1
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Mahomed O, Jaffer MN, Parker S. Morbidity amongst South African Hajj pilgrims in 2023-a retrospective cohort study. Sci Rep 2024; 14:12622. [PMID: 38824134 PMCID: PMC11144184 DOI: 10.1038/s41598-024-62682-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 05/20/2024] [Indexed: 06/03/2024] Open
Abstract
South Africans are not accustomed to the dry arid climate and sweltering heat in Saudi Arabia. We conducted a retrospective cohort study to identify the common health conditions pre-Hajj, during the 5 days of Hajj and on return to South Africa from Hajj amongst the 2023 pilgrims. A QR code and a mobile link to a self-administered questionnaire was sent to all 3500 South African pilgrims. Five hundred and seventy-seven pilgrims returned the completed surveys. Mean age of the participants was 48 years (SD 12) with a higher female representation (3:2). Forty eight percent (279) had pre-existing chronic conditions. Forty five percent (259) reported being ill during their stay in the Kingdom, 20% (115) reported having an illness during the main 5 days, whilst 51% (293) reported having an illness within 7 days of returning to South Africa. Only six pilgrims were admitted to hospital after their return home. Respiratory tract linked symptoms were the most frequently reported (95% pre Hajj and 99% post Hajj). Participants who reported having a chronic condition (AOR 1.52 95% CI 1.09-2.11) and engaging in independent exercising prior to Hajj (AOR 1.52-1.07-2.10) were at an increased likelihood of developing an illness within 7 days of returning home. Post travel surveillance swabs to identify potential pathogens that the returning pilgrims are incubating should be explored to guide further interventions.
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Affiliation(s)
- Ozayr Mahomed
- Discipline of Public Health Medicine, University of KwaZulu-Natal Nelson Mandela School of Medicine, George Campbell Building, Howard College Campus, Durban, South Africa.
| | | | - Salim Parker
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
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2
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Alahmari AA, Khan AA, Alamri FA, Almuzaini YS, Habash AK, Jokhdar H. Healthcare policies, precautionary measures and outcomes of mass gathering events in the era of COVID-19 pandemic: Expedited review. J Infect Public Health 2024; 17 Suppl 1:27-33. [PMID: 37059635 PMCID: PMC10049799 DOI: 10.1016/j.jiph.2023.03.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/14/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023] Open
Abstract
With the onset of the COVID-19 pandemic in early 2020, several countries suspended or restricted mass gathering (MG) events to mitigate the risk of superspreading events. Prohibiting MGs aimed to lessen the likelihood of highly infectious persons coming into close contact with many others. Now that the world has opened its doors wide and removed most of precautionary measures, many questions arise. In this review, we aimed to summarize the current evidence regarding the policies and regulations that were implemented for the safe return of MG events. Besides, we highlighted the impact of the return of MG events during 2021 on the trajectory of COVID-19 spread. Canceling MG events can carry religious, societal, economic, and public negative consequences necessitating the safe return of these events. The experience with the COVID-19 pandemic was the foundation for the recommendations for the safe conduction of MG events during the pandemic by international public health bodies. When policymakers adequately applied precautionary measures and strategic approaches, we witnessed the safe holding of huge MG events without aggravating the COVID-19 situation or increasing the number of new cases beyond the capacity and readiness of the national healthcare system.
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Affiliation(s)
- Ahmed A Alahmari
- Global Centre for Mass Gatherings Medicine, Ministry of Health, Saudi Arabia
| | - Anas A Khan
- Department of Emergency Medicine, College of Medicine, King Saud University, Saudi Arabia
| | - Fahad A Alamri
- Global Centre of Mass Gatherings Medicine, Family Medicine, Primary Health Centre, Ministry of Health, Riyadh, Saudi Arabia.
| | - Yasir S Almuzaini
- Global Centre for Mass Gatherings Medicine, Ministry of Health, Saudi Arabia
| | - Alia K Habash
- Global Centre for Mass Gatherings Medicine, Ministry of Health, Saudi Arabia
| | - Hani Jokhdar
- Deputyship of Public Health, Ministry of Health, Riyadh, Saudi Arabia
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3
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Alghadeer S, Babelghaith SD, Syed W, Al-Arifi MN. Community pharmacists' knowledge, prospective and practice towards health related illness at Hajj and Umrah: A cross sectional study. Saudi Pharm J 2023; 31:101786. [PMID: 37771956 PMCID: PMC10523272 DOI: 10.1016/j.jsps.2023.101786] [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: 07/04/2023] [Accepted: 09/08/2023] [Indexed: 09/30/2023] Open
Abstract
Objectives To assess the community pharmacists' (CPs) knowledge, attitude, and perception of health-related illness among pilgrims, and to investigate the common diseases and the pattern of medications dispensed by CPs during Hajj and Umrah seasons. Method A cross-sectional study was carried out in Riyadh, Saudi Arabia over two months in 2022, through electronic platform using prevalidated questionnaires adopted from the literature. The questionnaires were divided into 4 sections assessing the CP's knowledge, attitude, and perception about health-related illness, common dispensed agents, and required vaccination during Hajj and Umrah. Results A total of 544 CPs, mostly between the age of 31-40 (69.9%), participated in this research. About 87.9% of the CPs received a pilgrim after performing their rituals coming to the pharmacy complaining of infection or health problem. In this study, 99.8%(n = 544), 99.6%(n = 543), and 92.7% (n = 505) of the CPs identified influenza, food poisoning, and diarrhea/gastroenteritis as the most common issues during the Hajj & Umrah season respectively. As results, anti-diarrheal agents (96.3%), painkillers (87.3%), inhalers (89.4%), and sunscreens (88.3%) were the most requested pharmaceutical agents. Additionally, 96.7%(n = 527) of the CPs agreed that vaccination is safe to be given to Hajj and Umrah pilgrims particularly for those aged ≥ 65 years, and 89.4%(n = 487) of them reported awareness of vaccines that are required by Saudi Ministry of Health. Both Influenza and meningococcal meningitis vaccines were identified by 99.8% of the CPs, but polio vaccine was identified by 33.9%. Conclusion Community pharmacists provided pharmaceutical care services for Hajj and Umrah pilgrims. The majority of CPs had adequate knowledge about viral diseases during Hajj and Umrah and their requirement for vaccination.
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Affiliation(s)
- Sultan Alghadeer
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Salmeen D Babelghaith
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Wajid Syed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed N. Al-Arifi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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4
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Lovey T, Hasler R, Gautret P, Schlagenhauf P. Travel-related respiratory symptoms and infections in travellers (2000-22): a systematic review and meta-analysis. J Travel Med 2023; 30:taad081. [PMID: 37310895 PMCID: PMC10481419 DOI: 10.1093/jtm/taad081] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Respiratory tract infections (RTIs) are common in travellers due to the year-round or seasonal presence of respiratory pathogen and exposure to crowded environments during the itinerary. No study has systematically examined the burden of RTI infections among travellers. The aim of this systematic review and meta-analysis is to evaluate the prevalence of RTIs and symptoms suggestive of RTIs among travellers according to risk groups and/or geographic region, and to describe the spectrum of RTIs. METHODS The systematic review and meta-analysis was registered in PROSPERO (CRD42022311261). We searched Medline, Embase, Scopus, Cochrane Central, Web of Science, Science Direct and preprint servers MedRxiv, BioRxiv, SSRN and IEEE Xplore on 1 February 2022. Studies reporting RTIs or symptoms suggestive of RTIs in international travellers after 1 January 2000 were eligible. Data appraisal and extraction were performed by two authors, and proportional meta-analyses were used to obtain estimates of the prevalence of respiratory symptoms and RTIs in travellers and predefined risk groups. FINDINGS A total of 429 articles on travellers' illness were included. Included studies reported 86 841 symptoms suggestive of RTIs and 807 632 confirmed RTIs. Seventy-eight percent of reported respiratory symptoms and 60% of RTIs with available location data were acquired at mass gatherings events. Cough was the most common symptom suggestive of respiratory infections, and the upper respiratory tract was the most common site for RTIs in travellers. The prevalence of RTIs and respiratory symptoms suggestive of RTIs were 10% [8%; 14%] and 37% [27%; 48%], respectively, among travellers. Reporting of RTIs in travellers denoted by publication output was found to correlate with global waves of new respiratory infections. INTERPRETATION This study demonstrates a high burden of RTIs among travellers and indicates that travellers' RTIs reflect respiratory infection outbreaks. These findings have important implications for understanding and managing RTIs among travellers.
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Affiliation(s)
- Thibault Lovey
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Hirschengraben 84, 8001 Zürich Switzerland
| | - Robin Hasler
- HFR Fribourg – Cantonal Hospital, 1708 Fribourg, Switzerland
| | | | - Patricia Schlagenhauf
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Hirschengraben 84, 8001 Zürich Switzerland
- Department of Global and Public Health, MilMedBiol Competence Centre, Epidemiology Biostatistics and Prevention Institute, WHO Collaborating Centre for Travellers’ Health, Hirschengraben 84, 8001 Zürich, Switzerland
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5
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Hoang VT, Dao TL, Ly TDA, Drali T, Yezli S, Parola P, Pommier de Santi V, Gautret P. Respiratory pathogens among ill pilgrims and the potential benefit of using point-of-care rapid molecular diagnostic tools during the Hajj. Acta Microbiol Immunol Hung 2022; 69:283-289. [PMID: 36370366 DOI: 10.1556/030.2022.01895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/21/2022] [Indexed: 11/13/2022]
Abstract
We investigated respiratory pathogens among ill Hajj pilgrims from Marseille. We also discuss the potential role of point-of-care (POC) rapid molecular diagnostic tools for this purpose. Clinical data were collected using a standardised questionnaire. Influenza A and B viruses, human rhinovirus and human coronaviruses, Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae and Klebsiella pneumoniae were investigated using real-time PCR in respiratory samples obtained during travel, at the onset of symptoms. 207 participants were included. A cough, expectoration, rhinitis and a sore throat were the most frequent respiratory symptoms, followed by loss of voice and dyspnoea. 38.7% and 25.1% of pilgrims reported a fever and influenza-like symptoms, respectively. 59.4% pilgrims received antibiotics. Rhinovirus (40.6%) was the most frequent pathogen, followed by S. aureus (35.8%) and H. influenzae (30.4%). Virus and bacteria co-infections were identified in 28.5% of participants. 25.1% pilgrims who were positive for respiratory bacteria did not receive antibiotic treatment. In the context of the Hajj pilgrimage, it is important to detect infections that can be easily managed with appropriate treatment, and those that can affect prognosis, requiring hospitalisation. POC rapid molecular diagnostic tools could be used for patient management at small Hajj medical missions and to rationalise antibiotic consumption among Hajj pilgrims.
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Affiliation(s)
- Van-Thuan Hoang
- 1Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Thi-Loi Dao
- 1Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Tran Duc Anh Ly
- 2IHU-Méditerranée Infection, Marseille, France.,3Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
| | | | - Saber Yezli
- 4The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Philippe Parola
- 2IHU-Méditerranée Infection, Marseille, France.,3Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Vincent Pommier de Santi
- 2IHU-Méditerranée Infection, Marseille, France.,3Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France.,5French Military Centre for Epidemiology and Public Health, Marseille, France
| | - Philippe Gautret
- 2IHU-Méditerranée Infection, Marseille, France.,3Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
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6
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Alahmari AA, Khan AA, Alamri FA, Almuzaini YS, Alradini FA, Almohamadi E, Alsaeedi S, Asiri S, Motair W, Almadah A, Assiri AM, Jokhdar HA. Hajj 2021: Role of mitigation measures for health security. J Infect Public Health 2022; 15:1350-1354. [PMID: 36184475 DOI: 10.1016/j.jiph.2022.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/04/2022] [Accepted: 09/19/2022] [Indexed: 10/31/2022] Open
Abstract
PURPOSE After the impressive results of the 2020 Hajj management, Saudi authorities decided to expand the quota to 60,000 pilgrims in 2021, which resulted in a convenient and successful experience. PATIENTS AND METHODS This was a retrospective pre and post-study study conducted on all pilgrims attending the 2021 Hajj using the polymerase chain reaction (PCR) test surveillance with paired-swab samples (pre-Hajj and post-Hajj) to evaluate the risk potential of COVID-19 among Hajj pilgrims, the effectiveness of preventive measures and the potential effect of the Hajj ritual as a huge mass gathering on the epidemiological situation of the Saudi Arabian population. RESULT Forty-one cases had positive COVID-19 infections out of a total of 58,428 pilgrims who attended the 2021 Hajj season, as detected by nonmandatory pre- and post-Hajj PCR. Notably, the 2021 Hajj season achieved a decreasing leg of the COVID-19 pandemic curve. The adjusted incidence rate in KSA from July 11th to August 7th ranged from 19 to 24 cases per 100,000 population. In contrast, the incidence rate for the same duration in Hajj ranged from 3 to 7 cases per 100,000 pilgrims. CONCLUSION The Saudi mitigation plan ensured the safety of pilgrims and healthcare workers for Hajj, successfully limited the risk of COVID-19 transmission inside and contributed to global health security. The success story of Hajj in 2020 and 2021 during the pandemic represents a successful model for planning, achieving and managing future mass gatherings by integrating technology with global and national health policies and public health measures.
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Affiliation(s)
- Ahmed A Alahmari
- Global Centre for Mass Gatherings Medicine, Ministry of Health, Saudi Arabia.
| | - Anas A Khan
- Department of Emergency Medicine, College of Medicine, King Saud University, Saudi Arabia.
| | - Fahad A Alamri
- Global Centre of Mass Gatherings Medicine, Family Medicine, Primary Health Centre, Ministry of Health, Riyadh, Saudi Arabia.
| | - Yasir S Almuzaini
- Global Centre for Mass Gatherings Medicine, Ministry of Health, Saudi Arabia.
| | - Faten A Alradini
- Department of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.
| | | | - Sami Alsaeedi
- Command and Control Centre (CCC), Ministry of Health, Riyadh, Saudi Arabia.
| | - Sari Asiri
- General Directorate of Hajj and Umrah, Ministry of Health, Riyadh, Saudi Arabia.
| | - Wael Motair
- General Directorate of Health Affairs, Makkah Region; Ministry of Health, Makkah, Saudi Arabia.
| | - Amr Almadah
- Faculty of Engineering, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Abdullah M Assiri
- Deputyship of Public Health, Ministry of Health, Riyadh, Saudi Arabia.
| | - Hani A Jokhdar
- Deputyship of Public Health, Ministry of Health, Riyadh, Saudi Arabia.
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7
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Bokhary H, Research Team H, Barasheed O, Othman HB, Saha B, Rashid H, Hill-Cawthorne GA, Abd El Ghany M. Evaluation of the rate, pattern and appropriateness of antibiotic prescription in a cohort of pilgrims suffering from upper respiratory tract infection during the 2018 Hajj season. Access Microbiol 2022; 4:000338. [PMID: 35812707 PMCID: PMC9260093 DOI: 10.1099/acmi.0.000338] [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: 11/17/2021] [Accepted: 02/01/2022] [Indexed: 11/18/2022] Open
Abstract
Hajj is associated with an increased risk of the transmission of infectious diseases including upper respiratory tract infections (URTIs). It can be a focal point for the emergence, persistence and dissemination of antimicrobial-resistant (AMR) bacteria. The overuse of antibiotics during Hajj can promote the development of antimicrobial resistance. Little information is known regarding the true appropriateness of prescribing antibiotics for treating URTIs during Hajj. Here we studied the rate, patterns and appropriateness of antibiotic prescription among a cohort of pilgrims who were treated for URTIs during the 2018 Hajj season. Adult pilgrims who sought medical services for URTIs [presenting with coryza, runny nose, nasal irritation, nasal congestion, cough, sore throat, headache or fever (even if subjective)] within the Holy sites were enrolled in this study and consented to provide swabs and medical information. A total of 121 pilgrims were enrolled, with the majority (60.3 %) originating from North African Arab countries. Most were male (89.3 %) with a median age of 45 years. Bacterial infections were detected in 7.3 % (n=9) of the URTI cases. The identified bacteria included
Haemophilus influenzae
(n=6, all resistant to ampicillin),
Streptococcus pneumoniae
(n=2),
Staphylococcus aureus
(n=1, resistant to oxacillin) and
Moraxella catarrhalis
(n=1, resistant to ampicillin and trimethoprim/sulfamethoxazole). The antibiotic prescription rate was 52.1%, most of which was amoxicillin (81 %). The data demonstrated that the proportion of appropriate practices in treating bacterial URTIs in this cohort was 45.5 %. This study highlights the need for implementing laboratory identification of the aetiological agents and related AMR profiles when treating URTIs in Hajj, rather than relying on clinical assessment alone.
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Affiliation(s)
- Hamid Bokhary
- The Westmead Institute for Medical Research, Westmead, NSW, Australia
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
- University Medical Centre, Umm Al-Qura University, Makkah, Saudi Arabia
- Sydney Institute for Infectious Diseases, The University of Sydney, Westmead, NSW, Australia
| | | | | | - Hala B. Othman
- Clinical Pathology Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
- King Abdullah Medical City, Makkah, Saudi Arabia
| | | | - Harunor Rashid
- National Centre for Immunization Research and Surveillance of Vaccine Preventable Diseases, Kids Research Institute, The Children’s Hospital at Westmead, Westmead, NSW, Australia
- Sydney Institute for Infectious Diseases, The University of Sydney, Westmead, NSW, Australia
| | | | - Moataz Abd El Ghany
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
- The Westmead Institute for Medical Research, Westmead, NSW, Australia
- Sydney Institute for Infectious Diseases, The University of Sydney, Westmead, NSW, Australia
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8
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Neal EFG, Chan J, Nguyen CD, Russell FM. Factors associated with pneumococcal nasopharyngeal carriage: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000327. [PMID: 36962225 PMCID: PMC10021834 DOI: 10.1371/journal.pgph.0000327] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/14/2022] [Indexed: 11/19/2022]
Abstract
Pneumococcal disease is a major contributor to global childhood morbidity and mortality and is more common in low- and middle-income countries (LMICs) than in high-income countries. Pneumococcal carriage is a prerequisite for pneumococcal disease. Pneumococcal conjugate vaccine reduces vaccine-type carriage and disease. However, pneumococcal carriage and disease persist, and it is important to identify other potentially modifiable factors associated with pneumococcal carriage and determine if risk factors differ between low, middle, and high-income countries. This information may help inform pneumococcal disease prevention programs. This systematic literature review describes factors associated with pneumococcal carriage stratified by country income status and summarises pneumococcal carriage rates for included studies. We undertook a systematic search of English-language pneumococcal nasopharyngeal carriage studies up to 30th June 2021. Peer-reviewed studies reporting factors associated with overall pneumococcal nasopharyngeal carriage in healthy, community-based study populations were eligible for inclusion. Two researchers independently reviewed studies to determine eligibility. Results are presented as narrative summaries. This review is registered with PROSPERO, CRD42020186914. Eighty-two studies were included, and 46 (56%) were conducted in LMICs. There was heterogeneity in the factors assessed in each study. Factors positively associated with pneumococcal carriage in all income classification were young age, ethnicity, symptoms of respiratory tract infection, childcare attendance, living with young children, poverty, exposure to smoke, season, and co-colonisation with other pathogens. Breastfeeding and antibiotic use were protective against carriage in all income classifications. Median (interquartile range) pneumococcal carriage rates differed by income classification, ranging from 51% (19.3-70.2%), 38.5% (19.3-51.6%), 31.5% (19.0-51.0%), 28.5% (16.8-35.4%), (P = 0.005) in low-, lower-middle, upper-middle, and high-income classifications, respectively. Our findings suggest that where measured, factors associated with pneumococcal nasopharyngeal carriage are similar across income classifications, despite the highest pneumococcal carriage rates being in low-income classifications. Reducing viral transmission through vaccination and public health interventions to address social determinants of health would play an important role.
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Affiliation(s)
- Eleanor Frances Georgina Neal
- Infection & Immunity, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Jocelyn Chan
- Infection & Immunity, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Cattram Duong Nguyen
- Infection & Immunity, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Fiona Mary Russell
- Infection & Immunity, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
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Dao TL, Hoang VT, Ly TDA, Goumballa N, Gautret P. Epidemiological Investigations of Infectious Diseases among Mobile Populations at the University Hospital Institute Mediterranean Infection in Marseille, France. J Epidemiol Glob Health 2021; 11:271-282. [PMID: 34514760 PMCID: PMC8435867 DOI: 10.2991/jegh.k.210526.001] [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: 10/17/2020] [Accepted: 05/21/2021] [Indexed: 11/29/2022] Open
Abstract
We review the most recent work conducted by our group on the circulation of infectious agents in mobile populations, including pilgrims participating in the Hajj (Mecca, Saudi Arabia) and the Grand Magal of Touba (Senegal) pilgrimages, homeless people, and medical students participating in an elective abroad. Using a similar epidemiological study design with standardized questionnaires and molecular assays allows comparison of different populations of travelers. The main infectious pathogens and antibiotic resistance genes linked to travel were identified in certain specific populations of travelers, as well as in a group of homeless migrant people in Marseille. The role of several risk factors has also been demonstrated, allowing identifying individuals at increased risk of disease or pathogen carriage on which to base targeted preventive measures. Such results, together with those obtained through international surveillance networks allow better description of the epidemiology of travel-associated infectious diseases.
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Affiliation(s)
- Thi Loi Dao
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, France.,IHU-Méditerranée Infection, 19-21 Boulevard Jean, Moulin 13385, Marseille Cedex 05, France.,Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Van Thuan Hoang
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, France.,IHU-Méditerranée Infection, 19-21 Boulevard Jean, Moulin 13385, Marseille Cedex 05, France.,Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Tran Duc Anh Ly
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, France.,IHU-Méditerranée Infection, 19-21 Boulevard Jean, Moulin 13385, Marseille Cedex 05, France
| | - Ndiaw Goumballa
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, France.,IHU-Méditerranée Infection, 19-21 Boulevard Jean, Moulin 13385, Marseille Cedex 05, France
| | - Philippe Gautret
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, France.,IHU-Méditerranée Infection, 19-21 Boulevard Jean, Moulin 13385, Marseille Cedex 05, France
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10
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Respiratory infections among pilgrims at the Grand Magal of Touba: A comparative cohort controlled survey. Travel Med Infect Dis 2021; 43:102104. [PMID: 34098094 DOI: 10.1016/j.tmaid.2021.102104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/14/2021] [Accepted: 06/01/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Grand Magal of Touba (GMT) is a large event gathering around 4-5 million participants every year. A pilot study conducted in 2017 among GMT pilgrims showed that 41.8% of participants reported respiratory symptoms, mostly due to rhinovirus (13.0%), coronaviruses (16.0%) and adenovirus (4.6%). METHODS A PCR-based prospective cohort study was conducted among GMT pilgrims and controls (who did not participate to the event) in two rural villages in South Senegal, in 2019. RESULTS 93 pilgrims and 84 controls were included in the study. There were no significant differences between pilgrims and controls regarding demographic characteristics and chronic conditions. 60.2% of pilgrims reported respiratory symptoms during their stay in Touba, or soon after their return. By contrast, only 8.3% of controls reported respiratory symptoms after the GMT. The acquisition of rhinovirus, coronaviruses, Streptococcus pneumoniae and Moraxella catarrhalis was 22.6%, 6.5%, 17.2% and 6.8% respectively in pilgrims and was significantly higher than in controls (3.6%, 0%, 4.8% and 1.2% respectively). Respiratory symptoms post-GMT were five times more frequent in S. pneumoniae carriers (aOR = 5.18, 95%CI = [1.98-13.57]). CONCLUSION This study demonstrates that individuals who participated in the GMT were at higher risk of suffering from respiratory symptoms and that this was linked to the acquisition of S. pneumoniae.
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11
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Hoang VT, Dao TL, Ly TDA, Pommier de Santi V, Gautret P. Annual variations of Haemophilus influenzae carriage among Hajj pilgrims. Eur J Clin Microbiol Infect Dis 2021; 40:1787-1788. [PMID: 34050408 DOI: 10.1007/s10096-021-04276-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/10/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Van-Thuan Hoang
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- IHU-Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Thi-Loi Dao
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- IHU-Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Tran Duc Anh Ly
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- IHU-Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
| | - Vincent Pommier de Santi
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- IHU-Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- French Military Center for Epidemiology and Public Health Marseille, Marseille, France
| | - Philippe Gautret
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.
- IHU-Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France.
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12
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A Longitudinal Study Regarding the Health Profile of the 2017 South African Hajj Pilgrims. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073607. [PMID: 33807142 PMCID: PMC8036399 DOI: 10.3390/ijerph18073607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 11/17/2022]
Abstract
The Hajj mass gathering annually attracts over two million Muslim pilgrims worldwide to the Kingdom of Saudi Arabia (KSA). We aimed to establish demographics and health profiles for the South African pilgrims performing the 2017 Hajj. Methods: This is a longitudinal survey-based study conducted on 1138 adult South African pilgrims in two phases (during and post-Hajj). Data on demographics, vaccination status, underlying health conditions, pre-Hajj training, health promotion, travel history, and health issues during and post-Hajj were collected using pre-designed questionnaires. Results: Participants had a mean age of 49.2 years (SD = 13.3; range 18–81), with a male: female ratio of 1.2:1. The majority of pilgrims were married (88.2%), of Indian/Asian background (73%), and literate (>99%). Nearly all pilgrims were vaccinated against meningococcal disease and yellow fever, but only 23.7% were vaccinated against Influenza. Hypertension, diabetes, and elevated cholesterol levels were the most common underlying health conditions reported by 22.6%, 13.2%, and 11.5% of pilgrims, respectively. One month after return to South Africa, nearly 65% of pilgrims reported illness during Hajj, while 40% reported falling ill post event upon return to South Africa. Nevertheless, only a few were admitted to hospitals (12 during Hajj and 15 post-Hajj). Among ill pilgrims, respiratory symptoms were the most commonly experienced symptoms during (70.2%) and post-Hajj (82.2%). Other symptoms such as walking-related symptoms include symptoms directly related or mainly caused by walking (e.g., leg pain, sore feet, blisters on the feet), dehydration, and gastrointestinal tract symptoms reported during Hajj. Medication to treat respiratory symptoms and antibiotics were the most commonly used medications during and post-Hajj. Having an underlying health condition was an independent predictor of falling ill during or post Hajj. Conclusion: Our study indicates that a sizable proportion of South African pilgrims are elderly with underlying health conditions and most contract respiratory tract infections during and post Hajj. Our study highlights the need for systematic collection of prospective pilgrims’ demographics and health data and more attention to post-Hajj health follow-ups of pilgrims.
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Alsharif SM, El-Sayed WS, Hanafy AM. Geographic distribution and prevalence of potential asymptomatic Staphylococcus spp. in the nasopharyngeal cavity of elementary school boys at Al-Madinah, KSA. JOURNAL OF TAIBAH UNIVERSITY FOR SCIENCE 2021. [DOI: 10.1080/16583655.2021.1892991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sultan M. Alsharif
- Department of Biology, College of Science, Taibah University, Al-Madinah, Kingdom of Saudi Arabia
| | - Wael S. El-Sayed
- Department of Microbiology, Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Ahmed M. Hanafy
- Department of Biology, College of Science, Taibah University, Al-Madinah, Kingdom of Saudi Arabia
- Department of Microbiology, Faculty of Science, Ain Shams University, Cairo, Egypt
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14
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Ly TDA, Hoang VT, Goumballa N, Louni M, Canard N, Dao TL, Medkour H, Borg A, Bardy K, Esteves-Vieira V, Filosa V, Davoust B, Mediannikov O, Fournier PE, Raoult D, Gautret P. Variations in respiratory pathogen carriage among a homeless population in a shelter for men in Marseille, France, March-July 2020: cross-sectional 1-day surveys. Eur J Clin Microbiol Infect Dis 2021; 40:1579-1582. [PMID: 33580843 PMCID: PMC7881748 DOI: 10.1007/s10096-020-04127-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/13/2020] [Indexed: 12/03/2022]
Abstract
We aimed to compare respiratory pathogen carriage by PCR during three different time periods in 2020 in sheltered homeless people in Marseille, France. The overall prevalence of respiratory pathogen carriage in late March–early April (69.9%) was significantly higher than in late April (42.3%) and mid-July (45.1%). Bacterial carriage significantly decreased between late March–early April and late April. SARS-CoV-2 was detected only in late March–early April samples (20.6%). Measures aiming at mitigating SARS-CoV-2 transmission were effective and also impacted bacterial carriage. Seasonal variations of bacterial carriage between winter and summer in this population were not marked.
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Affiliation(s)
- Tran Duc Anh Ly
- IRD, AP-HM, SSA, VITROME, Aix Marseille Univ, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Van Thuan Hoang
- IRD, AP-HM, SSA, VITROME, Aix Marseille Univ, Marseille, France.,IHU-Méditerranée Infection, Marseille, France.,Family Medicine Department, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Ndiaw Goumballa
- IRD, AP-HM, SSA, VITROME, Aix Marseille Univ, Marseille, France.,VITROME, Campus International IRD-UCAD de l'IRD, Dakar, Senegal
| | - Meriem Louni
- IRD, AP-HM, SSA, VITROME, Aix Marseille Univ, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Naomie Canard
- IRD, AP-HM, SSA, VITROME, Aix Marseille Univ, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Thi Loi Dao
- IRD, AP-HM, SSA, VITROME, Aix Marseille Univ, Marseille, France.,IHU-Méditerranée Infection, Marseille, France.,Pneumology Department, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Hacene Medkour
- IHU-Méditerranée Infection, Marseille, France.,IRD, AP-HM, SSA, MEPHI, Aix Marseille Univ, Marseille, France
| | - Audrey Borg
- IHU-Méditerranée Infection, Marseille, France
| | - Kevin Bardy
- IHU-Méditerranée Infection, Marseille, France
| | | | | | - Bernard Davoust
- IHU-Méditerranée Infection, Marseille, France.,IRD, AP-HM, SSA, MEPHI, Aix Marseille Univ, Marseille, France
| | - Oleg Mediannikov
- IHU-Méditerranée Infection, Marseille, France.,IRD, AP-HM, SSA, MEPHI, Aix Marseille Univ, Marseille, France
| | - Pierre-Edouard Fournier
- IRD, AP-HM, SSA, VITROME, Aix Marseille Univ, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Didier Raoult
- IRD, AP-HM, SSA, VITROME, Aix Marseille Univ, Marseille, France.,IHU-Méditerranée Infection, Marseille, France.,IRD, AP-HM, SSA, MEPHI, Aix Marseille Univ, Marseille, France
| | - Philippe Gautret
- IRD, AP-HM, SSA, VITROME, Aix Marseille Univ, Marseille, France. .,IHU-Méditerranée Infection, Marseille, France.
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15
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Yezli S, Mushi A, Almuzaini Y, Balkhi B, Yassin Y, Khan A. Prevalence of Diabetes and Hypertension among Hajj Pilgrims: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031155. [PMID: 33525524 PMCID: PMC7908531 DOI: 10.3390/ijerph18031155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/10/2021] [Accepted: 01/15/2021] [Indexed: 02/05/2023]
Abstract
The Hajj mass gathering is attended by over two million Muslims each year, many of whom are elderly and have underlying health conditions. Data on the number of pilgrims with health conditions would assist public health planning and improve health services delivery at the event. We carried out a systematic review of literature based on structured search in the MEDLINE/PubMed, SCOPUS and CINAHL databases, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, to estimate the prevalence of diabetes and hypertension among Hajj pilgrims. Twenty-six studies conducted between 1993 and 2018 with a total of 285,467 participants were included in the review. The weighted pooled prevalence rates of hypertension and diabetes among Hajj pilgrims in all included studies were 12.2% (95% CI: 12.0-12.3) and 5.0% (95% CI: 4.9-5.1), respectively. The reported prevalence of other underlying health conditions such as chronic respiratory, kidney or liver disease, cardiovascular disease, cancer and immune deficiency were generally low. Potentially a large number of pilgrims each Hajj have diabetes and/or hypertension and other underlying health conditions. Hajj could be a great opportunity to reduce the burden of these diseases within the over 180 countries participating in the event by identifying undiagnosed cases and optimizing patients' knowledge and management of their conditions. Prospero registration number: CRD42020171082.
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Affiliation(s)
- Saber Yezli
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh 12341, Saudi Arabia; (A.M.); (Y.A.); (Y.Y.); (A.K.)
- Correspondence:
| | - Abdulaziz Mushi
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh 12341, Saudi Arabia; (A.M.); (Y.A.); (Y.Y.); (A.K.)
| | - Yasir Almuzaini
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh 12341, Saudi Arabia; (A.M.); (Y.A.); (Y.Y.); (A.K.)
| | - Bander Balkhi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 12372, Saudi Arabia;
| | - Yara Yassin
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh 12341, Saudi Arabia; (A.M.); (Y.A.); (Y.Y.); (A.K.)
| | - Anas Khan
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh 12341, Saudi Arabia; (A.M.); (Y.A.); (Y.Y.); (A.K.)
- Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
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16
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Acquisition of multidrug-resistant bacteria and encoding genes among French pilgrims during the 2017 and 2018 Hajj. Eur J Clin Microbiol Infect Dis 2021; 40:1199-1207. [DOI: 10.1007/s10096-020-04122-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 12/02/2020] [Indexed: 12/23/2022]
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17
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Tobaiqy M, Alhasan AH, Shams MM, Amer SA, MacLure K, Alcattan MF, Almudarra SS. Assessment of Preventative Measures Practice among Umrah Pilgrims in Saudi Arabia, 1440H-2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E257. [PMID: 33396376 PMCID: PMC7796344 DOI: 10.3390/ijerph18010257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 11/23/2022]
Abstract
:Background: Annually, approximately 10 million pilgrims travel to the Kingdom of Saudi Arabia (KSA) for Umrah from more than 180 countries. This event presents major challenges for the Kingdom's public health sector, which strives to decrease the burden of infectious diseases and to adequately control their spread both in KSA and pilgrims home nations. The aims of the study were to assess preventative measures practice, including vaccination history and health education, among Umrah pilgrims in Saudi Arabia. Methods: A cross sectional survey was administered to pilgrims from February to April 2019 at the departure lounge at King Abdul Aziz International airport, Jeddah city. The questionnaire comprised questions on sociodemographic information (age, gender, marital status, level of education, history of vaccinations and chronic illnesses), whether the pilgrim had received any health education and orientation prior to coming to Saudi Arabia or on their arrival, and their experiences with preventative practices. Results: Pilgrims (n = 1012) of 41 nationalities completed the survey. Chronic diseases were reported among pilgrims (n = 387, 38.2%) with cardiovascular diseases being the most reported morbidity (n = 164, 42.3%). The majority of pilgrims had been immunized prior to travel to Saudi Arabia (n = 770, 76%). The most commonly reported immunizations were influenza (n = 514, 51%), meningitis (n = 418, 41%), and Hepatitis B virus vaccinations (n = 310, 31%). However, 242 (24%) had not received any vaccinations prior to travel, including meningitis vaccine and poliomyelitis vaccine, which are mandatory by Saudi Arabian health authorities for pilgrims coming from polio active countries. Nearly a third of pilgrims (n = 305; 30.1%) never wore a face mask in crowded areas during Umrah in 2019. In contrast, similar numbers said they always wore a face mask (n = 351, 34.6%) in crowded areas, while 63.2% reported lack of availability of face masks during Umrah. The majority of participants had received some form of health education on preventative measures, including hygiene aspects (n = 799, 78.9%), mostly in their home countries (n = 450, 44.4%). A positive association was found between receiving health education and practicing of preventative measures, such as wearing face masks in crowded areas (p = 0.04), and other health practice scores (p = 0.02). Conclusion: Although the experiences of the preventative measures among pilgrims in terms of health education, vaccinations, and hygienic practices were at times positive, this study identified several issues. These included the following preventative measures: immunizations, particularly meningitis and poliomyelitis vaccine, and using face masks in crowded areas. The recent COVID-19 pandemic highlights the need for further studies that focus on development of accessible health education in a form that engages pilgrims to promote comprehensive preventative measures during Umrah and Hajj and other religious pilgrimages.
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Affiliation(s)
- Mansour Tobaiqy
- Department of Pharmacology, College of Medicine, University of Jeddah, Jeddah 21512, Saudi Arabia
| | - Ahmed H. Alhasan
- Jeddah Eye Hospital, Ministry of Health, Jeddah 23331, Saudi Arabia;
| | - Manal M. Shams
- Health and Lifestyle Department, Ministry of Health (MOH), Riyadh 11176, Saudi Arabia;
| | - Samar A. Amer
- Public Health and Community Medicine, Zagazig University, Zagazig 44519, Egypt;
- Public Health, Ministry of Health (MOH), Riyadh 11176, Saudi Arabia
| | - Katie MacLure
- Independent Research Consultant, Aberdeen AB32 6RU, UK;
| | | | - Sami S. Almudarra
- Epidemiology, Surveillance and Preparedness, Saudi CDC, General Supervisor of Saudi Field Epidemiology Training Program, Ministry of Health (MOH), Riyadh 11176, Saudi Arabia;
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18
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Hoang VT, Gautret P, Memish ZA, Al-Tawfiq JA. Hajj and Umrah Mass Gatherings and COVID-19 Infection. CURRENT TROPICAL MEDICINE REPORTS 2020; 7:133-140. [PMID: 33169095 PMCID: PMC7609349 DOI: 10.1007/s40475-020-00218-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 12/23/2022]
Abstract
Purpose of Review We discuss the risk of COVID-19 in religious mass gathering events including Hajj and Umrah pilgrimages. Recent Findings The risk of transmission of respiratory viruses including COVID-19 is particularly high due to the overcrowding conditions at the Hajj and Umrah. The profile of the Hajj pilgrims who tend to be older and with multiple comorbidities corresponds to that of individuals at risk for severe COVID-19. In order to avoid a COVID-19 outbreak with potential spreading to many countries through returning pilgrims, Saudi Arabia suspended the Umrah, and access to the 2020 Hajj was very limited. Summary A clear relation between early suspension of religious mass gatherings and lower occurrence of COVID-19 transmission in countries that took such measures promptly was noticed. There are lessons to national and international health organizations for other mass gatherings in the context of the pandemic.
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Affiliation(s)
- Van-Thuan Hoang
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France.,Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Philippe Gautret
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Ziad A Memish
- Director Research and Innovation Center, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia.,Al-Faisal University, Riyadh, Saudi Arabia.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Jaffar A Al-Tawfiq
- Specialty Internal Medicine and Quality Division, Dhahran Health Center, Johns Hopkins Aramco Healthcare, P.O. Box 76, Room A-428-2, Building 61, Dhahran, 31311 Saudi Arabia.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
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19
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Hoang VT, Dao TL, Ly TDA, Belhouchat K, Larbi Chaht K, Yezli S, Alotaibi B, Raoult D, Parola P, Pommier de Santi V, Fournier PE, Gautret P. Dynamics and genetic diversity of Haemophilus influenzae carriage among French pilgrims during the 2018 Hajj: A prospective cohort survey. Travel Med Infect Dis 2020; 38:101883. [PMID: 32956850 DOI: 10.1016/j.tmaid.2020.101883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 07/01/2020] [Accepted: 08/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND To investigate the genetic diversity of Haemophilus influenzae positive samples among French pilgrims attending the 2018 Hajj pilgrimage. METHOD After screening by qPCR, multilocus sequence typing was performed for all H. influenzae-positive samples. The following housekeeping genes were amplified and assigned: adk, atpG, frdB, fucK, mdh, pgi and recA. RESULTS 121 pilgrims were included. H. influenzae was positive in 35.5% pre-Hajj samples, 12.4% at day five post-arrival, 15.7% at day 12 post-arrival, and 43.0% post-Hajj. Of the 129 positive swabs for H. influenzae, only one sample at D12 was negative for all seven genes amplified by standard PCR. The adk, atpG, frdB, mdh, pgi, recA and fucK genes were positive in 123, 107, 122, 70, 127, 118 and 69 samples, respectively. One sequence of atpG and two of recA genes were not possible to assign. None of the sequences of fucK gene was successfully obtained. Consequently, a complete sequence type characterisation was not possible. Of the 128 obtained strains, 111 had distinct patterns of alleles. CONCLUSION H. influenzae genotypes acquired were completely different from those present at pre-Hajj. We observed a great biodiversity and a lack of clonality of H. influenzae among French pilgrims during the 2018 Hajj. Further studies aiming at studying the genome of Hajj-acquired H. influenzae isolates are needed to define the clinical burden of H. influenzae infection during Hajj and to evaluate the potential interest of vaccination in Hajj pilgrims.
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Affiliation(s)
- Van-Thuan Hoang
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France; Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - Thi-Loi Dao
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France; Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - Tran Duc Anh Ly
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France
| | - Khadidja Belhouchat
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France
| | - Kamel Larbi Chaht
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France
| | - Saber Yezli
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Badriah Alotaibi
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Didier Raoult
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, MEPHI, Marseille, France
| | - Philippe Parola
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France
| | - Vincent Pommier de Santi
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France; French Military Center for Epidemiology and Public Health Marseille, France
| | - Pierre-Edouard Fournier
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France
| | - Philippe Gautret
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France.
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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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Abstract
PURPOSE OF REVIEW Mass gathering events bring people from across all continents increasing the risk of spread of aerosol transmissible respiratory tract infections. Respiratory tract infections for instance in pilgrims attending the world's largest recurring annual pilgrimage, the Hajj are common. We review recent literature on viral and bacterial infectious diseases with special focus on the Hajj. RECENT FINDINGS The prevalence of bacterial and viral infections continue to increase, because of the acquisition of rhinovirus, coronaviruses (229E, HKU1, OC43), influenza A H1N1, Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus during Hajj. Whilst MERS-CoV continues to circulate in the Middle East, no cases of MERS-CoV have yet been identified in pilgrims during Hajj. SUMMARY Respiratory tract infections are a major cause of morbidity in pilgrims attending mass gathering events. The management of severe respiratory infections should consider investigation and empirical coverage for the most likely agents based on syndromic surveillance data from hosting country and /or other relevant exposure history during events. Pneumococcal and Pertussis vaccines should be recommended for Hajj pilgrims.
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22
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Badahdah AM, Bakarman MA, Khatami A, Tashani M, Barasheed O, Alfelali M, Azeem MI, Bokhary H, Soltan O, Lahra MM, Jeoffreys N, Kok J, Dwyer DE, Booy R, Rashid H. Meningococcal and pneumococcal carriage in Hajj pilgrims: findings of a randomized controlled trial. J Travel Med 2020; 27:5775502. [PMID: 32125434 DOI: 10.1093/jtm/taaa032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/12/2020] [Accepted: 02/26/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND Intense congestion during the Hajj pilgrimage amplifies the risk of meningococcal carriage and disease, and there have been many meningococcal outbreaks reported amongst pilgrims. Thus, a strict vaccination policy is enforced by the host country and either polysaccharide or conjugate quadrivalent meningococcal vaccines are mandatory. However, unlike conjugate vaccines, the polysaccharide vaccine is not thought to reduce pharyngeal carriage of meningococci. METHODS A single-blinded, randomized, controlled trial amongst pilgrims from Saudi Arabia and Australia during the Hajj seasons of 2016-2017 was conducted to compare MenACWY-Conjugate vaccine with MenACWY-Polysaccharide vaccine, to determine if the conjugate vaccine is more effective in reducing asymptomatic carriage of meningococci, and whether the effect may be long-standing. Oropharyngeal swabs were obtained pre-, immediately post- and 6-11 months following completion of Hajj and tested for the presence of meningococci. RESULTS Amongst 2000 individuals approached, only 1146 participants aged 18-91 (mean 37.6) years agreed to participate and were randomized to receive either the polysaccharide (n = 561) or the conjugate (n = 561) vaccine, 60.8% were male, and 93.5% were from Saudi Arabia. Amongst oropharyngeal swabs obtained before Hajj, only two (0.2%) tested positive for Neisseria meningitidis. Similarly, meningococci were identified in only one sample at each of the post-Hajj and late follow-up visits. None of the carriage isolates were amongst the serogroups covered by the vaccines. A post hoc analysis of the third swabs revealed that 22.4% of all participants (50/223) were positive for Streptococcus pneumoniae nucleic acid. CONCLUSION The low overall carriage rate of meningococci found amongst Hajj pilgrims in 2016 and 2017 demonstrates a successful vaccination policy, but neither supports nor refutes the superiority of meningococcal conjugate ACWY vaccine over the polysaccharide vaccine against carriage. Although an association could not be established in this study, molecular epidemiology would help to establish the role of Hajj in facilitating transmission of pneumococci and inform vaccination policy.
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Affiliation(s)
- Al-Mamoon Badahdah
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 22252, Saudi Arabia.,National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW 2145, Australia.,The Discipline of Child and Adolescent Health, The Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia
| | - Marwan A Bakarman
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Ameneh Khatami
- The Discipline of Child and Adolescent Health, The Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia.,Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Mohamed Tashani
- The Discipline of Child and Adolescent Health, The Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia.,Faculty of Medicine, University of Tripoli, Ain Zara, Tripoli, Libya
| | - Osamah Barasheed
- The Executive Administration of Research and Innovation, King Abdullah Medical City in Holy Capital (KAMC-HC), Makkah 24246, Saudi Arabia
| | - Mohammad Alfelali
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 22252, Saudi Arabia.,National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW 2145, Australia.,The Discipline of Child and Adolescent Health, The Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia
| | - Mohammad I Azeem
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW 2145, Australia
| | - Hamid Bokhary
- Umm Al-Qura University, Makkah, Saudi Arabia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Westmead, NSW 2145, Australia
| | - Osama Soltan
- Microbiology department, Al Borg Medical Laboratories, Jeddah 21573, Saudi Arabia
| | - Monica M Lahra
- The World Health Organisation Collaborating Centre for STI and AMR, and Neisseria Reference Laboratory, New South Wales Health Pathology, Microbiology, Prince of Wales Hospital, Randwick, NSW, 2031, Australia.,Faculty of Medicine, The University of New South Wales, Randwick, NSW 2052, Australia
| | - Neisha Jeoffreys
- New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital and University of Sydney, Westmead NSW 2145, Australia
| | - Jen Kok
- New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital and University of Sydney, Westmead NSW 2145, Australia
| | - Dominic E Dwyer
- New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital and University of Sydney, Westmead NSW 2145, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW 2145, Australia.,The Discipline of Child and Adolescent Health, The Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Westmead, NSW 2145, Australia
| | - Harunor Rashid
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW 2145, Australia.,The Discipline of Child and Adolescent Health, The Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Westmead, NSW 2145, Australia
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23
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Hoang VT, Gautret P. Measles outbreaks at mass gathering mostly occur at youth events. THE LANCET. INFECTIOUS DISEASES 2020; 20:23. [PMID: 31876493 DOI: 10.1016/s1473-3099(19)30685-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Van Thuan Hoang
- Aix Marseille Université, IRD, AP-HM, SSA, VITROME 13005, Marseille, France; Institut Hospitalo-Universitaire-Méditerranée Infection, Marseille, France; Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Philippe Gautret
- Aix Marseille Université, IRD, AP-HM, SSA, VITROME 13005, Marseille, France; Institut Hospitalo-Universitaire-Méditerranée Infection, Marseille, France.
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24
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Nontypeable Haemophilus influenzae Responds to Virus-Infected Cells with a Significant Increase in Type IV Pilus Expression. mSphere 2020; 5:5/3/e00384-20. [PMID: 32461275 PMCID: PMC7253600 DOI: 10.1128/msphere.00384-20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Nontypeable Haemophilus influenzae (NTHI) is the predominant bacterial causative agent of many chronic and recurrent diseases of the upper and lower respiratory tracts. NTHI-induced chronic rhinosinusitis, otitis media, and exacerbations of cystic fibrosis and chronic obstructive pulmonary disease often develop during or just after an upper respiratory tract viral infection. We have developed a vaccine candidate immunogen for NTHI-induced diseases that targets the majority subunit (PilA) of the type IV twitching pilus (T4P), which NTHI uses to adhere to respiratory tract epithelial cells and that also plays a role in disease. Here, we showed that NTHI cocultured with virus-infected respiratory tract epithelial cells express significantly more of the vaccine-targeted T4P than NTHI that encounters mock-infected (healthy) cells. These results strongly suggest that a vaccine strategy that targets the NTHI T4P will be effective under the most common predisposing condition: when the human host has a respiratory tract virus infection. Nontypeable Haemophilus influenzae (NTHI) colonizes the human nasopharynx, but when the host immune response is dysregulated by upper respiratory tract (URT) virus infection, NTHI can gain access to more distal airway sites and cause disease. The NTHI type IV pilus (T4P) facilitates adherence, benign colonization, and infection, and its majority subunit PilA is in clinical trials as a vaccinogen. To further validate the strategy of immunization with PilA against multiple NTHI-induced diseases, it is important to demonstrate T4P expression under microenvironmental conditions that predispose to NTHI infection of the airway. Because URT infection commonly facilitates NTHI-induced diseases, we examined the influence of ongoing virus infection of respiratory tract epithelial cells on NTHI T4P expression in vitro. Polarized primary human airway epithelial cells (HAEs) were sequentially inoculated with one of three common URT viruses, followed by NTHI. Use of a reporter construct revealed that NTHI upregulated pilA promoter activity when cultured with HAEs infected with adenovirus (AV), respiratory syncytial virus (RSV), or rhinovirus (RV) versus that in mock-infected HAEs. Consistent with these results, pilA expression and relative PilA/pilin abundance, as assessed by quantitative reverse transcription-PCR (qRT-PCR) and immunoblot, respectively, were also significantly increased when NTHI was cultured with virus-infected HAEs. Collectively, our data strongly suggest that under conditions of URT virus infection, PilA vaccinogen induction of T4P-directed antibodies is likely to be highly effective against multiple NTHI-induced diseases by interfering with T4P-mediated adherence. We hypothesize that this outcome could thereby limit or prevent the increased load of NTHI in the nasopharynx that characteristically precedes these coinfections. IMPORTANCE Nontypeable Haemophilus influenzae (NTHI) is the predominant bacterial causative agent of many chronic and recurrent diseases of the upper and lower respiratory tracts. NTHI-induced chronic rhinosinusitis, otitis media, and exacerbations of cystic fibrosis and chronic obstructive pulmonary disease often develop during or just after an upper respiratory tract viral infection. We have developed a vaccine candidate immunogen for NTHI-induced diseases that targets the majority subunit (PilA) of the type IV twitching pilus (T4P), which NTHI uses to adhere to respiratory tract epithelial cells and that also plays a role in disease. Here, we showed that NTHI cocultured with virus-infected respiratory tract epithelial cells express significantly more of the vaccine-targeted T4P than NTHI that encounters mock-infected (healthy) cells. These results strongly suggest that a vaccine strategy that targets the NTHI T4P will be effective under the most common predisposing condition: when the human host has a respiratory tract virus infection.
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Bokhary H, Barasheed O, Abd El Ghany M, Khatami A, Hill-Cawthorne GA, Rasheed H. Pilot Survey of Knowledge, Attitudes and Perceptions of Hajj Deployed Health Care Workers on Antibiotics and Antibiotic Prescriptions for Upper Respiratory Tract Infections: Results from Two Hajj Seasons. Trop Med Infect Dis 2020; 5:E18. [PMID: 32013238 PMCID: PMC7157631 DOI: 10.3390/tropicalmed5010018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/11/2019] [Accepted: 01/22/2020] [Indexed: 12/22/2022] Open
Abstract
Antimicrobial resistance (AMR) is a global public health issue. Upper respiratory tract infections (URTIs) are common illnesses during Hajj, for which antibiotics are often inappropriately prescribed. Hajj healthcare workers' (HCW) knowledge, attitudes and perceptions (KAP) about AMR and antibiotic use for URTIs are not known. We conducted a survey among HCWs during Hajj to explore their KAP regarding antibiotic use for URTIs in pilgrims. Electronic or paper-based surveys were distributed to HCWs during the Hajj in 2016 and 2017. A total of 85 respondents aged 25 to 63 (median 40) years completed the surveys. Most participants were male (78.8%) and were physicians by profession (95.3%). Around 85% and 19% of respondents claimed to have heard about AMR and antimicrobial stewardship programs, respectively, among whom most had obtained their knowledge during their qualification. Implementation of URTI treatment guidelines was very low. In conclusion, HCWs at Hajj have significant knowledge gaps regarding AMR, often do not use standard clinical criteria to diagnose URTIs and display a tendency to prescribe antibiotics for URTIs.
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Affiliation(s)
- Hamid Bokhary
- School of Public Health, The University of Sydney, Sydney NSW 2006, Australia;
- University Medical Center, Umm Al-Qura University, Al Jamiah, Makkah, Makkah Region 24243, Saudi Arabia
- The Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Westmead NSW 2145, Australia (H.R.)
- The Westmead Institute for Medical Research, Westmead NSW 2145, Australia
| | - Osamah Barasheed
- The Executive Administration for Research and Innovation, King Abdullah Medical City, Al Mashair, Makkah, Makkah Region 24246, Saudi Arabia
| | - Moataz Abd El Ghany
- The Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Westmead NSW 2145, Australia (H.R.)
- The Westmead Institute for Medical Research, Westmead NSW 2145, Australia
- The Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead NSW 2145, Australia
| | - Ameneh Khatami
- The Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead NSW 2145, Australia
| | - Grant A. Hill-Cawthorne
- School of Public Health, The University of Sydney, Sydney NSW 2006, Australia;
- The Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Westmead NSW 2145, Australia (H.R.)
| | - Harunor Rasheed
- The Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Westmead NSW 2145, Australia (H.R.)
- The Discipline of Child and Adolescent Health, The Faculty of Medicine and Health, The University of Sydney, Sydney NSW 2145, Australia
- National Centre for Immunisation Research and Surveillance (NCIRS), Kids Research Institute at The Children’s Hospital at Westmead, Westmead NSW 2145, Australia
| | - Hajj Research Team
- The Executive Administration for Research and Innovation, King Abdullah Medical City, Al Mashair, Makkah, Makkah Region 24246, Saudi Arabia
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