable diseases that may not be prevented by vaccination has been recorded in association with mass gatherings. These were mainly gastrointestinal infections, caused by a variety of pathogens. It was also noted that some outbreaks occurring at mass gatherings have resulted in the international spread of communicable diseases.
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Affiliation(s)
- Philippe Gautret
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, F-13005 Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France.
| | - Robert Steffen
- Epidemiology, Biostatistics and Prevention Institute, World Health Organization Collaborating Centre for Traveller's Health, University of Zurich, Zurich, Switzerland
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Hopkins N, Reicher S. Adding a psychological dimension to mass gatherings medicine. Int J Infect Dis 2016; 47:112-6. [PMID: 26751239 DOI: 10.1016/j.ijid.2015.12.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 12/23/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022] Open
Abstract
Mass gatherings pose distinctive challenges for medicine. One neglected aspect of this is that the behaviour of people participating in such events is different from the behaviour they exhibit in their everyday lives. This paper seeks to describe a social psychological perspective on the processes shaping people's behaviour at mass gatherings and to explore how these are relevant for an understanding of the processes impacting on the transmission of infection. It is inadequate to conceptualize mass gatherings as simply an aggregate of a large number of individuals. Rather, those present may conceptualize themselves in terms of a collective with a shared group identity. Thinking of oneself and others as members of a collective changes one's behaviour. First, one behaves in terms of one's understanding of the norms associated with the group. Second, the relationships between group members become more trusting and supportive. Understanding these two behavioural changes is key to understanding how and why mass gathering participants may behave in ways that make them more or less vulnerable to infection transmission. Implications for health education interventions are discussed.
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Affiliation(s)
- Nick Hopkins
- Psychology, School of Social Sciences, University of Dundee, Dundee DD14HN, UK.
| | - Stephen Reicher
- School of Psychology and Neuroscience, University of St. Andrews, St. Andrews, UK
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Circulation of respiratory pathogens at mass gatherings, with special focus on the Hajj pilgrimage. THE MICROBIOLOGY OF RESPIRATORY SYSTEM INFECTIONS 2016. [PMCID: PMC7150026 DOI: 10.1016/b978-0-12-804543-5.00006-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Alqahtani AS, Alfelali M, Arbon P, Booy R, Rashid H. Burden of vaccine preventable diseases at large events. Vaccine 2015; 33:6552-63. [PMID: 26437018 DOI: 10.1016/j.vaccine.2015.09.076] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/14/2015] [Accepted: 09/22/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Large events or mass gatherings (MGs) are known to amplify the risk of infectious diseases, many of which can be prevented by vaccination. In this review we have evaluated the burden of vaccine preventable diseases (VPDs) in MGs. METHODS Major databases like PubMed and Embase, Google Scholar and pertinent websites were searched by using MeSH terms and text words; this was supplemented by hand searching. Following data abstraction, the pooled estimate of the burden of VPDs was calculated when possible; otherwise a narrative synthesis was conducted. RESULTS In the past, at religious MGs like Hajj and Kumbh Mela, cholera caused explosive outbreaks; but currently respiratory infections, notably influenza, are the commonest diseases not only at Hajj but also at World Youth Day and Winter Olympiad. The recent cumulative attack rate of influenza at Hajj is 8.7% (range 0.7-15.8%), and the cumulative prevalence is 3.6% (range: 0.3-38%). Small outbreaks of measles (13-42 cases per event) have been reported at sport, entertainment and religious events. A sizeable outbreak (>200 cases) was reported following a special Easter Festival in Austria. An outbreak of hepatitis A occurred following the 'Jam bands' music festival. Other VPDs including pneumococcal disease, pertussis and tuberculosis have been reported in relation to MG attendance. CONCLUSION VPDs not only affect the participants of MGs but also their contacts; vaccine uptake is variable and vaccine implementation is likely to have beneficial effects. Research to address the knowledge gaps surrounding VPDs at MGs is needed.
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Affiliation(s)
- Amani S Alqahtani
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, and the Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, NSW, Australia; School of Public Health, The University of Sydney, Sydney, NSW, Australia.
| | - Mohammad Alfelali
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, and the Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, NSW, Australia; Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Saudi Arabia
| | - Paul Arbon
- Flinders University World Health Organisation Collaborating Centre for Mass Gatherings and High Consequence/High Visibility Events, Adelaide, SA, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, and the Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Australia
| | - Harunor Rashid
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, and the Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Australia
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Hopkins N, Reicher S. The psychology of health and well-being in mass gatherings: A review and a research agenda. J Epidemiol Glob Health 2015; 6:49-57. [PMID: 26164280 PMCID: PMC7320437 DOI: 10.1016/j.jegh.2015.06.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 06/01/2015] [Accepted: 06/21/2015] [Indexed: 11/07/2022] Open
Abstract
Mass gatherings bring large numbers of people into physical proximity. Typically, this physical proximity has been assumed to contribute to ill health (e.g., through being stressful, facilitating infection transmission, etc.). In this paper, we add a new dimension to the emerging field of mass gatherings medicine. Drawing on psychological research concerning group processes, we consider the psychological transformations that occur when people become part of a crowd. We then consider how these transformations may have various consequences for health and well-being. Some of these consequences may be positive. For example, a sense of shared identity amongst participants may encourage participants to view others as a source of social support which in turn contributes to a sense of health and well-being. However, some consequences may be negative. Thus, this same sense of shared identity may result in a loss of disgust at the prospect of sharing resources (e.g., drinking utensils) which could, in turn, facilitate infection transmission. These, and related issues, are illustrated with research conducted at the Magh Mela (North India). We conclude with an agenda for future research concerning health practices at mass gatherings.
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Affiliation(s)
- Nick Hopkins
- School of Psychology, University of Dundee, Dundee, UK.
| | - Stephen Reicher
- School of Psychology and Neuroscience, University of St Andrews, St Andrews, UK
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Gautret P. Religious mass gatherings: connecting people and infectious agents. Clin Microbiol Infect 2014; 21:107-8. [PMID: 25682275 DOI: 10.1016/j.cmi.2014.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 11/21/2014] [Indexed: 11/28/2022]
Affiliation(s)
- P Gautret
- Assistance Publique Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, 13015 Marseille, France; Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), Faculté de Médecine, Marseille, France.
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