1
|
Alrufaidi KM, Nouh RM, Alkhalaf AA, AlGhamdi NM, Alshehri HZ, Alotaibi AM, Almashaykhi AO, AlGhamdi OM, Makhrashi HM, AlGhamdi SA, AlZahrani AG, Mujib SA, Abd-Ellatif EE. Prevalence of emergency cases among pilgrims presenting at King Abdulaziz International Airport Health Care Center at Hajj Terminal, Jeddah, Saudi Arabia during Hajj Season, 1440 H - 2019. DIALOGUES IN HEALTH 2023; 2:100099. [PMID: 38515476 PMCID: PMC10954003 DOI: 10.1016/j.dialog.2023.100099] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/23/2022] [Accepted: 01/05/2023] [Indexed: 09/02/2023]
Abstract
Introduction About 2-3 million pilgrims come to Makkah, Saudi Arabia from all countries to perform Hajj. During the Hajj season of 2019 (1440 H), the total number of pilgrims was 2,489,406, of whom 1,855,027 came from foreign countries. This study aims to investigate the prevalence, pattern, and findings of emergency health problems among pilgrims travelling through King Abdul Aziz International Airport Health Care Center (KAIA-HC) at Hajj Terminal in Jeddah during hajj season of 1440-H. Methodology A cross-sectional study was conducted by reviewing the medical records of pilgrims coming for treatment at KAIA-HC, before and after Hajj between 1 Dhul Qi'dah to 29 Dhul Hijjah 1440 AH (Corresponding to 4 July to 31 August 2019 AD). The collected data included demographics, medical history, diagnoses of the emergency health problems, infections, and their findings. Data were analyzed using Epi Info 7 and SPSS 25. Results About 296 (3.87%) of 7,643 pilgrims treated at KAIA-HC were emergency cases. Their average age was 43 years (Standard Deviation (SD) ±7.5); 51.3% were females; the highest (45.3%) was between 30 - 59 years age group, both males and females; the highest two nationalities were Indonesian (14.2%) and Egyptian (12.5%). Diagnoses included hypertension 59(19.9%), bronchial asthma 53 (17.9%), and 23 cases (10.5%) were suffering from hypotension. 16 (5.4%) of patients had a myocardial infarction and 10 (3.4%) had cerebrovascular accidents. In 13 cases (4.4%), a chest infection was reported. Diabetes complications (hyperglycemia, hypoglycemia, and diabetic ketoacidosis) were reported in 28 (9.4%) of the cases. There were 28 (9.5%) surgical diagnoses, 13 (4.4%) were cut wounds, 11 (3.7%) were bone fracture and dislocation, and 4 (1.4%) were head trauma. With regard to the findings, 82 (27.7%) were referred to hospitals; 10 (3.3%) cases required Cardio-Pulmonary Resuscitation, seven of whom survived. The most common referral causes were myocardial Infarction amounting 12(4.05%), followed by cerebrovascular accident 10(3.3%) and chest infection in 8 (2.7%). 13 (4.4%) of the total cases died. The most common causes of death were myocardial infarction, asthma, hypertension and hyperglycemia. Conclusion Our study emphasizes that emergency cases presented at KAIA-HC were few. Cardiovascular diseases represented the main reason for emergency cases, followed by respiratory diseases. 51% of patients were discharged without the need for a higher level of medical care.
Collapse
Affiliation(s)
| | - Randa Mohammed Nouh
- Consultant of Public Health, Field Epidemiology Training Program, MOH, Saudi Arabia
| | | | | | | | | | | | | | | | - Saeed Abdulaziz AlGhamdi
- Department of Nursing, Health Control Center at King Abdulaziz International Airport, Jeddah, Saudi Arabia
| | | | | | - Eman Elsayed Abd-Ellatif
- Department of Public Health and Community Medicine, Faculty of Medicine, Mansoura University, 35511, Egypt
| |
Collapse
|
2
|
Yezli S, Yassin Y, Mushi A, Alabdullatif L, Alburayh M, Alotaibi BM, Khan A, Walsh L, Lekshmi A, Walker A, Lucidarme J, Borrow R. Carriage of Neisseria meningitidis among travelers attending the Hajj pilgrimage, circulating serogroups, sequence types and antimicrobial susceptibility: A multinational longitudinal cohort study. Travel Med Infect Dis 2023; 53:102581. [PMID: 37178946 DOI: 10.1016/j.tmaid.2023.102581] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/27/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Travel to international mass gatherings such as the Hajj pilgrimage increases the risk of Neisseria meningitidis transmission and meningococcal disease. We investigated carriage and acquisition of N. meningitidis among travelers to Hajj and determined circulating serogroups, sequence types and antibiotic susceptibility among isolates. METHOD We conducted a multinational longitudinal cohort study among 3921 traveling pilgrims in two phases: Pre-Hajj and Post-Hajj. For each participant, a questionnaire was administered and an oropharyngeal swab was obtained. N. meningitidis was isolated, serogrouped, and subjected to whole genome sequence analysis and antibiotic susceptibility testing. RESULTS Overall carriage and acquisition rates of N. meningitidis were 0.74% (95%CI: 0.55-0.93) and 1.10% (95%CI: 0.77-1.42) respectively. Carriage was significantly higher Post-Hajj (0.38% vs 1.10%, p = 0.0004). All isolates were nongroupable, and most belonged to the ST-175 complex and were resistant to ciprofloxacin with reduced susceptibility to penicillins. Three potentially invasive isolates (all genogroup B) were identified in the Pre-Hajj samples. No factors were associated with Pre-Hajj carriage. Suffering influenza like illness symptoms and sharing a room with >15 people were associated with lower carriage Post-Hajj (adjOR = 0.23; p = 0.008 and adjOR = 0.27; p = 0.003, respectively). CONCLUSION Carriage of N. meningitidis among traveler to attending Hajj was low. However, most isolates were resistant to ciprofloxacin used for chemoprophylaxis. A review of the current meningococcal disease preventive measures for Hajj is warranted.
Collapse
Affiliation(s)
- Saber Yezli
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia; Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
| | - Yara Yassin
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Abdulaziz Mushi
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Lamis Alabdullatif
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Mariyyah Alburayh
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Badriah M Alotaibi
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Anas Khan
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia; Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Lloyd Walsh
- Meningococcal Reference Unit, UK Health Security Agency, Manchester, UK
| | - Aiswarya Lekshmi
- Meningococcal Reference Unit, UK Health Security Agency, Manchester, UK
| | - Andrew Walker
- Meningococcal Reference Unit, UK Health Security Agency, Manchester, UK
| | - Jay Lucidarme
- Meningococcal Reference Unit, UK Health Security Agency, Manchester, UK
| | - Ray Borrow
- Meningococcal Reference Unit, UK Health Security Agency, Manchester, UK
| |
Collapse
|
3
|
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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [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.
Collapse
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
| | | | | | | |
Collapse
|
4
|
Yezli S, Yassin Y, Mushi A, Bukhari M, Banasser T, Khan A. Carriage of Neisseria meningitidis Among Umrah Pilgrims: Circulating Serogroups and Antibiotic Resistance. Infect Drug Resist 2022; 15:4685-4696. [PMID: 36039322 PMCID: PMC9419905 DOI: 10.2147/idr.s375096] [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: 05/17/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background Meningococcal disease and outbreaks are a risk during mass gatherings such as the Umrah religious pilgrimage to the Kingdom of Saudi Arabia (KSA). We aimed to investigate the carriage of Neisseria meningitidis among the 2019 Umrah pilgrims and determine the circulating serogroups and their antibiotic susceptibility profiles. Methods We conducted a cross-sectional study among adult Umrah pilgrims from 17th to 29th April 2019 in Mecca city, KSA. A questionnaire was administered to each participant, and an oropharyngeal swab was obtained. Microbiological techniques were used to isolate, identify and serogroup N. meningitidis from the swabs. E-tests were used to determine the susceptibility of the isolates to nine antibiotics. Results The study enrolled 616 pilgrims from 17 countries with a mean age of 53.8 years (±13.1, range = 19–91) and a male-to-female ratio of 1.1:1. Nearly 39% of the respondents had no formal education, 32.5% declared having an underlying health condition and 17.2% were current or past smokers. During their Umrah stay, most pilgrims reported sharing accommodation (98.5%) and never using a face mask (98.5%). Also, 34.6% reported suffering from influenza-like symptoms and 11.8% used antibiotics. N. meningitidis was isolated from three pilgrims (carriage rate of 0.49%), two were serogroup A and one was serogroup B. Antibiotic susceptibility results were available for one isolate (serogroup B) which showed resistance to ciprofloxacin and decreased susceptibility to trimethoprim-sulfamethoxazole. Conclusion Carriage of N. meningitidis among Umrah pilgrims was low. However, invasive serogroups were identified, including an isolate resistant to ciprofloxacin used for chemoprophylaxis. Meningococcal disease preventive measures for Umrah should be regularly reviewed and updated accordingly to reduce the risk of the disease and future pilgrimage-associated outbreaks.
Collapse
Affiliation(s)
- Saber Yezli
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Yara Yassin
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Abdulaziz Mushi
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Mamdouh Bukhari
- Regional Laboratory, Makkah City General Directorate of Health Affairs, Ministry of Health, Makkah, Saudi Arabia
| | - Talib Banasser
- Regional Laboratory, Makkah City General Directorate of Health Affairs, Ministry of Health, Makkah, Saudi Arabia
| | - Anas Khan
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia.,Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
5
|
Macias-Mendoza M, Montes-Robledo A, Arteta-Acosta C, Baldiris-Avila R, Coronell-Rodríguez W. Identification of the nasopharyngeal carriage of Neisseria meningitidis by 16S rRNA Gene sequencing in asymptomatic adolescents and young adults in Cartagena, Colombia (2019–2020). Braz J Infect Dis 2022; 26:102330. [PMID: 35176256 PMCID: PMC9387479 DOI: 10.1016/j.bjid.2022.102330] [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: 10/11/2021] [Revised: 12/08/2021] [Accepted: 01/01/2022] [Indexed: 11/24/2022] Open
Abstract
The bacterium Neisseria meningitidis, a strictly human pathogen, can cause meningitis, meningococcemia, sepsis, and death; repeatedly it scause outbreaks around the world. The frequency of asymptomatic carriage is often high in adolescents and young adults, increasing the invasive meningococcal disease risk and likelihood of transmission. However, detailed analyses of meningococcal carriage in this population in Colombia, particularly in coastal areas, are lacking. In this study, the prevalence and characteristics of Neisseria meningitidis carriage were evaluated in asymptomatic adolescents and young adults (11-25 years old) in Cartagena, Colombia. Oropharynx samples were collected from participants between August and December 2019. The phenotypic identification of bacteria was performed by conventional methods and biochemical testing. Molecular identification to the species level was performed by 16S rRNA gene sequencing. In total, 12 of 648 samples were positive for Neisseria meningitidis by 16S rRNA sequencing, indicating a prevalence of 1.9%. Isolates were classified into four invasive serogroups (A, B, C, and W) by a comparative sequence analysis of the ribosomal gene. Despite the occurrence of meningococcal disease in Cartagena city in the last several years, the frequency of oropharyngeal carriage in adolescents and young adults was low. Serogroup A had not been previously reported in nasopharyngeal samples in Colombia. This is the first report of Neisseria meningitidis on the Colombian Caribbean coast based on 16S rRNA sequencing and is expected to guide the development of vaccination and follow-up strategies.
Collapse
|
6
|
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.
Collapse
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
| | | | | | | |
Collapse
|
7
|
Parikh SR, Campbell H, Bettinger JA, Harrison LH, Marshall HS, Martinon-Torres F, Safadi MA, Shao Z, Zhu B, von Gottberg A, Borrow R, Ramsay ME, Ladhani SN. The everchanging epidemiology of meningococcal disease worldwide and the potential for prevention through vaccination. J Infect 2020; 81:483-498. [PMID: 32504737 DOI: 10.1016/j.jinf.2020.05.079] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 05/31/2020] [Indexed: 12/31/2022]
Abstract
Neisseria meningitidis is a major cause of bacterial meningitis and septicaemia worldwide and is associated with high case fatality rates and serious life-long complications among survivors. Twelve serogroups are recognised, of which six (A, B, C, W, X and Y) are responsible for nearly all cases of invasive meningococcal disease (IMD). The incidence of IMD and responsible serogroups vary widely both geographically and over time. For the first time, effective vaccines against all these serogroups are available or nearing licensure. Over the past two decades, IMD incidence has been declining across most parts of the world through a combination of successful meningococcal immunisation programmes and secular trends. The introduction of meningococcal C conjugate vaccines in the early 2000s was associated with rapid declines in meningococcal C disease, whilst implementation of a meningococcal A conjugate vaccine across the African meningitis belt led to near-elimination of meningococcal A disease. Consequently, other serogroups have become more important causes of IMD. In particular, the emergence of a hypervirulent meningococcal group W clone has led many countries to shift from monovalent meningococcal C to quadrivalent ACWY conjugate vaccines in their national immunisation programmes. Additionally, the recent licensure of two protein-based, broad-spectrum meningococcal B vaccines finally provides protection against the most common group responsible for childhood IMD across Europe and Australia. This review describes global IMD epidemiology across each continent and trends over time, the serogroups responsible for IMD, the impact of meningococcal immunisation programmes and future needs to eliminate this devastating disease.
Collapse
Affiliation(s)
- Sydel R Parikh
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London, UK
| | - Helen Campbell
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London, UK
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lee H Harrison
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Helen S Marshall
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide and Women's and Children's Health Network, Adelaide, South Australia
| | - Federico Martinon-Torres
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC), Galicia, Spain
| | - Marco Aurelio Safadi
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Zhujun Shao
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Bingqing Zhu
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Mary E Ramsay
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London, UK
| | - Shamez N Ladhani
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London, UK; Paediatric Infectious Diseases Research Group (PIDRG), St. George's University of London, Cranmer Terrace, London SW17 0RE, UK.
| |
Collapse
|
8
|
Kling K, Wichmann O, Burchard G. [Travel vaccinations for certain groups of persons]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 63:85-92. [PMID: 31811312 DOI: 10.1007/s00103-019-03067-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The number of international travelers has been continuously increasing in recent decades. Among travelers, there are more and more people at an increased risk for acquiring diseases that could be prevented by vaccines or for the development of a severe course of disease. Risk groups in travel medicine are senior travelers, children, pregnant and breast-feeding women, persons with pre-existing medical conditions, and persons who visit their friends and relatives abroad (VFR). Individuals in these groups require attention during pretravel advice consultations, particularly with regards to recommended vaccinations. On the other hand, for some risk groups, particular vaccines cannot be given for safety reasons or because the response to vaccines is reduced. Not all risk groups or each vaccine have sufficient evidence available, so each patient's risks and benefits must be weighed during pretravel consultation. In this article, the particularities for each risk group with respect to pretravel immunization are highlighted.
Collapse
Affiliation(s)
- Kerstin Kling
- Fachgebiet Impfprävention, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland.
| | - Ole Wichmann
- Fachgebiet Impfprävention, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Gerd Burchard
- Bernhard-Nocht-Institut für Tropenmedizin, Hamburg, Deutschland.,Ständige Impfkommission (STIKO), Berlin, Deutschland
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Meningococcal Vaccine for Hajj Pilgrims: Compliance, Predictors, and Barriers. Trop Med Infect Dis 2019; 4:tropicalmed4040127. [PMID: 31618945 PMCID: PMC6958484 DOI: 10.3390/tropicalmed4040127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/02/2019] [Accepted: 10/09/2019] [Indexed: 02/07/2023] Open
Abstract
Background: Major intercontinental outbreaks of invasive meningococcal disease associated with the Hajj occurred in 1987, 2000, and 2001. Mandatory meningococcal vaccination for all pilgrims against serogroups A and C and, subsequently, A, C, W, and Y controlled the epidemics. Overseas pilgrims show excellent adherence to the policy; however, vaccine uptake among domestic pilgrims is suboptimal. This survey aimed to evaluate meningococcal vaccine uptake among Hajj pilgrims and to identify key factors affecting this. Methods: An anonymous cross-sectional survey was conducted among pilgrims in Greater Makkah during the Hajj in 2017–2018. Data on socio-demographic characteristics, vaccination status, cost of vaccination, and reasons behind non-receipt of the vaccine were collected. Results: A total of 509 respondents aged 13 to 82 (median 33.8) years participated in the survey: 86% male, 85% domestic pilgrims. Only 389/476 (81.7%) confirmed their meningococcal vaccination status; 64 individuals (13.4%), all domestic pilgrims, did not receive the vaccine, and 23 (4.8%) were unsure. Among overseas pilgrims, 93.5% certainly received the vaccine (6.5% were unsure) compared to 80.9% of domestic pilgrims (p < 0.01). Being employed and having a tertiary qualification were significant predictors of vaccination adherence (odds ratio (OR) = 2.2, 95% confidence interval (CI) = 1.3–3.8, p < 0.01; and OR = 1.7, CI = 1–2.5, p < 0.05, respectively). Those who obtained pre-Hajj health advice were more than three times as likely to be vaccinated than those who did not (OR = 3.3, CI = 1.9–5.9, p < 0.001). Lack of awareness (63.2%, 36/57) and lack of time (15.8%, 9/57) were the most common reasons reported for non-receipt of vaccine. Conclusion: Many domestic pilgrims missed the compulsory meningococcal vaccine; in this regard, lack of awareness is a key barrier. Being an overseas pilgrim (or living at a distance from Makkah), receipt of pre-Hajj health advice, and employment were predictors of greater compliance with the vaccination policy. Opportunities remain to reduce the policy–practice gap among domestic pilgrims.
Collapse
|
11
|
Affiliation(s)
- Alimuddin Zumla
- Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, London, UK
| | - Ziad A Memish
- Infectious Diseases Division, Department of Medicine and Department of Research, Prince Mohamed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| |
Collapse
|
12
|
Gallego V, Berberian G, Siu H, Verbanaz S, Rodríguez-Morales AJ, Gautret P, Schlagenhauf P, Lloveras S. The 2019 Pan American games: Communicable disease risks and travel medicine advice for visitors to Peru - Recommendations from the Latin American Society for Travel Medicine (SLAMVI). Travel Med Infect Dis 2019; 30:19-24. [PMID: 31238107 DOI: 10.1016/j.tmaid.2019.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 12/29/2022]
Abstract
The next Pan American Games will be held in Peru in the period July-August 2019. Around 6680 participants from 41 countries are expected to take part in the event. There will be a total of 62 sport disciplines. This event poses specific challenges, given its size and the diversity of attendees. Such gatherings also have potential for the transmission of imported or endemic communicable diseases, including measles in view of the global outbreak situation, but also tropical endemic diseases. In anticipation of increased travel, a panel of experts from the Latin American Society for Travel Medicine (SLAMVI) developed the current recommendations taking into consideration the epidemiology and risks of the main communicable diseases at potential destinations in Peru, recommended immunizations and other preventives measures. These recommendations can be used as a basis for advice for travelers and travel medicine practitioners. Mosquito-borne infections also pose a challenge. Although Lima is malaria free, travelers visiting Peruvian high-risk areas for malaria should be assessed regarding the need for chemoprophylaxis. Advice on the correct timing and use of repellents and other personal protection measures is key to preventing vector-borne infections. Other important recommendations for travelers should focus on preventing water- and food-borne diseases including travelers' diarrhea. This paper addresses pre-travel, preventive strategies to reduce the risk of acquiring communicable diseases during the Pan American Games and also reviews the spectrum of endemic infections in Lima and Peru to facilitate the recognition and management of infectious diseases in travelers returning to their countries of origin.
Collapse
Affiliation(s)
- Viviana Gallego
- Panel of Sports and Travel, Latin American Society for Travel Medicine (SLAMVI), Buenos Aires, Argentina
| | - Griselda Berberian
- Panel of Sports and Travel, Latin American Society for Travel Medicine (SLAMVI), Buenos Aires, Argentina
| | - Hugo Siu
- Panel of Sports and Travel, Latin American Society for Travel Medicine (SLAMVI), Lima, Peru
| | - Sergio Verbanaz
- Panel of Sports and Travel, Latin American Society for Travel Medicine (SLAMVI), Buenos Aires, Argentina
| | - Alfonso J Rodríguez-Morales
- Panel of Scientific Publications and Teaching, Latin American Society for Travel Medicine (SLAMVI), Pereira, Colombia; Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia.
| | - Philippe Gautret
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Patricia Schlagenhauf
- University of Zürich Centre for Travel Medicine, Institute for Epidemiology, Biostatistics and Prevention, Hirschengraben 84, 8001, Zürich, Switzerland
| | - Susana Lloveras
- Panel of Sports and Travel, Latin American Society for Travel Medicine (SLAMVI), Buenos Aires, Argentina; Panel of Scientific Publications and Teaching, Latin American Society for Travel Medicine (SLAMVI), Pereira, Colombia
| |
Collapse
|
13
|
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.
Collapse
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.
| |
Collapse
|
14
|
Acevedo R, Bai X, Borrow R, Caugant DA, Carlos J, Ceyhan M, Christensen H, Climent Y, De Wals P, Dinleyici EC, Echaniz-Aviles G, Hakawi A, Kamiya H, Karachaliou A, Lucidarme J, Meiring S, Mironov K, Sáfadi MAP, Shao Z, Smith V, Steffen R, Stenmark B, Taha MK, Trotter C, Vázquez JA, Zhu B. The Global Meningococcal Initiative meeting on prevention of meningococcal disease worldwide: Epidemiology, surveillance, hypervirulent strains, antibiotic resistance and high-risk populations. Expert Rev Vaccines 2018; 18:15-30. [PMID: 30526162 DOI: 10.1080/14760584.2019.1557520] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The 2018 Global Meningococcal Initiative (GMI) meeting focused on evolving invasive meningococcal disease (IMD) epidemiology, surveillance, and protection strategies worldwide, with emphasis on emerging antibiotic resistance and protection of high-risk populations. The GMI is comprised of a multidisciplinary group of scientists and clinicians representing institutions from several continents. AREAS COVERED Given that the incidence and prevalence of IMD continually varies both geographically and temporally, and surveillance systems differ worldwide, the true burden of IMD remains unknown. Genomic alterations may increase the epidemic potential of meningococcal strains. Vaccination and (to a lesser extent) antimicrobial prophylaxis are the mainstays of IMD prevention. Experiences from across the globe advocate the use of conjugate vaccines, with promising evidence growing for protein vaccines. Multivalent vaccines can broaden protection against IMD. Application of protection strategies to high-risk groups, including individuals with asplenia, complement deficiencies and human immunodeficiency virus, laboratory workers, persons receiving eculizumab, and men who have sex with men, as well as attendees at mass gatherings, may prevent outbreaks. There was, however, evidence that reduced susceptibility to antibiotics was increasing worldwide. EXPERT COMMENTARY The current GMI global recommendations were reinforced, with several other global initiatives underway to support IMD protection and prevention.
Collapse
Affiliation(s)
- Reinaldo Acevedo
- a Biologic Evaluation Department , Finlay Institute of Vaccines , Havana , Cuba
| | - Xilian Bai
- b Meningococcal Reference Unit , Public Health England , Manchester , UK
| | - Ray Borrow
- b Meningococcal Reference Unit , Public Health England , Manchester , UK
| | - Dominique A Caugant
- c Division of Infection Control and Environmental Health , Norwegian Institute of Public Health , Oslo , Norway
| | - Josefina Carlos
- d Department of Pediatrics, College of Medicine , University of the East - Ramon Magsaysay Memorial Medical Center , Quezon City , Philippines
| | - Mehmet Ceyhan
- e Faculty of Medicine, Department of Pediatric Infectious Diseases , Hacettepe University , Ankara , Turkey
| | - Hannah Christensen
- f Population Health Sciences, Bristol Medical School , University of Bristol , Bristol , UK
| | - Yanet Climent
- a Biologic Evaluation Department , Finlay Institute of Vaccines , Havana , Cuba
| | - Philippe De Wals
- g Department of Social and Preventive Medicine , Laval University , Quebec City , QC , Canada
| | - Ener Cagri Dinleyici
- h Department of Paediatrics , Eskisehir Osmangazi University Faculty of Medicine , Eskisehir , Turkey
| | - Gabriela Echaniz-Aviles
- i Center for Research on Infectious Diseases , Instituto Nacional de Salud Pública , Cuernavaca , México
| | - Ahmed Hakawi
- j Infectious Diseases Control , Ministry of Health , Riyadh , Saudi Arabia
| | - Hajime Kamiya
- k Infectious Disease Surveillance Center , National Institute of Infectious Diseases , Tokyo , Japan
| | | | - Jay Lucidarme
- b Meningococcal Reference Unit , Public Health England , Manchester , UK
| | - Susan Meiring
- m Division of Public Health Surveillance and Response , National Institute for Communicable Diseases , Johannesburg , South Africa
| | - Konstantin Mironov
- n Central Research Institute of Epidemiology , Moscow , Russian Federation
| | - Marco A P Sáfadi
- o Department of Pediatrics , FCM Santa Casa de São Paulo School of Medical Sciences , São Paulo , Brazil
| | - Zhujun Shao
- p National Institute for Communicable Disease Control and Prevention , Chinese Centre for Disease Control and Prevention , Beijing , China
| | - Vinny Smith
- q Meningitis Research Foundation , Bristol , UK
| | - Robert Steffen
- r Department of Epidemiology and Prevention of Infectious Diseases , WHO Collaborating Centre for Travellers' Health, University of Zurich , Zurich , Switzerland
| | - Bianca Stenmark
- s Department of Laboratory Medicine , Örebro University Hospital , Örebro , Sweden
| | - Muhamed-Kheir Taha
- t Institut Pasteur , National Reference Centre for Meningococci , Paris , France
| | - Caroline Trotter
- l Department of Veterinary Medicine , University of Cambridge , Cambridge , UK
| | - Julio A Vázquez
- u National Centre of Microbiology , Institute of Health Carlos III , Madrid , Spain
| | - Bingqing Zhu
- p National Institute for Communicable Disease Control and Prevention , Chinese Centre for Disease Control and Prevention , Beijing , China
| |
Collapse
|
15
|
Badahdah AM, Alfelali M, Alqahtani AS, Alsharif S, Barasheed O, Rashid H. Mandatory meningococcal vaccine, and other recommended immunisations: Uptake, barriers, and facilitators among health care workers and trainees at Hajj. World J Clin Cases 2018; 6:1128-1135. [PMID: 30613671 PMCID: PMC6306626 DOI: 10.12998/wjcc.v6.i16.1128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/21/2018] [Accepted: 11/24/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To evaluate the uptake of a mandatory meningococcal, a highly recommended influenza, and an optional pneumococcal vaccine, and to explore the key factors affecting vaccination rate among health care workers (HCWs) during the Hajj.
METHODS An anonymous cross-sectional online survey was distributed among HCWs and trainees who worked or volunteered at the Hajj 2015-2017 through their line managers, or by visiting their hospitals and healthcare centres in Makkah and Mina. Overseas HCWs who accompanied the pilgrims or those who work in foreign Hajj medical missions were excluded. Pearson’s χ2 test was used to compare categorical variables and odds ratio (OR) was calculated by “risk estimate” statistics along with 95% confidence interval (95%CI).
RESULTS A total of 138 respondents aged 20 to 59 (median 25.6) years with a male to female ratio of 2.5:1 participated in the survey. Only 11.6% (16/138) participants reported receiving all three vaccines, 15.2% (21/138) did not receive any vaccine, 76.1% (105/138) received meningococcal, 68.1% (94/138) influenza and 13.8% (19/138) pneumococcal vaccine. Females were more likely to receive a vaccine than males (OR 3.6, 95%CI: 1.0-12.7, P < 0.05). Willingness to follow health authority’s recommendation was the main reason for receipt of vaccine (78.8%) while believing that they were up-to-date with vaccination (39.8%) was the prime reason for non-receipt.
CONCLUSION Some HCWs at Hajj miss out the compulsory and highly recommended vaccines; lack of awareness is a key barrier and authority’s advice is an important motivator. Health education followed by stringent measures may be required to improve their vaccination rate.
Collapse
Affiliation(s)
- Al-Mamoon Badahdah
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 22252, Saudi Arabia
- Harunor Rashid, National Centre for Immunisation Research and Surveillance, the Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- Harunor Rashid, the Discipline of Child and Adolescent Health, the Faculty of Medicine and Health, the University of Sydney, Westmead, NSW 2145, Australia
| | - Mohammad Alfelali
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 22252, Saudi Arabia
- Harunor Rashid, National Centre for Immunisation Research and Surveillance, the Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- Harunor Rashid, the Discipline of Child and Adolescent Health, the Faculty of Medicine and Health, the University of Sydney, Westmead, NSW 2145, Australia
| | | | - Saeed Alsharif
- Command and Control Centre of Infectious Diseases of Public Health Department of Ministry of Health, Taif 26521, Saudi Arabia
| | - Osamah Barasheed
- Harunor Rashid, National Centre for Immunisation Research and Surveillance, the Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- Harunor Rashid, the Discipline of Child and Adolescent Health, the Faculty of Medicine and Health, the University of Sydney, Westmead, NSW 2145, Australia
- the Executive Administration of Research and Innovation at King Abdullah Medical City in Holy Capital, Makkah 24246, Saudi Arabia
| | | | | |
Collapse
|