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Tambe LAM, Mathobo P, Munzhedzi M, Bessong PO, Mavhandu-Ramarumo LG. Prevalence and Molecular Epidemiology of Human Coronaviruses in Africa Prior to the SARS-CoV-2 Outbreak: A Systematic Review. Viruses 2023; 15:2146. [PMID: 38005824 PMCID: PMC10675249 DOI: 10.3390/v15112146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/26/2023] Open
Abstract
Coronaviruses, re-emerging in human populations, cause mild or severe acute respiratory diseases, and occasionally epidemics. This study systematically reviewed human coronavirus (HCoVs) infections in Africa prior to the SARS-CoV-2 outbreak. Forty studies on the prevalence or molecular epidemiology of HCoVs were available from 13/54 African countries (24%). The first published data on HCoV was from South Africa in 2008. Eight studies (20%) reported on HCoV molecular epidemiology. Endemic HCoV prevalence ranged from 0.0% to 18.2%. The prevalence of zoonotic MERS-CoV ranged from 0.0% to 83.5%. Two studies investigated SARS-CoV infection, for which a prevalence of 0.0% was reported. There was heterogeneity in the type of tests used in determining HCoV prevalence. Two studies reported that risk factors for HCoV include exposure to infected animals or humans. The quantity of virologic investigations on HCoV on the African continent was scant, and Africa was not prepared for SARS-CoV-2.
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Affiliation(s)
- Lisa Arrah Mbang Tambe
- HIV/AIDS & Global Health Research Programme, Faculty of Science, Engineering and Agriculture, University of Venda, Thohoyandou 0950, South Africa; (L.A.M.T.); (P.M.); (M.M.); (P.O.B.)
- Department of Biochemistry and Microbiology, Faculty of Science, Engineering and Agriculture, University of Venda, Thohoyandou 0950, South Africa
| | - Phindulo Mathobo
- HIV/AIDS & Global Health Research Programme, Faculty of Science, Engineering and Agriculture, University of Venda, Thohoyandou 0950, South Africa; (L.A.M.T.); (P.M.); (M.M.); (P.O.B.)
- Department of Biochemistry and Microbiology, Faculty of Science, Engineering and Agriculture, University of Venda, Thohoyandou 0950, South Africa
| | - Mukhethwa Munzhedzi
- HIV/AIDS & Global Health Research Programme, Faculty of Science, Engineering and Agriculture, University of Venda, Thohoyandou 0950, South Africa; (L.A.M.T.); (P.M.); (M.M.); (P.O.B.)
- Department of Biochemistry and Microbiology, Faculty of Science, Engineering and Agriculture, University of Venda, Thohoyandou 0950, South Africa
| | - Pascal Obong Bessong
- HIV/AIDS & Global Health Research Programme, Faculty of Science, Engineering and Agriculture, University of Venda, Thohoyandou 0950, South Africa; (L.A.M.T.); (P.M.); (M.M.); (P.O.B.)
- Centre for Global Health Equity, School of Medicine, 1400 University Ave, Charlottesville, VA 22903, USA
| | - Lufuno Grace Mavhandu-Ramarumo
- HIV/AIDS & Global Health Research Programme, Faculty of Science, Engineering and Agriculture, University of Venda, Thohoyandou 0950, South Africa; (L.A.M.T.); (P.M.); (M.M.); (P.O.B.)
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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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Al-Tawfiq JA, Memish ZA. Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is Not Circulating Among Hajj Pilgrims. J Epidemiol Glob Health 2023; 13:387-390. [PMID: 37326821 PMCID: PMC10468469 DOI: 10.1007/s44197-023-00128-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Since the emergence of the middle east respiratory syndrome coronavirus (MERS-CoV) 2012, the virus had caused multiple healthcare-associated outbreaks. The initial 2012 Hajj season started few weeks after the first case of MERS-CoV, but there were no reported cases among pilgrims in 2012. Since then, there had been multiple studies examining the prevalence of MERS-CoV among Hajj pilgrims. Subsequently, multiple studies utilized screening of pilgrims for MERS-CoV and > 10,000 pilgrims were screened with no identifiable cases of MERS.
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Affiliation(s)
- Jaffar A. Al-Tawfiq
- Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN USA
- Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Ziad A. Memish
- Research and Innovation Center, King Saud Medical City, Ministry of Health, Jeddah, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
- Eminent Scientist of Kyung Hee University, Seoul, South Korea
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Mahdi HA, Alluhidan M, Almohammed AB, Alfelali M, Shaban RZ, Booy R, Rashid H. Epidemiological Differences in Hajj-Acquired Airborne Infections in Pilgrims Arriving from Low and Middle-Income versus High-Income Countries: A Systematised Review. Trop Med Infect Dis 2023; 8:418. [PMID: 37624356 PMCID: PMC10459586 DOI: 10.3390/tropicalmed8080418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/04/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023] Open
Abstract
This systematised review aims to compare the epidemiological patterns of Hajj-acquired airborne infections among pilgrims from low and middle-income countries (LMIC) versus those from high-income countries (HIC). A PubMed search was carried out for all published articles before February 2023, using a combination of MeSH terms and text words. The Newcastle-Ottawa Scale (NOS) was used to assess data quality. From a total of 453 titles identified, 58 studies were included in the review (LMIC = 32, and HIC = 26). In the pooled sample, there were 27,799 pilgrims aged 2 days to 105 years (male: female = 1.3:1) from LMIC and 70,865 pilgrims aged 2 months to 95 years (male: female = 1:1) from HIC. Pilgrims from both HIC and LMIC had viral and bacterial infections, but pilgrims from HIC tended to have higher attack rates of viral infections than their LMIC counterparts. However, the attack rates of bacterial infections were variable: for instance, pilgrims from LMIC seemed to have higher rates of meningococcal infections (0.015-82% in LMIC vs. 0.002-40% in HIC) based on the study population, but not Mycobacterium tuberculosis (0.7-20.3% in LMIC vs. 38% in HIC). Targeted measures are needed to prevent the spread of airborne infections at Hajj.
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Affiliation(s)
- Hashim A. Mahdi
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia
- Department of Public Health, College of Health Sciences, Saudi Electronic University, Jeddah 23442, Saudi Arabia
| | - Mohammed Alluhidan
- General Directorate for National Health Economics and Policy, Saudi Health Council, Riyadh 13315, Saudi Arabia
| | | | - Mohammad Alfelali
- Family and Community Medicine Department, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 25732, Saudi Arabia
| | - Ramon Z. Shaban
- New South Wales Biocontainment Centre, New South Wales Ministry of Health, Westmead, NSW 2151, Australia
- Faculty of Medicine and Health Susan Wakil School of Nursing, The University of Sydney, Sydney, NSW 2006, Australia
- Public Health Unit, Centre for Population Health, Western Sydney Local Health District, North Parramatta, NSW 2151, Australia
- Sydney Infectious Diseases Institute, The University of Sydney, Westmead, NSW 2145, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia
- Sydney Infectious Diseases Institute, The University of Sydney, Westmead, NSW 2145, Australia
| | - Harunor Rashid
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia
- Sydney Infectious Diseases Institute, The University of Sydney, Westmead, NSW 2145, Australia
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Hui DS, Zumla A. Mass gathering events and transmission of respiratory tract infections: updates pre and post COVID-19 lockdown. Curr Opin Pulm Med 2023; 29:133-137. [PMID: 36876655 PMCID: PMC10090332 DOI: 10.1097/mcp.0000000000000956] [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] [Indexed: 03/07/2023]
Abstract
PURPOSE OF REVIEW This article reviews the epidemiology and transmission of respiratory tract infections (RTIs) during mass gathering events (MGEs) before and during the COVID-19 pandemic. RECENT FINDINGS RTIs of viral cause such as influenza, rhinovirus and coronaviruses (229E, HKU1, OC43) are common in MGEs. No cases of MERS-CoV have yet been identified in pilgrims during Hajj, despite the fact that MERS-CoV continues to circulate in the Middle East. Due to the COVID-19 pandemic, organizers of mass gathering religious and sporting events have implemented risk-based infection control measures and lockdowns that limited transmission of RTIs. SUMMARY Large-scale RTI outbreaks at MGEs are uncommon due to more robust public health planning, prevention, risk assessment and improved health infrastructures in host countries during the COVID-19 pandemic.
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Affiliation(s)
- David S.C. Hui
- Department of Medicine & Therapeutics and Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, and NIHR Biomedical Research Centre, University College London Hospitals, London, UK
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Mercier A, Méheut A, Alidjinou EK, Lazrek M, Faure K, Hober D, Engelmann I. Respiratory virus detection in returning travelers and pilgrims from the Middle East. Travel Med Infect Dis 2023; 51:102482. [PMID: 36280020 PMCID: PMC9584832 DOI: 10.1016/j.tmaid.2022.102482] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/16/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pilgrims travelling to Saudi Arabia are commonly infected with respiratory viruses. Since the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) emerged in 2012, patients with acute respiratory symptoms returning from an endemic area can be suspected to be infected by this virus. METHODS 98 patients suspected to have MERS-CoV infection from 2014 to 2019 were included in this retrospective cohort study. Upper and lower respiratory tract samples were tested by real-time RT-PCR for the detection of MERS-CoV and other respiratory viruses. Routine microbiological analyses were also performed. Patient data were retrieved from laboratory and hospital databases retrospectively. RESULTS All patients with suspected MERS-CoV infection travelled before their hospitalization. Most frequent symptoms were cough (94.4%) and fever (69.4%). 98 specimens were tested for MERS-CoV RNA and none of them was positive. Most frequently detected viruses were Enterovirus/Rhinovirus (40/83; 48.2%), Influenzavirus A (34/90; 37.8%) and B (11/90; 12.2%), H-CoV (229E and OC43 10/83; 12% and 7/83; 8.4%, respectively). CONCLUSION From 2014 to 2019, none of 98 patients returning from endemic areas was MERS-CoV infected. However, infections with other respiratory viruses were frequent, especially with Enterovirus/Rhinoviruses and Influenzaviruses.
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Affiliation(s)
- Ambroise Mercier
- Univ Lille, CHU Lille, Laboratoire de Virologie ULR3610, F-59037, Lille, France
| | - Antoine Méheut
- CHU Lille, Service des Maladies Infectieuses et Tropicales, Lille, France, F-59037, Lille, France
| | | | - Mouna Lazrek
- Univ Lille, CHU Lille, Laboratoire de Virologie ULR3610, F-59037, Lille, France
| | - Karine Faure
- CHU Lille, Service des Maladies Infectieuses et Tropicales, Lille, France, F-59037, Lille, France,Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000, Lille, France,Service de Maladies Infectieuses, CHU Lille, F-59000, Lille, France
| | - Didier Hober
- Univ Lille, CHU Lille, Laboratoire de Virologie ULR3610, F-59037, Lille, France
| | - Ilka Engelmann
- Univ Lille, CHU Lille, Laboratoire de Virologie ULR3610, F-59037, Lille, France,Corresponding author. Laboratoire de Virologie, CHU Montpellier, Hôpital Saint-Eloi, 80 avenue Augustin Fliche, 34295 Montpellier, France
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Mahdi HA, Qashqari FS, Hariri SH, Bamerdah S, Altayyar SA, Almalki HM, Alwadani FA, Alabbasi RA, Alqahtani MH, Alfelali M, Shaban RZ, Booy R, Rashid H. Low Prevalence of Syndromic Respiratory Tract Infections among Returning Hajj Pilgrims Amidst the COVID-19 Pandemic: A Post-Hajj Survey. Trop Med Infect Dis 2022; 7:tropicalmed7080182. [PMID: 36006274 PMCID: PMC9413585 DOI: 10.3390/tropicalmed7080182] [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] [Received: 07/01/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 12/03/2022] Open
Abstract
This study estimates the point prevalence of symptomatic respiratory tract infections (RTIs) among returned Hajj pilgrims and their contacts in 2021. Using the computer-assisted telephone interview (CATI) technique, domestic pilgrims were invited to participate in this cross-sectional survey two weeks after their home return from Hajj. Of 600 pilgrims approached, 79.3% agreed to participate and completed the survey. Syndromic definitions were used to clinically diagnose possible influenza-like illnesses (ILI) and COVID-19. Median with range was applied to summarise the continuous data, and frequencies and proportions were used to present the categorical variables. Simple logistic regression was carried out to assess the correlations of potential factors with the prevalence of RTIs. The majority of pilgrims (88.7%) reported receiving at least two doses of the COVID-19 vaccine before Hajj. Eleven (2.3%) pilgrims reported respiratory symptoms with the estimated prevalence of possible ILI being 0.2%, and of possible COVID-19 being 0.4%. Among those who were symptomatic, five (45.5%) reported that one or more of their close contacts had developed similar RTI symptoms after the pilgrims’ home return. The prevalence of RTIs among pilgrims who returned home after attending the Hajj 2021 was lower compared with those reported in the pre-pandemic studies; however, the risk of spread of infection among contacts following Hajj is still a concern.
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Affiliation(s)
- Hashim A. Mahdi
- Public Health Department, College of Health Sciences, Saudi Electronic University, Jeddah 23442, Saudi Arabia
- The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- Correspondence:
| | - Fadi S. Qashqari
- Microbiology Department, Faculty of Medicine, Umm Al-Qura University, Makkah 24381, Saudi Arabia
| | - Sumyya H. Hariri
- Microbiology Department, Faculty of Medicine, Umm Al-Qura University, Makkah 24381, Saudi Arabia
| | - Shahad Bamerdah
- Faculty of Medicine, Umm Al-Qura University, Makkah 24381, Saudi Arabia
| | | | - Hazim M. Almalki
- Faculty of Medicine, Umm Al-Qura University, Makkah 24381, Saudi Arabia
| | - Fayez A. Alwadani
- Faculty of Medicine, Umm Al-Qura University, Makkah 24381, Saudi Arabia
| | - Renan A. Alabbasi
- Faculty of Medicine, Umm Al-Qura University, Makkah 24381, Saudi Arabia
| | | | - Mohammad Alfelali
- Family and Community Medicine Department, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 25732, Saudi Arabia
| | - Ramon Z. Shaban
- New South Wales Biocontainment Centre, Western Sydney Local Health District, Westmead, NSW 2145, Australia
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
- Centre for Population Health, Western Sydney Local Health District, North Parramatta, NSW 2151, Australia
- Sydney Institute for Infectious Diseases, The University of Sydney, Westmead, NSW 2145, Australia
| | - Robert Booy
- The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- Sydney Institute for Infectious Diseases, The University of Sydney, Westmead, NSW 2145, Australia
| | - Harunor Rashid
- The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- Sydney Institute for Infectious Diseases, The University of Sydney, Westmead, NSW 2145, Australia
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Shatizadeh Malekshahi S, Khani F, Shafiei-Jandaghi NZ, Shadab A, Mokhtari-Azad T, Yavarian J. Prevalence and Genotypes of Human Rhinoviruses among Iranian Hajj Pilgrims with Severe Acute Respiratory Infection. TANAFFOS 2022; 21:448-454. [PMID: 37583781 PMCID: PMC10423871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 06/27/2022] [Indexed: 08/17/2023]
Abstract
Background Hajj is one of the main challenges of public health and infection control. Hajj-associated respiratory tract infections are very common during the pilgrimage. Studies have shown that human rhinovirus (HRV) is one of the most common causes of respiratory illnesses among pilgrims. The aim of this study was to investigate the prevalence and genotypes of HRV among Iranian pilgrims with severe acute respiratory infection (SARI) during the 2017 Hajj season. Materials and Methods Throat swabs or washes were collected from 104 pilgrims with SARI and transported to the National Influenza Center, School of Public Health, Tehran University of Medical Sciences. Specimens were screened for HRV by Nested PCR with primers for 5'UTR, and virus genotypes were determined using PCR with VP4-VP2 primers and sequencing method. Results Twenty-one cases were positive for HRV (20.19 %). The HRV species and types of 8 positive samples were: HRV-A21 (1/8, 12.5%), followed by HRV-B91 (3/8, 37.5%) and HRV-C (4/8, 50%) un-typed. Conclusion This study showed that HRV has a high prevalence in Iranian Hajj pilgrims. As there is no vaccine or antiviral therapy for HRV, prevention methods are the best way for infection control.
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Affiliation(s)
| | - Fariba Khani
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Azadeh Shadab
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Talat Mokhtari-Azad
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Jila Yavarian
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Tehran University of Medical Sciences, Tehran, Iran
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Huang W, Chai GT, Thong BYH, Chan M, Ang B, Chow A. Comparing hospital-resource utilization by an enhanced pneumonia surveillance programme for COVID-19 with pre-pandemic pneumonia admissions - a Singaporean hospital's experience. J Med Microbiol 2021; 70. [PMID: 34898420 PMCID: PMC8744277 DOI: 10.1099/jmm.0.001452] [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: 11/18/2022] Open
Abstract
Introduction. During the early days of coronavirus disease 2019 (COVID-19) in Singapore, Tan Tock Seng Hospital implemented an enhanced pneumonia surveillance (EPS) programme enrolling all patients who were admitted from the Emergency Department (ED) with a diagnosis of pneumonia but not meeting the prevalent COVID-19 suspect case definition.Hypothesis/Gap Statement. There is a paucity of data supporting the implementation of such a programme.Aims. To compare and contrast our hospital-resource utilization of an EPS programme for COVID-19 infection detection with a suitable comparison group.Methodology. We enrolled all patients admitted under the EPS programme from TTSH's ED from 7 February 2020 (date of EPS implementation) to 20 March 2020 (date of study ethics application) inclusive. We designated a comparison cohort over a similar duration the preceding year. Relevant demographic and clinical data were extracted from the electronic medical records.Results. There was a 3.2 times higher incidence of patients with an admitting diagnosis of pneumonia from the ED in the EPS cohort compared to the comparison cohort (P<0.001). However, there was no significant difference in the median length of stay of 7 days (P=0.160). Within the EPS cohort, stroke and fluid overload occur more frequently as alternative primary diagnoses.Conclusions. Our study successfully evaluated our hospital-resource utilization demanded by our EPS programme in relation to an appropriate comparison group. This helps to inform strategic use of hospital resources to meet the needs of both COVID-19 related services and essential 'peace-time' healthcare services concurrently.
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Affiliation(s)
- Wenhui Huang
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore
| | - Gin Tsen Chai
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore.,Lee Kong Chian School of Medicine, 11 Mandalay Road, 308232, Singapore
| | | | - Mark Chan
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore
| | - Brenda Ang
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore
| | - Angela Chow
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore.,Lee Kong Chian School of Medicine, 11 Mandalay Road, 308232, Singapore
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Johari J, Hontz RD, Pike BL, Husain T, Chong CK, Rusli N, Sulaiman LH, Verasahib K, Mohd Zain R, Azman AS, Khor CS, Nor'e SS, Tiong V, Lee HY, Teoh BT, Sam SS, Khoo JJ, Abd Jamil J, Loong SK, Yaacob CN, Mahfodz NH, Azizan NS, Che Mat Seri NAA, Mohd-Rahim NF, Hassan H, Yahaya H, Garcia-Rivera JA, AbuBakar S. Multiyear prospective cohort study to evaluate the risk potential of MERS-CoV infection among Malaysian Hajj pilgrims (MERCURIAL): a study protocol. BMJ Open 2021; 11:e050901. [PMID: 34446498 PMCID: PMC8395290 DOI: 10.1136/bmjopen-2021-050901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Middle East respiratory syndrome (MERS) is a viral respiratory infection caused by the MERS-CoV. MERS was first reported in the Kingdom of Saudi Arabia in 2012. Every year, the Hajj pilgrimage to Mecca attracts more than two million pilgrims from 184 countries, making it one of the largest annual religious mass gatherings (MGs) worldwide. MGs in confined areas with a high number of pilgrims' movements worldwide continues to elicit significant global public health concerns. MERCURIAL was designed by adopting a seroconversion surveillance approach to provide multiyear evidence of MG-associated MERS-CoV seroconversion among the Malaysian Hajj pilgrims. METHODS AND ANALYSIS MERCURIAL is an ongoing multiyear prospective cohort study. Every year, for the next 5 years, a cohort of 1000 Hajj pilgrims was enrolled beginning in the 2016 Hajj pilgrimage season. Pre-Hajj and post-Hajj serum samples were obtained and serologically analysed for evidence of MERS-CoV seroconversion. Sociodemographic data, underlying medical conditions, symptoms experienced during Hajj pilgrimage, and exposure to camel and untreated camel products were recorded using structured pre-Hajj and post-Hajj questionnaires. The possible risk factors associated with the seroconversion data were analysed using univariate and multivariate logistic regression. The primary outcome of this study is to better enhance our understanding of the potential threat of MERS-CoV spreading through MG beyond the Middle East. ETHICS AND DISSEMINATION This study has obtained ethical approval from the Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia. Results from the study will be submitted for publication in peer-reviewed journals and presented in conferences and scientific meetings. TRIAL REGISTRATION NUMBER NMRR-15-1640-25391.
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Affiliation(s)
- Jefree Johari
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Brian L Pike
- U.S. Naval Medical Research Center - Asia, Singapore
| | - Tupur Husain
- U.S. Naval Medical Research Center - Asia, Singapore
| | | | | | | | | | | | | | - Chee Sieng Khor
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Siti-Sarah Nor'e
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Vunjia Tiong
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Hai Yen Lee
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Boon-Teong Teoh
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sing Sin Sam
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Jing-Jing Khoo
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Juraina Abd Jamil
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Shih-Keng Loong
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Che Norainon Yaacob
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Nur-Hidayana Mahfodz
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Noor Syahida Azizan
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Nurul-Farhana Mohd-Rahim
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Habibi Hassan
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Hasmawati Yahaya
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Sazaly AbuBakar
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
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Novel Respiratory Viruses in the Context of Mass-Gathering Events: A Systematic Review to Inform Event Planning from a Health Perspective. Prehosp Disaster Med 2021; 36:599-610. [PMID: 34261546 DOI: 10.1017/s1049023x21000662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Mass-gathering events (MGEs) occur regularly throughout the world. As people congregate at MGEs, there is an increased risk of transmission of communicable diseases. Novel respiratory viruses, such as Severe Acute Respiratory Syndrome Coronavirus-1 (SARS-CoV-1), Influenza A Virus Subtype H1N1 Strain 2009 (H1N1pdm09), Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), or Coronavirus Disease 2019 (COVID-19), may require specific infection prevention and control strategies to minimize the risk of transmission when planning MGEs. This literature review aimed to identify and analyze papers relating to novel respiratory viruses with pandemic potential and to inform MGE planning. METHOD This paper used a systematic literature review method. Various health care databases were searched using keywords relating to MGEs and novel respiratory viruses. Information was extracted from identified papers into various tables for analysis. The analysis identified infection prevention and control strategies used at MGEs to inform planning before, during, and following events. RESULTS In total, 27 papers met the criteria for inclusion. No papers were identified regarding SARS-CoV-1, while the remainder reported on H1N1pdm09 (n = 9), MERS-CoV (n = 15), and SARS-CoV-2 (n = 3). Various before, during, and after event mitigation strategies were identified that can be implemented for future events. CONCLUSIONS This literature review provided an overview of the novel respiratory virus epidemiology at MGEs alongside related public health mitigation strategies that have been implemented at these events. This paper also discusses the health security of event participants and host communities in the context of cancelling, postponing, and modifying events due to a novel respiratory virus. In particular, ways to recommence events incorporating various mitigation strategies are outlined.
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12
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Burns J, Movsisyan A, Stratil JM, Biallas RL, Coenen M, Emmert-Fees KM, Geffert K, Hoffmann S, Horstick O, Laxy M, Klinger C, Kratzer S, Litwin T, Norris S, Pfadenhauer LM, von Philipsborn P, Sell K, Stadelmaier J, Verboom B, Voss S, Wabnitz K, Rehfuess E. International travel-related control measures to contain the COVID-19 pandemic: a rapid review. Cochrane Database Syst Rev 2021; 3:CD013717. [PMID: 33763851 PMCID: PMC8406796 DOI: 10.1002/14651858.cd013717.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND In late 2019, the first cases of coronavirus disease 2019 (COVID-19) were reported in Wuhan, China, followed by a worldwide spread. Numerous countries have implemented control measures related to international travel, including border closures, travel restrictions, screening at borders, and quarantine of travellers. OBJECTIVES To assess the effectiveness of international travel-related control measures during the COVID-19 pandemic on infectious disease transmission and screening-related outcomes. SEARCH METHODS We searched MEDLINE, Embase and COVID-19-specific databases, including the Cochrane COVID-19 Study Register and the WHO Global Database on COVID-19 Research to 13 November 2020. SELECTION CRITERIA We considered experimental, quasi-experimental, observational and modelling studies assessing the effects of travel-related control measures affecting human travel across international borders during the COVID-19 pandemic. In the original review, we also considered evidence on severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). In this version we decided to focus on COVID-19 evidence only. Primary outcome categories were (i) cases avoided, (ii) cases detected, and (iii) a shift in epidemic development. Secondary outcomes were other infectious disease transmission outcomes, healthcare utilisation, resource requirements and adverse effects if identified in studies assessing at least one primary outcome. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts and subsequently full texts. For studies included in the analysis, one review author extracted data and appraised the study. At least one additional review author checked for correctness of data. To assess the risk of bias and quality of included studies, we used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool for observational studies concerned with screening, and a bespoke tool for modelling studies. We synthesised findings narratively. One review author assessed the certainty of evidence with GRADE, and several review authors discussed these GRADE judgements. MAIN RESULTS Overall, we included 62 unique studies in the analysis; 49 were modelling studies and 13 were observational studies. Studies covered a variety of settings and levels of community transmission. Most studies compared travel-related control measures against a counterfactual scenario in which the measure was not implemented. However, some modelling studies described additional comparator scenarios, such as different levels of stringency of the measures (including relaxation of restrictions), or a combination of measures. Concerns with the quality of modelling studies related to potentially inappropriate assumptions about the structure and input parameters, and an inadequate assessment of model uncertainty. Concerns with risk of bias in observational studies related to the selection of travellers and the reference test, and unclear reporting of certain methodological aspects. Below we outline the results for each intervention category by illustrating the findings from selected outcomes. Travel restrictions reducing or stopping cross-border travel (31 modelling studies) The studies assessed cases avoided and shift in epidemic development. We found very low-certainty evidence for a reduction in COVID-19 cases in the community (13 studies) and cases exported or imported (9 studies). Most studies reported positive effects, with effect sizes varying widely; only a few studies showed no effect. There was very low-certainty evidence that cross-border travel controls can slow the spread of COVID-19. Most studies predicted positive effects, however, results from individual studies varied from a delay of less than one day to a delay of 85 days; very few studies predicted no effect of the measure. Screening at borders (13 modelling studies; 13 observational studies) Screening measures covered symptom/exposure-based screening or test-based screening (commonly specifying polymerase chain reaction (PCR) testing), or both, before departure or upon or within a few days of arrival. Studies assessed cases avoided, shift in epidemic development and cases detected. Studies generally predicted or observed some benefit from screening at borders, however these varied widely. For symptom/exposure-based screening, one modelling study reported that global implementation of screening measures would reduce the number of cases exported per day from another country by 82% (95% confidence interval (CI) 72% to 95%) (moderate-certainty evidence). Four modelling studies predicted delays in epidemic development, although there was wide variation in the results between the studies (very low-certainty evidence). Four modelling studies predicted that the proportion of cases detected would range from 1% to 53% (very low-certainty evidence). Nine observational studies observed the detected proportion to range from 0% to 100% (very low-certainty evidence), although all but one study observed this proportion to be less than 54%. For test-based screening, one modelling study provided very low-certainty evidence for the number of cases avoided. It reported that testing travellers reduced imported or exported cases as well as secondary cases. Five observational studies observed that the proportion of cases detected varied from 58% to 90% (very low-certainty evidence). Quarantine (12 modelling studies) The studies assessed cases avoided, shift in epidemic development and cases detected. All studies suggested some benefit of quarantine, however the magnitude of the effect ranged from small to large across the different outcomes (very low- to low-certainty evidence). Three modelling studies predicted that the reduction in the number of cases in the community ranged from 450 to over 64,000 fewer cases (very low-certainty evidence). The variation in effect was possibly related to the duration of quarantine and compliance. Quarantine and screening at borders (7 modelling studies; 4 observational studies) The studies assessed shift in epidemic development and cases detected. Most studies predicted positive effects for the combined measures with varying magnitudes (very low- to low-certainty evidence). Four observational studies observed that the proportion of cases detected for quarantine and screening at borders ranged from 68% to 92% (low-certainty evidence). The variation may depend on how the measures were combined, including the length of the quarantine period and days when the test was conducted in quarantine. AUTHORS' CONCLUSIONS With much of the evidence derived from modelling studies, notably for travel restrictions reducing or stopping cross-border travel and quarantine of travellers, there is a lack of 'real-world' evidence. The certainty of the evidence for most travel-related control measures and outcomes is very low and the true effects are likely to be substantially different from those reported here. Broadly, travel restrictions may limit the spread of disease across national borders. Symptom/exposure-based screening measures at borders on their own are likely not effective; PCR testing at borders as a screening measure likely detects more cases than symptom/exposure-based screening at borders, although if performed only upon arrival this will likely also miss a meaningful proportion of cases. Quarantine, based on a sufficiently long quarantine period and high compliance is likely to largely avoid further transmission from travellers. Combining quarantine with PCR testing at borders will likely improve effectiveness. Many studies suggest that effects depend on factors, such as levels of community transmission, travel volumes and duration, other public health measures in place, and the exact specification and timing of the measure. Future research should be better reported, employ a range of designs beyond modelling and assess potential benefits and harms of the travel-related control measures from a societal perspective.
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Affiliation(s)
- Jacob Burns
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Ani Movsisyan
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Jan M Stratil
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Renke Lars Biallas
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Michaela Coenen
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Karl Mf Emmert-Fees
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Munich, Germany
| | - Karin Geffert
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Sabine Hoffmann
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Olaf Horstick
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Michael Laxy
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Munich, Germany
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Carmen Klinger
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Suzie Kratzer
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Tim Litwin
- Institute for Medical Biometry and Statistics (IMBI), Freiburg Center for Data Analysis and Modeling (FDM), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Susan Norris
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Oregon Health & Science University, Portland, OR, USA
| | - Lisa M Pfadenhauer
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Peter von Philipsborn
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Kerstin Sell
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Julia Stadelmaier
- Institute for Evidence in Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ben Verboom
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Stephan Voss
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Katharina Wabnitz
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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Prevalence of Influenza Among Hajj Pilgrims: A Systematic Review and Meta-Analysis. Disaster Med Public Health Prep 2021; 16:1221-1228. [PMID: 33757612 DOI: 10.1017/dmp.2020.472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Respiratory transmission, especially in mass gatherings, is considered one of the main ways of influenza transmission. The Hajj ceremony, as one of the largest gatherings worldwide, can increase the distribution of influenza infection. Thus, the present study aimed to evaluate the incidence of influenza among Hajj pilgrims. METHODS In this present systematic review and meta-analysis, all English studies published by 2019 were extracted from several databases such as the Web of Science, PubMed, Scopus, Cochrane Library, Science Direct, and Google Scholar. Finally, the data were extracted using a pre-prepared checklist and then analyzed by fixed and random effects model tests in the meta-analysis, Cochran, meta-regression, and Begg's test. RESULTS Eighteen studies with a sample size of 62 431 were entered into the meta-analysis process. The overall prevalence of influenza, in addition to the prevalence of types A, B, and C influenza, was estimated at 5.9 (95% CI: 4.3-8.0), 3.6 (95% CI: 2.6-4.9), 2.9 (95% CI: 2.8-3.1), and 0.9% (95% CI: 0.5-1.5), respectively. CONCLUSIONS In general, influenza remains widespread regardless of vaccinating pilgrims and following health protocols. Therefore, it is recommended that comprehensive management and educational approaches be used to reduce the prevalence of influenza and its adverse consequences among the pilgrims.
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Occupational exposure and challenges in tackling M. bovis at human-animal interface: a narrative review. Int Arch Occup Environ Health 2021; 94:1147-1171. [PMID: 33725176 PMCID: PMC7961320 DOI: 10.1007/s00420-021-01677-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 01/12/2021] [Indexed: 01/09/2023]
Abstract
Zoonotic tuberculosis caused by Mycobacterium bovis (M. bovis), a member of Mycobacterium tuberculosis complex (MTBC) has increasingly gathered attention as a public health risk, particularly in developing countries with higher disease prevalence. M. bovis is capable of infecting multiple hosts encompassing a number of domestic animals, in particular cattle as well as a broad range of wildlife reservoirs. Humans are the incidental hosts of M. bovis whereby its transmission to humans is primarily through the consumption of cattle products such as unpasteurized milk or raw meat products that have been contaminated with M. bovis or the transmission could be due to close contact with infected cattle. Also, the transmission could occur through aerosol inhalation of infective droplets or infected body fluids or tissues in the presence of wound from infected animals. The zoonotic risk of M. bovis in humans exemplified by miscellaneous studies across different countries suggested the risk of occupational exposure towards M. bovis infection, especially those animal handlers that have close and unreserved contact with cattle and wildlife populations These animal handlers comprising of livestock farmers, abattoir workers, veterinarians and their assistants, hunters, wildlife workers as well as other animal handlers are at different risk of contracting M. bovis infection, depending on the nature of their jobs and how close is their interaction with infected animals. It is crucial to identify the underlying transmission risk factors and probable transmission pathways involved in the zoonotic transmission of M. bovis from animals to humans for better designation and development of specific preventive measures and guidelines that could reduce the risk of transmission and to protect these different occupational-related/populations at risk. Effective control and disease management of zoonotic tuberculosis caused by M. bovis in humans are also hindered by various challenges and factors involved at animal–human interface. A closer look into factors affecting proper disease control and management of M. bovis are therefore warranted. Hence, in this narrative review, we have gathered a number of different studies to highlight the risk of occupational exposure to M. bovis infection and addressed the limitations and challenges underlying this context. This review also shed lights on various components and approaches in tackling M. bovis infection at animal–human interface.
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Pattern of Respiratory Viruses among Pilgrims during 2019 Hajj Season Who Sought Healthcare Due to Severe Respiratory Symptoms. Pathogens 2021; 10:pathogens10030315. [PMID: 33800223 PMCID: PMC8001913 DOI: 10.3390/pathogens10030315] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/28/2021] [Accepted: 02/28/2021] [Indexed: 12/01/2022] Open
Abstract
The aim of our study was to define the spectrum of viral infections in pilgrims with acute respiratory tract illnesses presenting to healthcare facilities around the holy places in Makkah, Saudi Arabia during the 2019 Hajj pilgrimage. During the five days of Hajj, a total of 185 pilgrims were enrolled in the study. Nasopharyngeal swabs (NPSs) of 126/185 patients (68.11%) tested positive for one or more respiratory viruses by PCR. Among the 126 pilgrims whose NPS were PCR positive: (a) there were 93/126 (74%) with a single virus infection, (b) 33/126 (26%) with coinfection with more than one virus (up to four viruses): of these, 25/33 cases had coinfection with two viruses; 6/33 were infected with three viruses, while the remaining 2/33 patients had infection with four viruses. Human rhinovirus (HRV) was the most common detected viruses with 53 cases (42.06%), followed by 27 (21.43%) cases of influenza A (H1N1), and 23 (18.25%) cases of influenza A other than H1N1. Twenty-five cases of CoV-229E (19.84%) were detected more than other coronavirus members (5 CoV-OC43 (3.97%), 4 CoV-HKU1 (3.17%), and 1 CoV-NL63 (0.79%)). PIV-3 was detected in 8 cases (6.35%). A single case (0.79%) of PIV-1 and PIV-4 were found. HMPV represented 5 (3.97%), RSV and influenza B 4 (3.17%) for each, and Parechovirus 1 (0.79%). Enterovirus, Bocavirus, and M. pneumoniae were not detected. Whether identification of viral nucleic acid represents nasopharyngeal carriage or specific causal etiology of RTI remains to be defined. Large controlled cohort studies (pre-Hajj, during Hajj, and post-Hajj) are required to define the carriage rates and the specific etiology and causal roles of specific individual viruses or combination of viruses in the pathogenesis of respiratory tract infections in pilgrims participating in the annual Hajj. Studies of the specific microbial etiology of respiratory track infections (RTIs) at mass gathering religious events remain a priority, especially in light of the novel SARS-CoV-2 pandemic.
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AL-Eitan LN, Tarkhan AH, Alghamdi MA, Marston DA, Wu G, McElhinney LM, Brown IH, Fooks AR. Bat-Borne Coronaviruses in Jordan and Saudi Arabia: A Threat to Public Health? Viruses 2020; 12:E1413. [PMID: 33316899 PMCID: PMC7764733 DOI: 10.3390/v12121413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 11/22/2022] Open
Abstract
Emerging infectious diseases are of great concern to public health, as highlighted by the ongoing coronavirus disease 2019 (COVID-19) pandemic. Such diseases are of particular danger during mass gathering and mass influx events, as large crowds of people in close proximity to each other creates optimal opportunities for disease transmission. The Hashemite Kingdom of Jordan and the Kingdom of Saudi Arabia are two countries that have witnessed mass gatherings due to the arrival of Syrian refugees and the annual Hajj season. The mass migration of people not only brings exotic diseases to these regions but also brings new diseases back to their own countries, e.g., the outbreak of MERS in South Korea. Many emerging pathogens originate in bats, and more than 30 bat species have been identified in these two countries. Some of those bat species are known to carry viruses that cause deadly diseases in other parts of the world, such as the rabies virus and coronaviruses. However, little is known about bats and the pathogens they carry in Jordan and Saudi Arabia. Here, the importance of enhanced surveillance of bat-borne infections in Jordan and Saudi Arabia is emphasized, promoting the awareness of bat-borne diseases among the general public and building up infrastructure and capability to fill the gaps in public health preparedness to prevent future pandemics.
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Affiliation(s)
- Laith N. AL-Eitan
- Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid 22110, Jordan;
| | - Amneh H. Tarkhan
- Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid 22110, Jordan;
| | - Mansour A. Alghamdi
- Department of Anatomy, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia;
- Genomics and Personalized Medicine Unit, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
| | - Denise A. Marston
- Department of Virology, Animal and Plant Health Agency (APHA, Weybridge), Surrey KT15 3NB, UK; (D.A.M.); (G.W.); (L.M.M.); (I.H.B.); (A.R.F.)
| | - Guanghui Wu
- Department of Virology, Animal and Plant Health Agency (APHA, Weybridge), Surrey KT15 3NB, UK; (D.A.M.); (G.W.); (L.M.M.); (I.H.B.); (A.R.F.)
| | - Lorraine M. McElhinney
- Department of Virology, Animal and Plant Health Agency (APHA, Weybridge), Surrey KT15 3NB, UK; (D.A.M.); (G.W.); (L.M.M.); (I.H.B.); (A.R.F.)
| | - Ian H. Brown
- Department of Virology, Animal and Plant Health Agency (APHA, Weybridge), Surrey KT15 3NB, UK; (D.A.M.); (G.W.); (L.M.M.); (I.H.B.); (A.R.F.)
| | - Anthony R. Fooks
- Department of Virology, Animal and Plant Health Agency (APHA, Weybridge), Surrey KT15 3NB, UK; (D.A.M.); (G.W.); (L.M.M.); (I.H.B.); (A.R.F.)
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Burns J, Movsisyan A, Stratil JM, Coenen M, Emmert-Fees KM, Geffert K, Hoffmann S, Horstick O, Laxy M, Pfadenhauer LM, von Philipsborn P, Sell K, Voss S, Rehfuess E. Travel-related control measures to contain the COVID-19 pandemic: a rapid review. Cochrane Database Syst Rev 2020; 10:CD013717. [PMID: 33502002 DOI: 10.1002/14651858.cd013717] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND In late 2019, first cases of coronavirus disease 2019, or COVID-19, caused by the novel coronavirus SARS-CoV-2, were reported in Wuhan, China. Subsequently COVID-19 spread rapidly around the world. To contain the ensuing pandemic, numerous countries have implemented control measures related to international travel, including border closures, partial travel restrictions, entry or exit screening, and quarantine of travellers. OBJECTIVES To assess the effectiveness of travel-related control measures during the COVID-19 pandemic on infectious disease and screening-related outcomes. SEARCH METHODS We searched MEDLINE, Embase and COVID-19-specific databases, including the WHO Global Database on COVID-19 Research, the Cochrane COVID-19 Study Register, and the CDC COVID-19 Research Database on 26 June 2020. We also conducted backward-citation searches with existing reviews. SELECTION CRITERIA We considered experimental, quasi-experimental, observational and modelling studies assessing the effects of travel-related control measures affecting human travel across national borders during the COVID-19 pandemic. We also included studies concerned with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) as indirect evidence. Primary outcomes were cases avoided, cases detected and a shift in epidemic development due to the measures. Secondary outcomes were other infectious disease transmission outcomes, healthcare utilisation, resource requirements and adverse effects if identified in studies assessing at least one primary outcome. DATA COLLECTION AND ANALYSIS One review author screened titles and abstracts; all excluded abstracts were screened in duplicate. Two review authors independently screened full texts. One review author extracted data, assessed risk of bias and appraised study quality. At least one additional review author checked for correctness of all data reported in the 'Risk of bias' assessment, quality appraisal and data synthesis. For assessing the risk of bias and quality of included studies, we used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool for observational studies concerned with screening, ROBINS-I for observational ecological studies and a bespoke tool for modelling studies. We synthesised findings narratively. One review author assessed certainty of evidence with GRADE, and the review author team discussed ratings. MAIN RESULTS We included 40 records reporting on 36 unique studies. We found 17 modelling studies, 7 observational screening studies and one observational ecological study on COVID-19, four modelling and six observational studies on SARS, and one modelling study on SARS and MERS, covering a variety of settings and epidemic stages. Most studies compared travel-related control measures against a counterfactual scenario in which the intervention measure was not implemented. However, some modelling studies described additional comparator scenarios, such as different levels of travel restrictions, or a combination of measures. There were concerns with the quality of many modelling studies and the risk of bias of observational studies. Many modelling studies used potentially inappropriate assumptions about the structure and input parameters of models, and failed to adequately assess uncertainty. Concerns with observational screening studies commonly related to the reference test and the flow of the screening process. Studies on COVID-19 Travel restrictions reducing cross-border travel Eleven studies employed models to simulate a reduction in travel volume; one observational ecological study assessed travel restrictions in response to the COVID-19 pandemic. Very low-certainty evidence from modelling studies suggests that when implemented at the beginning of the outbreak, cross-border travel restrictions may lead to a reduction in the number of new cases of between 26% to 90% (4 studies), the number of deaths (1 study), the time to outbreak of between 2 and 26 days (2 studies), the risk of outbreak of between 1% to 37% (2 studies), and the effective reproduction number (1 modelling and 1 observational ecological study). Low-certainty evidence from modelling studies suggests a reduction in the number of imported or exported cases of between 70% to 81% (5 studies), and in the growth acceleration of epidemic progression (1 study). Screening at borders with or without quarantine Evidence from three modelling studies of entry and exit symptom screening without quarantine suggests delays in the time to outbreak of between 1 to 183 days (very low-certainty evidence) and a detection rate of infected travellers of between 10% to 53% (low-certainty evidence). Six observational studies of entry and exit screening were conducted in specific settings such as evacuation flights and cruise ship outbreaks. Screening approaches varied but followed a similar structure, involving symptom screening of all individuals at departure or upon arrival, followed by quarantine, and different procedures for observation and PCR testing over a period of at least 14 days. The proportion of cases detected ranged from 0% to 91% (depending on the screening approach), and the positive predictive value ranged from 0% to 100% (very low-certainty evidence). The outcomes, however, should be interpreted in relation to both the screening approach used and the prevalence of infection among the travellers screened; for example, symptom-based screening alone generally performed worse than a combination of symptom-based and PCR screening with subsequent observation during quarantine. Quarantine of travellers Evidence from one modelling study simulating a 14-day quarantine suggests a reduction in the number of cases seeded by imported cases; larger reductions were seen with increasing levels of quarantine compliance ranging from 277 to 19 cases with rates of compliance modelled between 70% to 100% (very low-certainty evidence). AUTHORS' CONCLUSIONS With much of the evidence deriving from modelling studies, notably for travel restrictions reducing cross-border travel and quarantine of travellers, there is a lack of 'real-life' evidence for many of these measures. The certainty of the evidence for most travel-related control measures is very low and the true effects may be substantially different from those reported here. Nevertheless, some travel-related control measures during the COVID-19 pandemic may have a positive impact on infectious disease outcomes. Broadly, travel restrictions may limit the spread of disease across national borders. Entry and exit symptom screening measures on their own are not likely to be effective in detecting a meaningful proportion of cases to prevent seeding new cases within the protected region; combined with subsequent quarantine, observation and PCR testing, the effectiveness is likely to improve. There was insufficient evidence to draw firm conclusions about the effectiveness of travel-related quarantine on its own. Some of the included studies suggest that effects are likely to depend on factors such as the stage of the epidemic, the interconnectedness of countries, local measures undertaken to contain community transmission, and the extent of implementation and adherence.
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Affiliation(s)
- Jacob Burns
- Institute for Medical Information Processing, Biometry and Epidemiology, IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Ani Movsisyan
- Institute for Medical Information Processing, Biometry and Epidemiology, IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Jan M Stratil
- Institute for Medical Information Processing, Biometry and Epidemiology, IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Michaela Coenen
- Institute for Medical Information Processing, Biometry and Epidemiology, IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Karl Mf Emmert-Fees
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Munich, Germany
| | - Karin Geffert
- Institute for Medical Information Processing, Biometry and Epidemiology, IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Sabine Hoffmann
- Institute for Medical Information Processing, Biometry and Epidemiology, IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Olaf Horstick
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Michael Laxy
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Munich, Germany
| | - Lisa M Pfadenhauer
- Institute for Medical Information Processing, Biometry and Epidemiology, IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Peter von Philipsborn
- Institute for Medical Information Processing, Biometry and Epidemiology, IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Kerstin Sell
- Institute for Medical Information Processing, Biometry and Epidemiology, IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Stephan Voss
- Institute for Medical Information Processing, Biometry and Epidemiology, IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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18
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Ayim-Akonor M, Mertens E, May J, Harder T. Exposure of domestic swine to influenza A viruses in Ghana suggests unidirectional, reverse zoonotic transmission at the human-animal interface. Zoonoses Public Health 2020; 67:697-707. [PMID: 32710707 DOI: 10.1111/zph.12751] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/14/2020] [Accepted: 06/08/2020] [Indexed: 01/02/2023]
Abstract
Influenza A viruses (IAVs) have both zoonotic and anthroponotic potential and are of public and veterinary importance. Swine are intermediate hosts and 'mixing vessels' for generating reassortants, progenies of which may harbour pandemic propensity. Swine handlers are at the highest risk of becoming infected with IAVs from swine but there is little information on the ecology of IAVs at the human-animal interface in Africa. We analysed and characterized nasal and throat swabs from swine and farmers respectively, for IAVs using RT-qPCR, from swine farms in the Ashanti region, Ghana. Sera were also analysed for IAVs antibodies and serotyped using ELISA and HI assays. IAV was detected in 1.4% (n = 17/1,200) and 2.0% (n = 2/99) of swine and farmers samples, respectively. Viral subtypes H3N2 and H1N1pdm09 were found in human samples. All virus-positive swine samples were subtyped as H1N1pdm09 phylogenetically clustering closely with H1N1pdm09 that circulated among humans during the study period. Phenotypic markers that confer sensitivity to Oseltamivir were found. Serological prevalence of IAVs in swine and farmers by ELISA was 3.2% (n = 38/1,200) and 18.2% (n = 18/99), respectively. Human H1N1pdm09 and H3N2 antibodies were found in both swine and farmers sera. Indigenous swine influenza A viruses and/or antibodies were not detected in swine or farmers samples. Majority (98%, n = 147/150) of farmers reported of not wearing surgical mask and few (4%, n = 6) reported to wear gloves when working. Most (n = 74, 87.7%) farmers reported of working on the farm when experiencing influenza-like illness. Poor husbandry and biosafety practices of farmers could facilitate virus transmission across the human-swine interface. Farmers should be educated on the importance of good farm practices to mitigate influenza transmission at the human-animal interface.
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Affiliation(s)
- Matilda Ayim-Akonor
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,Department of Animal Health and Food Safety, Council for Scientific and Industrial Research-Animal Research Institute, Accra, Ghana
| | - Eva Mertens
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Jürgen May
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Timm Harder
- Institute for Diagnostic Virology, Friedrich-Loeffler-Institut, Insel Riems, Germany
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19
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Goni MD, Naing NN, Hasan H, Wan-Arfah N, Deris ZZ, Arifin WN, Hussin TMAR, Abdulrahman AS, Baaba AA, Arshad MR. Development and validation of knowledge, attitude and practice questionnaire for prevention of respiratory tract infections among Malaysian Hajj pilgrims. BMC Public Health 2020; 20:189. [PMID: 32114986 PMCID: PMC7050115 DOI: 10.1186/s12889-020-8269-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 01/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background Hajj pilgrimage faces numerous challenges including a high prevalence of respiratory tract infection as well as its prevention strategies. The aim of this study was to develop and validate a questionnaire to evaluate knowledge, attitude and practice (KAP) towards respiratory tract infections (RTIs) prevention among Malaysian Hajj pilgrims. Methods This study was conducted among Malaysian Umrah pilgrims in Malaysia from Kuala Lumpur and Kelantan. The questionnaire then underwent a series of validation process that included content, face validity and exploratory part. Item response theory (IRT) analysis was utilized for the validation of the knowledge domain. The attitude and practice were validated using the exploratory factor analysis (EFA). Results The validation process resulted in a questionnaire that comprised of four main sections: demography, knowledge, attitude, and practice. Following IRT analysis of the knowledge domain, all items analyzed were within the acceptable range of difficulty and discrimination. The Kaiser-Meyer-Olkin measure of sampling adequacy (KMO) was 0.72 and 0.84 for attitude and practice domain respectively and Bartlett’s test of Sphericity for both domains were highly significant (P < 0.001). The factor analysis resulted in two factors with total of 12 items in attitude domain, and 2 factors with total of 13 items in the practice domain with satisfactory factor loading (> 0.3). The Cronbach’s alpha for reliability of the knowledge, attitude and practice domains all showed acceptable values of > 0.6 (0.92, 0.77 and 0.85). Conclusion The findings of this validation and reliability study showed that the developed questionnaire had a satisfactory psychometric property for measuring KAP of Malaysian Hajj pilgrims.
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Affiliation(s)
- Mohammed Dauda Goni
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Nyi Nyi Naing
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Medical Campus, 20400, Kuala Terengganu, Malaysia.
| | - Habsah Hasan
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Nadiah Wan-Arfah
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak Campus, 21300, Kuala Nerus, Terengganu, Malaysia
| | - Zakuan Zainy Deris
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Wan Nor Arifin
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia
| | | | - Abdulwali Sabo Abdulrahman
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Aisha Abubakar Baaba
- Centre for Language Studies and Generic Development, Universiti Malaysia Kelantan, Locked Bag 01, 16300, Bachok, Kelantan, Malaysia
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20
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Farooq HZ, Davies E, Ahmad S, Machin N, Hesketh L, Guiver M, Turner AJ. Middle East respiratory syndrome coronavirus (MERS-CoV) - Surveillance and testing in North England from 2012 to 2019. Int J Infect Dis 2020; 93:237-244. [PMID: 32004690 PMCID: PMC7129156 DOI: 10.1016/j.ijid.2020.01.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 11/30/2022] Open
Abstract
MERS is an emerging infectious disease with high consequences. PHE Manchester receives a high number of MERS surveillance samples. Sputum samples are the optimum samples for diagnosing respiratory viruses. Multiple samples per patient result in a 100% diagnostic yield and a confirmed end-diagnosis.
Background Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in Saudi Arabia in 2012 and caused an epidemic in the Middle East. Public Health England (PHE) Manchester is one of the two PHE centres in the UK that perform testing for MERS-CoV. The results of the PHE Manchester MERS surveillance from 2012 to 2019 are presented in this report. Methods Retrospective data were collected for returning travellers from the Middle East fitting the PHE MERS case definition. Respiratory samples were tested for respiratory viruses and MERS-CoV using an in-house RT-PCR assay. Results Four hundred and twenty-six (426) samples from 264 patients were tested for MERS Co-V and respiratory viruses. No MERS-CoV infections were identified by PCR. Fifty-six percent of samples were PCR positive for viral or bacterial pathogen with Influenza A as the predominant virus (44%). Sixty-two percent of all patients had a pathogen identified with the highest positivity from sputum samples. Patients with multiple samples demonstrated a 100% diagnostic yield. Conclusions Although no cases of MERS were identified, the majority of patients had Influenza infection for which oseltamivir treatment was indicated and isolation warranted. Sputum samples were the most useful in diagnosing respiratory viruses with a 100% diagnostic yield from patients with multiple samples.
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Affiliation(s)
- Hamzah Z Farooq
- Department of Virology, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, Manchester, United Kingdom; Public Health Laboratory Manchester, Manchester, United Kingdom.
| | - Emma Davies
- Department of Virology, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Public Health Laboratory Manchester, Manchester, United Kingdom
| | - Shazaad Ahmad
- Department of Virology, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, Manchester, United Kingdom; Public Health Laboratory Manchester, Manchester, United Kingdom
| | - Nicholas Machin
- Department of Virology, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Public Health Laboratory Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom
| | - Louise Hesketh
- Department of Virology, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Public Health Laboratory Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom
| | - Malcolm Guiver
- Department of Virology, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Public Health Laboratory Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom
| | - Andrew J Turner
- Department of Virology, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Public Health Laboratory Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom
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21
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Yezli S, Alotaibi B, Al-Abdely H, Balkhy HH, Yassin Y, Mushi A, Maashi F, Pezzi L, Benkouiten S, Charrel R, Raoult D, Gautret P. Acquisition of respiratory and gastrointestinal pathogens among health care workers during the 2015 Hajj season. Am J Infect Control 2019; 47:1071-1076. [PMID: 30979562 PMCID: PMC7132678 DOI: 10.1016/j.ajic.2019.02.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Data on the risk of transmission of infection to health care workers (HCWs) serving ill pilgrims during the Hajj is scarce. METHODS Two cohorts of HCWs, the first serving Hajj pilgrims in Mecca and the second serving patients in Al-Ahsa, were investigated for respiratory and gastrointestinal symptoms and pathogen carriage using multiplex polymerase chain reaction before and after the 2015 Hajj. RESULTS A total of 211 HCWs were enrolled of whom 92 were exposed to pilgrims (Mecca cohort), whereas 119 were not exposed (Al-Ahsa cohort). Symptoms were observed only in HCWs from the Mecca cohort, with 29.3% experiencing respiratory symptoms during the Hajj period or in the subsequent days and 3.3% having gastrointestinal symptoms. Acquisition rates of at least 1 respiratory virus were 14.7% in the Mecca cohort and 3.4% in the Al-Ahsa cohort (P = .003). Acquisition rates of at least 1 respiratory bacterium were 11.8% and 18.6% in the Mecca and Al-Ahsa cohorts, respectively (P = .09). Gastrointestinal pathogens were rarely isolated in both cohorts of HCWs and acquisition of pathogens after the Hajj was documented in only a few individuals. CONCLUSIONS HCWs providing care for pilgrims both acquire pathogens and present symptoms (especially respiratory symptoms) more frequently than those not working during Hajj.
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Affiliation(s)
- Saber Yezli
- Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia.
| | - Badriah Alotaibi
- Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Hail Al-Abdely
- General Directorate of Infection Prevention and Control, Ministry of Health, Kingdom of Saudi Arabia
| | - Hanan H Balkhy
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Infection Prevention and Control Department, Ministry of National Guard Health Affairs (MNGHA), Riyadh, Saudi Arabia
| | - Yara Yassin
- Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Abdulaziz Mushi
- Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Fuad Maashi
- Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Laura Pezzi
- UMR “Emergence des Pathologies Virales” (EPV: Aix-Marseille Univ–IRD 190–Inserm 1207–EHESP–IHU Méditerranée Infection), Marseille, France
| | - Samir Benkouiten
- Aix Marseille Univ, Institut de Recherche pour le Développement (IRD), Assistance Publique-Hôpitaux de Marseille, Microbes Vecteurs Infections Tropicales et Méditerranéennes (VITROME), Institut Hospitalo-Universitaire-Méditerranée Infection, Marseille, France
| | - Rémi Charrel
- UMR “Emergence des Pathologies Virales” (EPV: Aix-Marseille Univ–IRD 190–Inserm 1207–EHESP–IHU Méditerranée Infection), Marseille, France
| | - Didier Raoult
- Aix Marseille Univ, Institut de Recherche pour le Développement (IRD), Assistance Publique-Hôpitaux de Marseille, Evolution Phylogénie et Infections (MEPHI), Institut Hospitalo-Universitaire-Méditerranée Infection, Marseille, France
| | - Philippe Gautret
- Aix Marseille Univ, Institut de Recherche pour le Développement (IRD), Assistance Publique-Hôpitaux de Marseille, Microbes Vecteurs Infections Tropicales et Méditerranéennes (VITROME), Institut Hospitalo-Universitaire-Méditerranée Infection, Marseille, France
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22
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Al-Tawfiq JA, Memish ZA. The Hajj 2019 Vaccine Requirements and Possible New Challenges. J Epidemiol Glob Health 2019; 9:147-152. [PMID: 31529930 PMCID: PMC7310822 DOI: 10.2991/jegh.k.190705.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/05/2019] [Indexed: 01/02/2023] Open
Abstract
Each year millions of pilgrims perform the annual Hajj from more than 180 countries around the world. This is one of the largest mass gathering events and may result in the occurrence and spread of infectious diseases. As such, there are mandatory vaccinations for the pilgrims such as meningococcal vaccines. The 2019 annual Hajj will take place during August 8-13, 2019. Thus, we review the recommended and mandated vaccinations for the 2019 Hajj and Umrah. The mandatory vaccines required to secure the visa include the quadrivalent meningococcal vaccine for all pilgrims, while yellow fever, and poliomyelitis vaccines are required for pilgrims coming from countries endemic or with disease activity. The recommended vaccines are influenza, pneumococcal, in addition to full compliance with basic vaccines for all pilgrims against diphtheria, tetanus, pertussis, polio, measles, and mumps. It is imperative to continue surveillance for the spread of antimicrobial resistance and occurrence of all infectious diseases causing outbreaks across the globe in the last year, like Zika virus, MDR-Typhoid, Nipah, Ebola, cholera, chikungunya and Middle East Respiratory Syndrome Coronavirus.
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Affiliation(s)
- Jaffar A. Al-Tawfiq
- Infectious Disease Section, Specialty Medicine Department, Johns Hopkins Aramco Healthcare, Dhahran, Kingdom of Saudi Arabia
- Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ziad A. Memish
- Department of Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Infectious Diseases Division, Department of Medicine, Prince Mohammed Bin Abdulaziz Hospital (PMAH), Ministry of Health, Riyadh, Saudi Arabia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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23
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Farrag MA, Hamed ME, Amer HM, Almajhdi FN. Epidemiology of respiratory viruses in Saudi Arabia: toward a complete picture. Arch Virol 2019; 164:1981-1996. [PMID: 31139937 PMCID: PMC7087236 DOI: 10.1007/s00705-019-04300-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/01/2019] [Indexed: 02/07/2023]
Abstract
Acute lower respiratory tract infection is a major health problem that affects more than 15% of the total population of Saudi Arabia each year. Epidemiological studies conducted over the last three decades have indicated that viruses are responsible for the majority of these infections. The epidemiology of respiratory viruses in Saudi Arabia is proposed to be affected mainly by the presence and mobility of large numbers of foreign workers and the gathering of millions of Muslims in Mecca during the Hajj and Umrah seasons. Knowledge concerning the epidemiology, circulation pattern, and evolutionary kinetics of respiratory viruses in Saudi Arabia are scant, with the available literature being inconsistent. This review summarizes the available data on the epidemiology and evolution of respiratory viruses. The demographic features associated with Middle East respiratory syndrome-related coronavirus infections are specifically analyzed for a better understanding of the epidemiology of this virus. The data support the view that continuous entry and exit of pilgrims and foreign workers with different ethnicities and socioeconomic backgrounds in Saudi Arabia is the most likely vehicle for global dissemination of respiratory viruses and for the emergence of new viruses (or virus variants) capable of greater dissemination.
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Affiliation(s)
- Mohamed A Farrag
- Department of Botany and Microbiology, College of Science, King Saud University, P.O. Box 2455QA6, Riyadh, 11451, Saudi Arabia
| | - Maaweya E Hamed
- Department of Botany and Microbiology, College of Science, King Saud University, P.O. Box 2455QA6, Riyadh, 11451, Saudi Arabia
| | - Haitham M Amer
- Department of Virology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Fahad N Almajhdi
- Department of Botany and Microbiology, College of Science, King Saud University, P.O. Box 2455QA6, Riyadh, 11451, Saudi Arabia.
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Acquisition of respiratory viruses and presence of respiratory symptoms in French pilgrims during the 2016 Hajj: A prospective cohort study. Travel Med Infect Dis 2019; 30:32-38. [PMID: 30858034 PMCID: PMC7110710 DOI: 10.1016/j.tmaid.2019.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/02/2019] [Accepted: 03/05/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Viral respiratory tract infections are frequent among Hajj pilgrims. However, it is still not known whether viruses are responsible for the symptoms observed in sick pilgrims or whether they only colonize sick and asymptomatic pilgrims. PATIENTS AND METHODS A prospective cohort study was conducted among French Hajj pilgrims in 2016. Medical follow-up and systematic nasal swabbing were performed pre- and post-Hajj. Additional samples were obtained per-Hajj, at symptom onset in ill pilgrims. Viruses were identified using the BioFire FilmArray® Respiratory multiplex qualitative PCR panel. RESULTS 109 pilgrims were included. 83.5% presented respiratory symptoms during Hajj and 39.5% were still symptomatic on return. 5.5% of pre-Hajj, 95.2% of per-Hajj (at symptom onset) and 46.5% of post-Hajj samples tested positive (p < 0.0001). Acquisition rates of rhinovirus/enterovirus, coronavirus 229E and influenza A virus were respectively 38.6%, 19.8% and 2.0%. Although rhinovirus/enterovirus, coronavirus 229E and influenza A clearance were respectively 70.6%, 71.4% and 100% on return, overall virus carriage proportion on return was 75.0% in pilgrims with influenza-like illness and 44.0% in those who have never experienced this symptoms or resolved it (OR = 4.05, 95% CI [1.02-16.02]). CONCLUSIONS Viruses likely play some role in the pathogenesis of the respiratory tract infections at the Hajj. Point of care-rapid multiplex PCR assays are valuable diagnosis tools in this context when used at respiratory symptom onset or soon after.
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25
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Hashem AM, Al-Subhi TL, Badroon NA, Hassan AM, Bajrai LHM, Banassir TM, Alquthami KM, Azhar EI. MERS-CoV, influenza and other respiratory viruses among symptomatic pilgrims during 2014 Hajj season. J Med Virol 2019; 91:911-917. [PMID: 30729547 PMCID: PMC7166944 DOI: 10.1002/jmv.25424] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 12/24/2022]
Abstract
More than two million Muslims visit Makkah, Saudi Arabia, annually to perform the religious rituals of Hajj where the risk of spreading respiratory infections is very common. The aim here was to screen symptomatic pilgrims for Middle East respiratory syndrome coronavirus (MERS-CoV) and other viral etiologies. Thus, 132 nasopharyngeal samples were collected from pilgrims presenting with acute respiratory symptoms at the healthcare facilities in the holy sites during the 5 days of the 2014 Hajj season. Samples were tested using real-time reverse transcription polymerase chain reactions and microarray. Demographic data including age, sex, and country of origin were obtained for all participants. While we did not detect MERS-CoV in any of the samples, several other viruses were detected in 50.8% of the cases. Among the detected viruses, 64.2% of the cases were due to a single-virus infection and 35.8% were due to the coinfections with up to four viruses. The most common respiratory virus was influenza A, followed by non-MERS human coronaviruses, rhinoviruses, and influenza B. Together, we found that it was not MERS-CoV but other respiratory viruses that caused acute respiratory symptoms among pilgrims. The observed high prevalence of influenza viruses underscores the need for more effective surveillance during the Hajj and adoption of stringent vaccination requirements from all pilgrims.
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Affiliation(s)
- Anwar M Hashem
- Special Infectious Agent Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Tagreed L Al-Subhi
- Special Infectious Agent Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nassrin A Badroon
- Special Infectious Agent Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed M Hassan
- Special Infectious Agent Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Leena Hussein M Bajrai
- Special Infectious Agent Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | | | - Esam I Azhar
- Special Infectious Agent Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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Dawson P, Malik MR, Parvez F, Morse SS. What Have We Learned About Middle East Respiratory Syndrome Coronavirus Emergence in Humans? A Systematic Literature Review. Vector Borne Zoonotic Dis 2019; 19:174-192. [PMID: 30676269 PMCID: PMC6396572 DOI: 10.1089/vbz.2017.2191] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Middle East respiratory syndrome coronavirus (MERS-CoV) was first identified in humans in 2012. A systematic literature review was conducted to synthesize current knowledge and identify critical knowledge gaps. MATERIALS AND METHODS We conducted a systematic review on MERS-CoV using PRISMA guidelines. We identified 407 relevant, peer-reviewed publications and selected 208 of these based on their contributions to four key areas: virology; clinical characteristics, outcomes, therapeutic and preventive options; epidemiology and transmission; and animal interface and the search for natural hosts of MERS-CoV. RESULTS Dipeptidyl peptidase 4 (DPP4/CD26) was identified as the human receptor for MERS-CoV, and a variety of molecular and serological assays developed. Dromedary camels remain the only documented zoonotic source of human infection, but MERS-like CoVs have been detected in bat species globally, as well as in dromedary camels throughout the Middle East and Africa. However, despite evidence of camel-to-human MERS-CoV transmission and cases apparently related to camel contact, the source of many primary cases remains unknown. There have been sustained health care-associated human outbreaks in Saudi Arabia and South Korea, the latter originating from one traveler returning from the Middle East. Transmission mechanisms are poorly understood; for health care, this may include environmental contamination. Various potential therapeutics have been identified, but not yet evaluated in human clinical trials. At least one candidate vaccine has progressed to Phase I trials. CONCLUSIONS There has been substantial MERS-CoV research since 2012, but significant knowledge gaps persist, especially in epidemiology and natural history of the infection. There have been few rigorous studies of baseline prevalence, transmission, and spectrum of disease. Terms such as "camel exposure" and the epidemiological relationships of cases should be clearly defined and standardized. We strongly recommend a shared and accessible registry or database. Coronaviruses will likely continue to emerge, arguing for a unified "One Health" approach.
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Affiliation(s)
- Patrick Dawson
- 1 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Mamunur Rahman Malik
- 2 Infectious Hazard Management, Department of Health Emergency, World Health Organization Eastern Mediterranean Regional Office (WHO/EMRO), Cairo, Egypt
| | - Faruque Parvez
- 3 Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Stephen S Morse
- 1 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Abstract
A mass gathering is “any occasion, either organized or spontaneous, that attracts sufficient numbers of people to strain the planning and response resources of the community, city, or nation hosting the event.”2 Often the existing infrastructure (e.g., public health, health care, or emergency services) is inadequate for the disproportionate sudden surge in demand, hence careful planning is required. Although infectious diseases are most feared due to the potential for rapid international spread, noncommunicable diseases, accidents, and stampedes are more frequent. Mass gatherings may lead to three potential infectious disease public health threats: the risk of importation of infectious diseases usually not seen in the country of the gathering; the amplification of transmission during the event; and the international spread of infectious disease through global mobility networks. Mass gatherings are the temporary collection of large numbers of people at one site or location for a common purpose. Mass gatherings present some of the most complex management challenges faced by governments and organizers. Mass gatherings may lead to three potential infectious disease public health threats: the risk of importation of infectious diseases usually not seen in the country of the gathering; the amplification of transmission during the event; and the international spread of infectious disease through global mobility networks. While infectious diseases may be of greater global public health relevance, noncommunicable diseases, accidents, and stampede usually have a higher local impact with respect to morbidity and mortality during mass gatherings.
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Al-Tawfiq JA, Gautret P. Asymptomatic Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: Extent and implications for infection control: A systematic review. Travel Med Infect Dis 2018; 27:27-32. [PMID: 30550839 PMCID: PMC7110966 DOI: 10.1016/j.tmaid.2018.12.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 01/05/2023]
Abstract
Background The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) emerged in 2012 and attracted an international attention as the virus caused multiple healthcare associated outbreaks. There are reports of the role of asymptomatic individuals in the transmission of MERS-CoV, however, the exact role is not known. Method The MEDLINE/PubMed and Scopus databases were searched for relevant papers published till August 2018 describing asymptomatic MERS-CoV infection. Results A total of 10 papers were retrieved and included in the final analysis and review. The extent of asymptomatic MERS infection had increased with change in the policy of testing asymptomatic contacts. In early cases in April 2012–October 2013, 12.5% were asymptomatic among 144 PCR laboratory-confirmed MERS-CoV cases while in 2014 the proportion rose to 25.1% among 255 confirmed cases. The proportion of asymptomatic cases reported among pediatric confirmed MERS-CoV cases were higher (41.9%–81.8%). Overall, the detection rate of MERS infection among asymptomatic contacts was 1-3.9% in studies included in this review. Asymptomatic individuals were less likely to have underlying condition compared to fatal cases. Of particular interest is that most of the identified pediatric cases were asymptomatic with no clear explanation. Conclusions The proportion of asymptomatic MERS cases were detected with increasing frequency as the disease progressed overtime. Those patients were less likely to have comorbid disease and may contribute to the transmission of the virus.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Philippe Gautret
- Aix Marseille Univ, Institut de Recherche pour le Développement (IRD), Assistance Publique-Hôpitaux de Marseille (AP-HM), Service de Santé des Armées (SSA), Microbes Vecteurs Infections Tropicales et Méditerranéennes (VITROME), Institut Hospitalo-Universitaire-Méditerranée Infection (IHU-Méditerranée Infection), Marseille, France
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Benkouiten S, Al-Tawfiq JA, Memish ZA, Albarrak A, Gautret P. Clinical respiratory infections and pneumonia during the Hajj pilgrimage: A systematic review. Travel Med Infect Dis 2018; 28:15-26. [PMID: 30528743 PMCID: PMC7110718 DOI: 10.1016/j.tmaid.2018.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 12/01/2018] [Accepted: 12/03/2018] [Indexed: 12/14/2022]
Abstract
Background The Islamic Hajj pilgrimage to Mecca is one of the world's largest annual mass gatherings. Inevitable overcrowding during the pilgrims' stay greatly increases the risk of acquiring and spreading infectious diseases, especially respiratory diseases. Method The MEDLINE/PubMed and Scopus databases were searched for all relevant papers published prior to February 2018 that evaluated the prevalence of clinical symptoms of respiratory infections, including pneumonia, among Hajj pilgrims, as well as their influenza and pneumococcal vaccination status. Results A total of 61 papers were included in the review. Both cohort- and hospital-based studies provide complementary data, and both are therefore necessary to provide a complete picture of the total burden of respiratory diseases during the Hajj. Respiratory symptoms have been common among Hajj pilgrims over the last 15 years. In cohorts of pilgrims, cough ranged from 1.9% to 91.5%. However, the prevalence rates of the most common symptoms (cough, sore throat, and subjective fever) of influenza-like illness (ILI) varied widely across the included studies. These studies have shown variable results, with overall rates of ILI ranging from 8% to 78.2%. These differences might result from differences in study design, study period, and rates of vaccination against seasonal influenza that ranged from 1.1% to 100% among study participants. Moreover, the definition of ILI was inconsistent across studies. In hospitalized Hajj pilgrims, the prevalence of pneumonia, that remains a major concern in critically ill patients, ranged from 0.2% to 54.8%. Conclusions Large multinational follow-up studies are recommended for clinic-based syndromic surveillance, in conjunction with microbiological surveillance. Matched cohorts ensure better comparability across studies. However, study design and data collection procedures should be standardized to facilitate reporting and to achieve comparability between studies. Furthermore, the definition of ILI, and of most common symptoms used to define respiratory infections (e.g., upper respiratory tract infection), need to be precisely defined and consistently used. Future studies need to address potential effect of influenza and pneumococcal vaccine in the context of the Hajj pilgrimage.
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Affiliation(s)
- Samir Benkouiten
- Aix Marseille Univ, Institut de Recherche pour le Développement (IRD), Assistance Publique-Hôpitaux de Marseille (AP-HM), Service de Santé des Armées (SSA), Microbes Vecteurs Infections Tropicales et Méditerranéennes (VITROME), Institut Hospitalo-Universitaire-Méditerranée Infection (IHU-Méditerranée Infection), Marseille, France
| | - Jaffar A Al-Tawfiq
- Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ziad A Memish
- Ministry of Health, Riyadh, Saudi Arabia; College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
| | - Ali Albarrak
- Department of Internal Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Philippe Gautret
- Aix Marseille Univ, Institut de Recherche pour le Développement (IRD), Assistance Publique-Hôpitaux de Marseille (AP-HM), Service de Santé des Armées (SSA), Microbes Vecteurs Infections Tropicales et Méditerranéennes (VITROME), Institut Hospitalo-Universitaire-Méditerranée Infection (IHU-Méditerranée Infection), Marseille, France.
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MERS: Progress on the global response, remaining challenges and the way forward. Antiviral Res 2018; 159:35-44. [PMID: 30236531 PMCID: PMC7113883 DOI: 10.1016/j.antiviral.2018.09.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 09/04/2018] [Indexed: 01/04/2023]
Abstract
This article summarizes progress in research on Middle East Respiratory Syndrome (MERS) since a FAO-OIE-WHO Global Technical Meeting held at WHO Headquarters in Geneva on 25-27 September 2017. The meeting reviewed the latest scientific findings and identified and prioritized the global activities necessary to prevent, manage and control the disease. Critical needs for research and technical guidance identified during the meeting have been used to update the WHO R&D MERS-CoV Roadmap for diagnostics, therapeutics and vaccines and a broader public health research agenda. Since the 2017 meeting, progress has been made on several key actions in animal populations, at the animal/human interface and in human populations. This report also summarizes the latest scientific studies on MERS since 2017, including data from more than 50 research studies examining the presence of MERS-CoV infection in dromedary camels.
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31
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Abstract
Purpose of Review Mass gatherings (MGs) are characterized by a high concentration of people at a specific time and location. Infectious diseases are of particular concern at MGs. The aim of this review was to summarize findings in the field of infectious diseases with a variety of pathogens associated with international MGs in the last 5 years. Recent Findings In the context of Hajj, one of the largest religious MGs at Mecca, Saudi Arabia, respiratory tract infections are the leading cause of infectious diseases in pilgrims with a prevalence of 50–93%. The most commonly acquired respiratory viruses were human rhinovirus, followed by human coronaviruses and influenza A virus, in decreasing order. Haemophilus influenzae, Staphylococcus aureus, and Streptococcus pneumoniae were the predominant bacteria. The prevalence of Hajj-related diarrhea ranged from 1.1 to 23.3% and etiologies included Salmonella spp., and Escherichia coli, with evidence of acquisition of antimicrobial-resistant bacteria. In other MGs such as Muslim, Christian, and Hindu religious events, sports events, and large-scale open-air festivals, outbreaks have been reported less frequently. The most common outbreaks at these events involved diseases preventable by vaccination, notably measles and influenza. Gastrointestinal infections caused by a variety of pathogens were also recorded. Summary Because social distancing and contact avoidance are difficult measures to implement in the context of many MGs, individual preventive measures including vaccination, use of face mask, disposable handkerchief and hand hygiene may be recommended. Nevertheless, the effectiveness of these measures has been poorly investigated in the context of MGs.
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Affiliation(s)
- Van-Thuan Hoang
- IRD, AP-HM, SSA, VITROME, Institut Hospitalo-Universitaire Méditerranée Infection, Aix Marseille University, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France.,Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Philippe Gautret
- IRD, AP-HM, SSA, VITROME, Institut Hospitalo-Universitaire Méditerranée Infection, Aix Marseille University, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France.
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Bleibtreu A, Jaureguiberry S, Houhou N, Boutolleau D, Guillot H, Vallois D, Lucet JC, Robert J, Mourvillier B, Delemazure J, Jaspard M, Lescure FX, Rioux C, Caumes E, Yazdanapanah Y. Clinical management of respiratory syndrome in patients hospitalized for suspected Middle East respiratory syndrome coronavirus infection in the Paris area from 2013 to 2016. BMC Infect Dis 2018; 18:331. [PMID: 30012113 PMCID: PMC6048819 DOI: 10.1186/s12879-018-3223-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 06/28/2018] [Indexed: 11/15/2022] Open
Abstract
Background Patients with suspected Middle East respiratory syndrome coronavirus (MERS-CoV) infection should be hospitalized in isolation wards to avoid transmission. This suspicion can also lead to medical confusion and inappropriate management of acute respiratory syndrome due to causes other than MERS-CoV. Methods We studied the characteristics and outcome of patients hospitalized for suspected MERS-CoV infection in the isolation wards of two referral infectious disease departments in the Paris area between January 2013 and December 2016. Results Of 93 adult patients (49 male (52.6%), median age 63.4 years) hospitalized, 82 out of 93 adult patients had returned from Saudi Arabia, and 74 of them were pilgrims (Hajj). Chest X-ray findings were abnormal in 72 (77%) patients. The 93 patients were negative for MERS-CoV RT-PCR, and 70 (75.2%) patients had documented infection, 47 (50.5%) viral, 22 (23.6%) bacterial and one Plasmodium falciparum malaria. Microbiological analysis identified Rhinovirus (27.9%), Influenza virus (26.8%), Legionella pneumophila (7.5%), Streptococcus pneumoniae (7.5%), and non-MERS-coronavirus (6.4%). Antibiotics were initiated in 81 (87%) cases, with two antibiotics in 63 patients (67.7%). The median duration of hospitalization and isolation was 3 days (1–33) and 24 h (8–92), respectively. Time of isolation decreased over time (P < 0.01). Two patients (2%) died. Conclusion The management of patients with possible MERS-CoV infection requires medical facilities with trained personnel, and rapid access to virological results. Empirical treatment with neuraminidase inhibitors and an association of antibiotics effective against S. pneumoniae and L. pneumophila are the cornerstones of the management of patients hospitalized for suspected MERS-CoV infection. Electronic supplementary material The online version of this article (10.1186/s12879-018-3223-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Bleibtreu
- APHP, Hôpital Bichat Claude Bernard, Service des Maladies Infectieuses et Tropicales, Paris Diderot University, Paris, France. .,APHP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Service des Maladies Infectieuses et Tropicales, Paris, France. .,INSERM, IAME, UMR 1137, Paris, France. .,Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France.
| | - S Jaureguiberry
- APHP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - N Houhou
- Virology Department, APHP-Bichat-Claude Bernard Hospital, Paris, France
| | - D Boutolleau
- AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Service de Virologie, et Sorbonne Universités, UPMC Univ Paris 06, CR7, CIMI, INSERM U1135, Paris, France
| | - H Guillot
- APHP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - D Vallois
- APHP, Hôpital Bichat Claude Bernard, Service des Maladies Infectieuses et Tropicales, Paris Diderot University, Paris, France
| | - J C Lucet
- APHP, Infection control unit, Bichat Claude Bernard hospital, Paris Diderot University, Paris, France.,INSERM, IAME, UMR 1137, Paris, France.,Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France
| | - J Robert
- AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Bactériologie-Hygiène Hospitalière, Paris, France.,Faculté de Médecine P. & M. Curie Paris-6 - Site Pitié, Centre d'Immunologie et des Maladies Infectieuses (CIMI) - E13, Paris, France
| | - B Mourvillier
- INSERM, IAME, UMR 1137, Paris, France.,Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France.,APHP- Hôpital Bichat Claude Bernard, Service de Réanimation médicale et Infectieuse, Paris, France
| | - J Delemazure
- Service de pneumologie et réanimation Département R3S, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, unité de Soin de Réadaptation Post Réanimation (SRPR), Paris, France
| | - M Jaspard
- APHP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - F X Lescure
- APHP, Hôpital Bichat Claude Bernard, Service des Maladies Infectieuses et Tropicales, Paris Diderot University, Paris, France.,INSERM, IAME, UMR 1137, Paris, France.,Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France
| | - C Rioux
- APHP, Hôpital Bichat Claude Bernard, Service des Maladies Infectieuses et Tropicales, Paris Diderot University, Paris, France
| | - E Caumes
- APHP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Y Yazdanapanah
- APHP, Hôpital Bichat Claude Bernard, Service des Maladies Infectieuses et Tropicales, Paris Diderot University, Paris, France.,INSERM, IAME, UMR 1137, Paris, France.,Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France
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Infectious Diseases and Preventive Measures During Hajj Mass Gatherings: A Review of the Literature. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2018. [DOI: 10.5812/archcid.62526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Al-Tawfiq JA, Benkouiten S, Memish ZA. A systematic review of emerging respiratory viruses at the Hajj and possible coinfection with Streptococcus pneumoniae. Travel Med Infect Dis 2018; 23:6-13. [PMID: 29673810 PMCID: PMC7110954 DOI: 10.1016/j.tmaid.2018.04.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/10/2018] [Accepted: 04/11/2018] [Indexed: 12/15/2022]
Abstract
Background The annual Hajj to the Kingdom of Saudi Arabia attracts millions of pilgrims from around the world. International health community's attention goes towards this mass gathering and the possibility of the development of any respiratory tract infections due to the high risk of acquisition of respiratory viruses. Method We searched MEDLINE/PubMed and Scopus databases for relevant papers describing the prevalence of respiratory viruses among Hajj pilgrims. Results The retrieved articles were summarized based on the methodology of testing for these viruses. A total of 31 studies were included in the quantitative/qualitative analyses. The main methods used for the diagnosis of most common respiratory viruses were polymerase chain reaction (PCR), culture and enzyme-linked immunosorbent assay (ELISA). Influenza, rhinovirus and parainfluenza were the most common viruses detected among pilgrims. Coronaviruses other than MERS-CoV were also detected among pilgrims. The acquisition of MERS-CoV remains very limited and systematic screening of pilgrims showed no infections. Conclusions Well conducted multinational follow-up studies using the same methodology of testing are necessary for accurate surveillance of respiratory viral infections among Hajj pilgrims. Post-Hajj cohort studies would further evaluate the impact of the Hajj on the acquisition of respiratory viruses.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- Specialty Internal Medicine Unit, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN 46202, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Samir Benkouiten
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Ziad A Memish
- Department of Medicine and Research, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Rollins School of Public Health, Emory University, Atlanta, GA, United States.
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35
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Lethbridge R, Prastanti F, Robertson C, Oo S, Khoo SK, Le Souëf PN, Laing IA. Prospective Assessment of Rhinovirus Symptoms and Species Recurrence in Children With and Without an Acute Wheezing Exacerbation. Viral Immunol 2018; 31:299-305. [PMID: 29446705 DOI: 10.1089/vim.2017.0152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
To assess if the difference in species-specific immune response to RV-C correlates with a higher frequency of reinfection, shorter time to reinfection, or different symptom severity than infections with RV-A or RV-B. Forty-three patients were enrolled of which 34 were successfully tracked longitudinally over 3 months, with nasal swabs and symptom questionnaires provided every 2 weeks to identify rhinovirus (RV) strains and the concurrent symptomatology. No difference was found in the time to reinfection with an RV species between RV-C and RV-A or RV-B (p = 0.866). There was a trend toward more rapid reinfection with the same species in RV-C than RV-A (55.1 days vs. 67.9 days), but this failed to reach statistical significance (p = 0.105). RV infections were generally associated with only minor symptoms, with rhinorrhea being the only significantly associated symptom (p = 0.01). RV-C was shown to have higher levels of lethargy and wheeze than other RV species. Time to reinfection with subsequent RV is not influenced by the species of the preceding RV.
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Affiliation(s)
- Robert Lethbridge
- School of Paediatrics and Child Health, University of Western Australia , Perth, Australia
| | - Franciska Prastanti
- School of Paediatrics and Child Health, University of Western Australia , Perth, Australia
| | - Cassandra Robertson
- School of Paediatrics and Child Health, University of Western Australia , Perth, Australia
| | - Stephen Oo
- School of Paediatrics and Child Health, University of Western Australia , Perth, Australia
| | - Siew-Kim Khoo
- School of Paediatrics and Child Health, University of Western Australia , Perth, Australia
| | - Peter N Le Souëf
- School of Paediatrics and Child Health, University of Western Australia , Perth, Australia
| | - Ingrid A Laing
- School of Paediatrics and Child Health, University of Western Australia , Perth, Australia
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Abstract
The mass gathering of people is a potential source for developing, propagating, and disseminating infectious diseases on a global scale. Of the illnesses associated with mass gatherings, respiratory tract infections are the most common, the most easily transmitted, and the most likely to be spread widely beyond the site of the meeting by attendees returning home. Many factors contribute to the spread of these infections during mass gatherings, including crowding, the health of the attendees, and the type and location of meetings. The annual Hajj in the Kingdom of Saudi Arabia is the largest recurring single mass gathering in the world. Every year more than 10 million pilgrims attend the annual Hajj and Umrah. Attendees assemble in confined areas for several days. People with a wide range of age, health, susceptibility to illness, and hygiene sophistication come in close contact, creating an enormous public health challenge. Controlling respiratory infections at the Hajj requires surveillance, rapid diagnostic testing, and containment strategies. Although the Hajj is without equal, other mass gatherings can generate similar hazards. The geographic colocalization of the Zika virus epidemic and the 2016 Summer Olympic Games in Brazil is a current example of great concern. The potential of international mass gatherings for local and global calamity calls for greater global attention and research.
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Ma X, Liu F, Liu L, Zhang L, Lu M, Abudukadeer A, Wang L, Tian F, Zhen W, Yang P, Hu K. No MERS-CoV but positive influenza viruses in returning Hajj pilgrims, China, 2013-2015. BMC Infect Dis 2017; 17:715. [PMID: 29126397 PMCID: PMC5681762 DOI: 10.1186/s12879-017-2791-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 10/04/2017] [Indexed: 11/24/2022] Open
Abstract
Background There is global health concern that the mass movement of pilgrims to and from Mecca annually could contribute to the international spread of Middle East Respiratory Syndrome Coronavirus (MERS-CoV). In China, about 11,000 Muslim pilgrims participate in the Hajj gathering in Mecca annually. This is the first report of MERS-CoV and respiratory virus molecular screening of returning pilgrims at points of entry in China from 2013 to 2015. Methods and results A total of 847 returning Hajj pilgrims participated in this study. The test results indicated that of the travelers, 34 tested positive for influenza A virus, 14 for influenza B virus, 4 for metapneumo virus, 2 for respiratory syncytial virus, and 3 for human coronavirus. There was a significant difference in the rates of positive and negative influenza virus tests between Hajj pilgrims with symptoms and those without. The detection rates of influenza virus were not significantly different among the three years studied, at 5.3, 6.0 and 6.3% for 2013, 2014 and 2015, respectively. Discussion and conclusion The MERS-CoV and respiratory viruses detection results at points of entry in China from 2013 to 2015 indicated that there were no MERS-CoV infection but a 5.7% positive influenza viruses in returning Chinese pilgrims.
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Affiliation(s)
- Xuezheng Ma
- Institute of Health Quarantine, Chinese Academy of Inspection and Quarantine, No. 11 Ronghua South St., Beijing, 100176, China
| | - Fang Liu
- Gansu International Travel Healthcare Center, Lanzhou, No.387 Jiayuguan E. Rd, Gansu, 730001, China
| | - Lijuan Liu
- Institute of Health Quarantine, Chinese Academy of Inspection and Quarantine, No. 11 Ronghua South St., Beijing, 100176, China
| | - Liping Zhang
- Institute of Health Quarantine, Chinese Academy of Inspection and Quarantine, No. 11 Ronghua South St., Beijing, 100176, China
| | - Mingzhu Lu
- Gansu International Travel Healthcare Center, Lanzhou, No.387 Jiayuguan E. Rd, Gansu, 730001, China
| | - Abuduzhayier Abudukadeer
- Xinjiang Entry-Exit Inspection and Quarantine Bureau, No. 237, Gaoxin St. Urumqi, Xinjiang, 830001, China
| | - Lingbing Wang
- Xinjiang Entry-Exit Inspection and Quarantine Bureau, No. 237, Gaoxin St. Urumqi, Xinjiang, 830001, China
| | - Feng Tian
- Xinjiang Entry-Exit Inspection and Quarantine Bureau, No. 237, Gaoxin St. Urumqi, Xinjiang, 830001, China
| | - Wei Zhen
- National Institute for Disease Control and Prevention, No.155, Changbai Rd., Beijing, 102206, China
| | - Pengfei Yang
- Huaian Center for Disease Control and Prevention, No. 84, Zhenhuailou E Rd., Jiangsu, 223200, China
| | - Kongxin Hu
- Institute of Health Quarantine, Chinese Academy of Inspection and Quarantine, No. 11 Ronghua South St., Beijing, 100176, China.
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Alfelali M, Khandaker G, Booy R, Rashid H. Mismatching between circulating strains and vaccine strains of influenza: Effect on Hajj pilgrims from both hemispheres. Hum Vaccin Immunother 2017; 12:709-15. [PMID: 26317639 DOI: 10.1080/21645515.2015.1085144] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The trivalent seasonal influenza vaccine is expected to provide optimum protection if the vaccine strains match the circulating strains. The effect of worldwide mismatch between the vaccine strains and extant strains on travelers attending Hajj pilgrimage is not known. Annually 2-3 million Muslims coming from north and south hemispheres congregate at Hajj in Mecca, Saudi Arabia, where intense congestion amplifies the risk of respiratory infection up to eight fold. In order to estimate, to what extent mismatching increases the risk of vaccine failure in Hajj pilgrims, we have examined the global data on influenza epidemiology since 2003, in light of the available data from Hajj. These data demonstrate that globally mismatching between circulating and vaccine strains has occurred frequently over the last 12 years, and the mismatch seems to have affected the Hajj pilgrims, however, influenza virus characteristics were studied only in a limited number of Hajj seasons. When the vaccines are different, dual vaccination of travelers by vaccines for southern and northern hemispheres should be considered for Hajj pilgrims whenever logistically feasible. Consideration should also be given to the use of vaccines with broader coverage, i.e., quadrivalent, or higher immunogenicity. Continuous surveillance of influenza at Hajj is important.
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Affiliation(s)
- Mohammad Alfelali
- a National Center for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead and the University of Sydney ; Sydney , NSW , Australia.,b Department of Family and Community Medicine ; Faculty of Medicine in Rabigh, King Abdulaziz University ; Jeddah , Saudi Arabia
| | - Gulam Khandaker
- a National Center for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead and the University of Sydney ; Sydney , NSW , Australia.,c Centre for Perinatal Infection Research, The Children's Hospital at Westmead and the University of Sydney ; Sydney , NSW , Australia.,d Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, The University of Sydney ; Sydney , NSW , Australia
| | - Robert Booy
- a National Center for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead and the University of Sydney ; Sydney , NSW , Australia.,d Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, The University of Sydney ; Sydney , NSW , Australia
| | - Harunor Rashid
- a National Center for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead and the University of Sydney ; Sydney , NSW , Australia.,d Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, The University of Sydney ; Sydney , NSW , Australia
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Al-Tawfiq JA, Gautret P, Memish ZA. Expected immunizations and health protection for Hajj and Umrah 2018 -An overview. Travel Med Infect Dis 2017; 19:2-7. [PMID: 29037978 PMCID: PMC7110709 DOI: 10.1016/j.tmaid.2017.10.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND The annual Hajj and Umrah are one of the largest recurring religious mass gatherings across the globe drawing pilgrims from more than 185 countries. The living circumstances and activities of the pilgrims may create an environment for the occurrence and spread of communicable diseases. Each year, the Health authority of the Kingdom of Saudi Arabia, in coordination with international health authorities, updates health requirements for pilgrims. The Hajj for 2017 took place from August 24 to September 5, 2017. Here, we review the expected obligations for immunizations for the 2018 Hajj and Umrah. RESULTS The Hajj and Umrah vaccine requirements include mandatory vaccinations against yellow fever, quadrivalent meningococcal polysaccharide (every 3 years) or conjugated (every 5 years) vaccines and poliomyelitis vaccine. Influenza vaccine utilizing the 2016 (Southern Hemisphere vaccine to all pilgrims) was recommended but was not obligatory for pilgrims. Ciprofloxacin is required for individuals >12 years excluding pregnant women as chemoprophylaxis to be given at the port of entry for Pilgrims coming from the meningitis belt. With the ongoing outbreaks of measles in Europe, it is recommended that all pilgrims have an updated immunization against vaccine-preventable diseases (diphtheria, tetanus, pertussis, polio, measles and mumps). CONCLUSION The mandatory vaccines remain the same with continued vigilance for the development of any new or emerging infectious diseases. Continuing surveillance for Zika virus, cholera and MERS-CoV are ongoing.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Philippe Gautret
- Unité de Recherche sur Les Maladies Infectieuses et Tropicales émergentes (URMITE) CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille-Université, Marseille, France
| | - Ziad A Memish
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Infectious Diseases Division, Department of Medicine, Prince Mohamed Bin Abdulaziz Hospital ("PMAH"), Ministry of Health, Riyadh, Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Multiple Sources of Genetic Diversity of Influenza A Viruses during the Hajj. J Virol 2017; 91:JVI.00096-17. [PMID: 28331081 DOI: 10.1128/jvi.00096-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/11/2017] [Indexed: 11/20/2022] Open
Abstract
Outbreaks of respiratory virus infection at mass gatherings pose significant health risks to attendees, host communities, and ultimately the global population if they help facilitate viral emergence. However, little is known about the genetic diversity, evolution, and patterns of viral transmission during mass gatherings, particularly how much diversity is generated by in situ transmission compared to that imported from other locations. Here, we describe the genome-scale evolution of influenza A viruses sampled from the Hajj pilgrimages at Makkah during 2013 to 2015. Phylogenetic analysis revealed that the diversity of influenza viruses at the Hajj pilgrimages was shaped by multiple introduction events, comprising multiple cocirculating lineages in each year, including those that have circulated in the Middle East and those whose origins likely lie on different continents. At the scale of individual hosts, the majority of minor variants resulted from de novo mutation, with only limited evidence of minor variant transmission or minor variants circulating at subconsensus level despite the likely identification of multiple transmission clusters. Together, these data highlight the complexity of influenza virus infection at the Hajj pilgrimages, reflecting a mix of global genetic diversity drawn from multiple sources combined with local transmission, and reemphasize the need for vigilant surveillance at mass gatherings.IMPORTANCE Large population sizes and densities at mass gatherings such as the Hajj (Makkah, Saudi Arabia) can contribute to outbreaks of respiratory virus infection by providing local hot spots for transmission followed by spread to other localities. Using a genome-scale analysis, we show that the genetic diversity of influenza A viruses at the Hajj gatherings during 2013 to 2015 was largely shaped by the introduction of multiple viruses from diverse geographic regions, including the Middle East, with only little evidence of interhost virus transmission at the Hajj and seemingly limited spread of subconsensus mutational variants. The diversity of viruses at the Hajj pilgrimages highlights the potential for lineage cocirculation during mass gatherings, in turn fuelling segment reassortment and the emergence of novel variants, such that the continued surveillance of respiratory pathogens at mass gatherings should be a public health priority.
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Goeijenbier M, van Genderen P, Ward BJ, Wilder-Smith A, Steffen R, Osterhaus ADME. Travellers and influenza: risks and prevention. J Travel Med 2017; 24:taw078. [PMID: 28077609 PMCID: PMC5505480 DOI: 10.1093/jtm/taw078] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Influenza viruses are among the major causes of serious human respiratory tract infection worldwide. In line with the high disease burden attributable to influenza, these viruses play an important, but often neglected, role in travel medicine. Guidelines and recommendations regarding prevention and management of influenza in travellers are scarce. Of special interest for travel medicine are risk populations and also circumstances that facilitate influenza virus transmission and spread, like travel by airplane or cruise ship and mass gatherings. METHODS We conducted a PUBMED/MEDLINE search for a combination of the MeSH terms Influenza virus, travel, mass gathering, large scale events and cruise ship. In addition we gathered guidelines and recommendations from selected countries and regarding influenza prevention and management in travellers. By reviewing these search results in the light of published knowledge in the fields of influenza prevention and management, we present best practice advice for the prevention and management of influenza in travel medicine. RESULTS Seasonal influenza is among the most prevalent infectious diseases in travellers. Known host-associated risk factors include extremes of age and being immune-compromised, while the most relevant environmental factors are associated with holiday cruises and mass gatherings. CONCLUSIONS Pre-travel advice should address influenza and its prevention for travellers, whenever appropriate on the basis of the epidemiological situation concerned. Preventative measures should be strongly recommended for travellers at high-risk for developing complications. In addition, seasonal influenza vaccination should be considered for any traveller wishing to reduce the risk of incapacitation, particularly cruise ship crew and passengers, as well as those participating in mass gatherings. Besides advice concerning preventive measures and vaccination, advice on the use of antivirals may be considered for some travellers.
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Affiliation(s)
- M Goeijenbier
- Institute for Tropical Diseases, Havenziekenhuis, Rotterdam, The Netherlands
| | - P van Genderen
- Institute for Tropical Diseases, Havenziekenhuis, Rotterdam, The Netherlands
| | - B J Ward
- Research institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - A Wilder-Smith
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Institute of Public Health, University of Heidelberg, Germany
| | - R Steffen
- Epidemiology, Biostatistics and Prevention Institute, WHO Collaborating Centre for Travelers Health, University of Zurich Travel Health Centre, Zurich, Switzerland
| | - A D M E Osterhaus
- ARTEMIS One Health Research Institute Utrecht, The Netherlands
- Research Center for Emerging Infections and Zoonoses (RIZ), University of Veterinary Medicine, Hannover, Germany
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Refaey S, Amin MM, Roguski K, Azziz-Baumgartner E, Uyeki TM, Labib M, Kandeel A. Cross-sectional survey and surveillance for influenza viruses and MERS-CoV among Egyptian pilgrims returning from Hajj during 2012-2015. Influenza Other Respir Viruses 2016; 11:57-60. [PMID: 27603034 PMCID: PMC5155725 DOI: 10.1111/irv.12429] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Approximately 80 000 Egyptians participate in Hajj pilgrimage annually. The purpose of this study was to estimate influenza virus and MERS-CoV prevalence among Egyptian pilgrims returning from Hajj. STUDY A cross-sectional survey among 3 364 returning Egyptian pilgrims from 2012 to 2015 was conducted. Nasopharyngeal (NP) and oropharyngeal (OP) swabs were collected from all participants. Sputum specimens were collected from participants with respiratory symptoms and productive cough at the time of their interview. Specimens were tested for influenza viruses, and a convenience sample of NP/OP specimens was tested for MERS-CoV. Thirty percent of participants met the case definition for influenza-like illness (ILI), 14% tested positive for influenza viruses, and none tested positive for MERS-CoV. Self-reported influenza vaccination was 20%. CONCLUSIONS High prevalence of reported ILI during pilgrimage and confirmed influenza virus on return from pilgrimage suggest a continued need for influenza prevention strategies for Egyptian Hajj pilgrims. An evaluation of the Ministry of Health and Population's current risk communication campaigns to increase influenza vaccine use among pilgrims may help identify strategies to improve vaccine coverage.
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Affiliation(s)
- Samir Refaey
- Egyptian Ministry of Health and Population (MOHP), Cairo, Egypt
| | | | - Katherine Roguski
- Influenza Division, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - Timothy M Uyeki
- Influenza Division, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Manal Labib
- Egyptian Ministry of Health and Population (MOHP), Cairo, Egypt
| | - Amr Kandeel
- Egyptian Ministry of Health and Population (MOHP), Cairo, Egypt
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Gautret P, Benkouiten S, Al-Tawfiq JA, Memish ZA. The spectrum of respiratory pathogens among returning Hajj pilgrims: myths and reality. Int J Infect Dis 2016; 47:83-5. [PMID: 26845442 PMCID: PMC7110688 DOI: 10.1016/j.ijid.2016.01.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 01/23/2016] [Accepted: 01/25/2016] [Indexed: 12/04/2022] Open
Abstract
Enhanced surveillance systems have been implemented recently in many countries in order to rapidly detect and investigate any possible cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection among travellers returning from the Middle East, including notably Hajj pilgrims. According to the available surveillance data, only a few sporadic travel-associated MERS-CoV cases have been reported outside the Arabian Peninsula so far, mainly in Europe, North Africa, and Asia. These have resulted in no cases, or limited numbers of secondary cases except in Korea. The vast majority of viral respiratory infections in pilgrims returning home have been due to seasonal influenza viruses, rhinoviruses, and other known coronaviruses distinct from the MERS coronavirus. Influenza vaccination should be a priority for all Hajj pilgrims, as recommended by experts.
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Affiliation(s)
- Phillipe Gautret
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France.
| | - Samir Benkouiten
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Jaffar A Al-Tawfiq
- Johns Hopkins Aramco Healthcare, Dhahran, Kingdom of Saudi Arabia; Indiana University School of Medicine, Indianapolis, USA
| | - Ziad A Memish
- Ministry of Health, Riyadh, College of Medicine, Al Faisal University, Kingdom of Saudi Arabia
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Al-Tawfiq JA, Omrani AS, Memish ZA. Middle East respiratory syndrome coronavirus: current situation and travel-associated concerns. Front Med 2016; 10:111-9. [PMID: 27146399 PMCID: PMC7089395 DOI: 10.1007/s11684-016-0446-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 03/21/2016] [Indexed: 01/05/2023]
Abstract
The emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012 brought back memories of the occurrence of severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002. More than 1500 MERS-CoV cases were recorded in 42 months with a case fatality rate (CFR) of 40%. Meanwhile, 8000 cases of SARS-CoV were confirmed in six months with a CFR of 10%. The clinical presentation of MERS-CoV ranges from mild and non-specific presentation to progressive and severe pneumonia. No predictive signs or symptoms exist to differentiate MERS-CoV from community-acquired pneumonia in hospitalized patients. An apparent heterogeneity was observed in transmission. Most MERS-CoV cases were secondary to large outbreaks in healthcare settings. These cases were secondary to community-acquired cases, which may also cause family outbreaks. Travel-associated MERS infection remains low. However, the virus exhibited a clear tendency to cause large outbreaks outside the Arabian Peninsula as exemplified by the outbreak in the Republic of Korea. In this review, we summarize the current knowledge about MERS-CoV and highlight travel-related issues.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- Johns Hopkins Aramco Healthcare, Dhahran, 31311, Kingdom of Saudi Arabia.,Indiana University School of Medicine, Indianapolis, IN, 46202-3082, USA
| | - Ali S Omrani
- Department of Medicine, Section of Infectious Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Kingdom of Saudi Arabia
| | - Ziad A Memish
- Ministry of Health, Riyadh, 11514, Kingdom of Saudi Arabia. .,College of Medicine, Alfaisal University, Riyadh, 11533, Kingdom of Saudi Arabia.
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Erdem H, Ak O, Elaldi N, Demirdal T, Hargreaves S, Nemli SA, Cag Y, Ulug M, Naz H, Gunal O, Sirmatel F, Sipahi OR, Alpat SN, Ertem-Tuncer G, Sozen H, Evlice O, Meric-Koc M, Dogru A, Koksaldi-Motor V, Tekin R, Ozdemir D, Ozturk-Engin D, Savasci U, Karagoz E, Cekli Y, Inan A. Infections in travellers returning to Turkey from the Arabian peninsula: a retrospective cross-sectional multicenter study. Eur J Clin Microbiol Infect Dis 2016; 35:903-10. [PMID: 26964538 PMCID: PMC7087946 DOI: 10.1007/s10096-016-2614-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/17/2016] [Indexed: 11/17/2022]
Abstract
Mass gatherings pooling people from different parts of the world—the largest of which is to Mecca, Saudi Arabia, for Hajj—may impose risks for acquisition and dissemination of infectious diseases. A substantial number of pilgrims to Hajj and Umrah are Turkish citizens (456,000 in 2014) but data are lacking on scale of the problem. We did a retrospective cross-sectional multicenter study in Turkey to explore the range of infections among inpatients who had recently returned from the Arabian Peninsula. Our inclusion criteria were patients who had acquired an infection during their trip to an Arabian Peninsula country, or who became symptomatic within 1 week of their return. The data were collected retrospectively for January 1, 2013 and March 1, 2015. 185 Turkish patients were recruited to the study across 15 referral centers with travel associated infectious diseases after returning from Arabian Peninsula countries (predominantly Saudi Arabia 163 [88.1 %] for religious purposes 162 [87.5 %]). Seventy four (40.0 %) of them were ≥ 65 years old with numerous comorbidities including diabetes (24.3 %) and COPD (14.1 %). The most common clinical diagnosis was respiratory tract infections (169 [91.5 %]), followed by diarrheal diseases (13 [7 %]), and there was one case of MERS-CoV. Patients spent a median of 5 (3–7) days as hospital inpatients and overall mortality was 1.1 %. Returning travellers from the Arabian Peninsula present as inpatients with a broad range of infectious diseases similar to common community acquired infections frequently seen in daily medical practices in Turkey.
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Affiliation(s)
- H Erdem
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey.
| | - O Ak
- Department of Infectious Diseases and Clinical Microbiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - N Elaldi
- Department of Infectious Diseases and Clinical Microbiology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - T Demirdal
- Department of Infectious Diseases and Clinical Microbiology, Katip Celebi University School of Medicine, Izmir, Turkey
| | - S Hargreaves
- International Health Unit, Section of Infectious Diseases and Immunity, Imperial College London, Commonwealth Building, Hammersmith Campus, London, UK
| | - S A Nemli
- Department of Infectious Diseases and Clinical Microbiology, Katip Celebi University School of Medicine, Izmir, Turkey
| | - Y Cag
- Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Istanbul, Turkey
| | - M Ulug
- Department of Infectious Diseases and Clinical Microbiology, Private Umit Hospital, Eskisehir, Turkey
| | - H Naz
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli State Hospital, Kocaeli, Turkey
| | - O Gunal
- Department of Infectious Diseases and Clinical Microbiology, Samsun Training and Research Hospital, Samsun, Turkey
| | - F Sirmatel
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Abant Izzet Baysal University, Bolu, Turkey
| | - O R Sipahi
- Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, Izmir, Turkey
| | - S N Alpat
- Department of Infectious Diseases and Clinical Microbiology, Osmangazi University School of Medicine, Eskisehir, Turkey
| | - G Ertem-Tuncer
- Department of Infectious Diseases and Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - H Sozen
- Department of Infectious Diseases and Clinical Microbiology, Mugla Sitki Kocman University School of Medicine, Mugla, Turkey
| | - O Evlice
- Department of Infectious Diseases and Clinical Microbiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - M Meric-Koc
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli University School of Medicine, Izmit, Turkey
| | - A Dogru
- Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Istanbul, Turkey
| | - V Koksaldi-Motor
- Tayfur Ata Sokmen School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Mustafa Kemal University, Hatay, Turkey
| | - R Tekin
- Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - D Ozdemir
- Department of Infectious Diseases and Clinical Microbiology, Duzce University School of Medicine, Konuralp, Duzce, Turkey
| | - D Ozturk-Engin
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - U Savasci
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey
| | - E Karagoz
- Department of Infectious Diseases and Clinical Microbiology, Military Hospital, Van, Turkey
| | - Y Cekli
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey
| | - A Inan
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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Gautret P, Benkouiten S, Al-Tawfiq JA, Memish ZA. Hajj-associated viral respiratory infections: A systematic review. Travel Med Infect Dis 2016; 14:92-109. [PMID: 26781223 PMCID: PMC7110587 DOI: 10.1016/j.tmaid.2015.12.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 12/14/2015] [Accepted: 12/22/2015] [Indexed: 12/28/2022]
Abstract
Respiratory tract infections (RTI) are the most common infections transmitted between Hajj pilgrims. The aim of this systematic review was to determine the prevalence of virus carriage potentially responsible for RTI among pilgrims before and after participating in the Hajj. A systematic search for relevant literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. 31 studies were identified. Severe Acute Respiratory Syndrome coronavirus and Middle East Respiratory Syndrome coronavirus (MERS) were never isolated in Hajj pilgrims. The viruses most commonly isolated from symptomatic patients during the Hajj by PCR were rhinovirus (5.9-48.8% prevalence), followed by influenza virus (4.5-13.9%) and non-MERS coronaviruses (2.7-13.2%) with most infections due to coronavirus 229E; other viruses were less frequently isolated. Several viruses including influenza A, rhinovirus, and non-MERS coronaviruses had low carriage rates among arriving pilgrims and a statistically significant increase in their carriage rate was observed, following participation in the Hajj. Further research is needed to assess the role of viruses in the pathogenesis of respiratory symptoms and their potential role in the severity of the symptoms.
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Affiliation(s)
- Phillipe Gautret
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France.
| | - Samir Benkouiten
- Institut Hospitalo-Universitaire Méditerranée Infection, 13005 Marseille, France
| | - Jaffar A Al-Tawfiq
- Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, USA
| | - Ziad A Memish
- Ministry of Health, Riyadh, College of Medicine, Al Faisal University, Saudi Arabia
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Hashim S, Ayub ZN, Mohamed Z, Hasan H, Harun A, Ismail N, Rahman ZA, Suraiya S, Naing NN, Aziz AA. The prevalence and preventive measures of the respiratory illness among Malaysian pilgrims in 2013 Hajj season. J Travel Med 2016; 23:tav019. [PMID: 26858268 PMCID: PMC7107508 DOI: 10.1093/jtm/tav019] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Respiratory illness continues to exert a burden on hajj pilgrims in Makkah. The purpose of this study is to determine the prevalence of respiratory illness and its associated factors among Malaysian hajj pilgrims in 2013 and to describe its preventive measures. METHODS A cross-sectional study was conducted in Makkah and Malaysia during the 2013 hajj season. A self-administered proforma on social demographics, previous experience of hajj or umrah, smoking habits, co-morbid illness and practices of preventive measures against respiratory illness were obtained. RESULTS A total of 468 proforma were analysed. The prevalence of the respiratory illness was 93.4% with a subset of 78.2% fulfilled the criteria for influenza-like illness (ILI). Most of them (77.8%) had a respiratory illness of <2 weeks duration. Approximately 61.8% were administered antibiotics but only 2.1% of them had been hospitalized. Most of them acquired the infection after a brief stay at Arafat (81.2%). Vaccination coverages for influenza virus and pneumococcal disease were quite high, 65.2% and 59.4%, respectively. For other preventive measures practices, only 31.8% of them practiced good hand hygiene, ∼82.9% of pilgrims used surgical face masks, N95 face masks, dry towels, wet towels or veils as their face masks. Nearly one-half of the respondents (44.4%) took vitamins as their food supplement. Malaysian hajj pilgrims with previous experience of hajj (OR 0.24; 95% CI 0.10-0.56) or umrah (OR 0.19; 95% CI 0.07-0.52) and those who have practiced good hand hygiene (OR 0.35; 95% CI 0.16-0.79) were found to be significantly associated with lower risk of having respiratory illness. Otherwise, pilgrims who had contact with those with respiratory illness (OR 2.61; 95% CI 1.12-6.09) was associated with higher risk. CONCLUSIONS The prevalence of respiratory illness remains high among Malaysian hajj pilgrims despite having some practices of preventive measures. All preventive measures which include hand hygiene, wearing face masks and influenza vaccination must be practiced together as bundle of care to reduce respiratory illness effectively.
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Affiliation(s)
- Suhana Hashim
- Department of Medical Microbiology and Parasitology and
| | - Zeti N Ayub
- Department of Medical Microbiology and Parasitology and
| | | | - Habsah Hasan
- Department of Medical Microbiology and Parasitology and
| | - Azian Harun
- Department of Medical Microbiology and Parasitology and
| | | | | | - Siti Suraiya
- Department of Medical Microbiology and Parasitology and
| | - Nyi Nyi Naing
- Biostatistic and Research Methodology Unit, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian Kelantan, Malaysia and
| | - Aniza A Aziz
- Faculty of Medicine & Health Sciences, Kota Campus, Universiti Sultan Zainal Abidin, Jalan Sultan Mahmud 20400 Kuala Terengganu, Terengganu
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Circulation of respiratory pathogens at mass gatherings, with special focus on the Hajj pilgrimage. THE MICROBIOLOGY OF RESPIRATORY SYSTEM INFECTIONS 2016. [PMCID: PMC7150026 DOI: 10.1016/b978-0-12-804543-5.00006-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Bats have been recognized as the natural reservoirs of a large variety of viruses. Special attention has been paid to bat coronaviruses as the two emerging coronaviruses which have caused unexpected human disease outbreaks in the 21st century, Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and Middle East Respiratory Syndrome Coronavirus (MERS-CoV), are suggested to be originated from bats. Various species of horseshoe bats in China have been found to harbor genetically diverse SARS-like coronaviruses. Some strains are highly similar to SARS-CoV even in the spike protein and are able to use the same receptor as SARS-CoV for cell entry. On the other hand, diverse coronaviruses phylogenetically related to MERS-CoV have been discovered worldwide in a wide range of bat species, some of which can be classified to the same coronavirus species as MERS-CoV. Coronaviruses genetically related to human coronavirus 229E and NL63 have been detected in bats as well. Moreover, intermediate hosts are believed to play an important role in the transmission and emergence of these coronaviruses from bats to humans. Understanding the bat origin of human coronaviruses is helpful for the prediction and prevention of another pandemic emergence in the future.
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Omrani A, Shalhoub S. Middle East respiratory syndrome coronavirus (MERS-CoV): what lessons can we learn? J Hosp Infect 2015. [DOI: 10.1016/j.jhin.2015.08.002 0195-6701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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