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Alhajaji R, Al Sulaiman K, Abdelwahab OA, Alfahmi M, Abualenain JT, Asiri SI, Aljuhani O, Alharbi A, Alkofide H, Ahmed M, Saeedi AY, Alturkistani A, Al-Jedai A. Effectiveness of Face Mask for Prevention of Respiratory Tract Infection during Hajj: A Systematic Review and Meta-Analysis. Am J Trop Med Hyg 2024; 111:914-923. [PMID: 39084213 PMCID: PMC11448512 DOI: 10.4269/ajtmh.23-0667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/31/2024] [Indexed: 08/02/2024] Open
Abstract
The Hajj is an annual mass gathering of people in Makkah, Saudi Arabia. Respiratory infections are common due to their potential for rapid spread in crowded settings. There is a lack of data regarding the effectiveness of face masks in preventing respiratory tract infections (RTIs), specifically during Hajj. We systematically searched PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials until July 3, 2023 for studies comparing the incidence or prevalence of RTIs in those who used any face mask during Hajj compared with no mask. Risk ratio (RRs) and 95% CIs were calculated using either a fixed or random-effect model, depending on the heterogeneity. A comprehensive analysis encompassed 10 studies involving 5007 participants. The overall RR favored wearing masks over not wearing masks regarding the incidence of RTIs; however, the difference was not statistically significant (RR = 0.78; 95% CI = 0.55-1.10; P = 0.16). A significantly lower incidence of RTIs was found in those wearing masks most of the time versus intermittently (RR = 0.59; 95% CI = [0.38-0.94; P = 0.02). In subgroup analyses, there was no difference between wearing masks and not wearing masks across different study designs (cohort/case-control), different groups (pilgrims/healthcare workers), and different years of Hajj, except from 2000 to 2008, when there was a significant difference favoring wearing face masks. This meta-analysis found wearing masks most of the time was associated with significantly lower risk of RTIs than wearing it intermittently.
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Affiliation(s)
- Raghad Alhajaji
- Public Health Administration, Makkah Health Affairs, Ministry of Health, Makkah, Saudi Arabia
- Alhajj Primary Health Care, Makkah Health Cluster, Makkah, Saudi Arabia
| | - Khalid Al Sulaiman
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Saudi Critical Care Pharmacy Research (SCAPE) Platform, Riyadh, Saudi Arabia
- Saudi Society for Multidisciplinary Research Development and Education (SCAPE Society), Riyadh, Saudi Arabia
| | - Omar A. Abdelwahab
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Medical Research Group of Egypt, Cairo, Egypt
| | - Manal Alfahmi
- Clinical Research Administration at the Executive Administration of Research and Innovation, King Abdullah Medical City (KAMC), Makkah, Saudi Arabia
- Executive Administration of Research and Innovation, King Abdullah Medical City (KAMC), Makkah, Saudi Arabia
- King Abdullah Medical City (KAMC) Medical Ethics Committee, Makkah, Saudi Arabia
| | - Jameel T. Abualenain
- General Directorate of Emergencies, Disasters, & Medical Transportation, Deputyship of Curative Services, Ministry of Health, Riyadh, Saudi Arabia
- Department of Emergency Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sari I. Asiri
- Public Health Administration, Makkah Health Affairs, Ministry of Health, Makkah, Saudi Arabia
- The General Directorate of Hajj and Umrah, Ministry of Health, Riyadh, Saudi Arabia
| | - Ohoud Aljuhani
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Aisha Alharbi
- Pharmaceutical Care Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Hadeel Alkofide
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Malaz Ahmed
- Public Health Administration, Makkah Health Affairs, Ministry of Health, Makkah, Saudi Arabia
| | - Ahmed Y. Saeedi
- Public Health Administration, Makkah Health Affairs, Ministry of Health, Makkah, Saudi Arabia
- The General Directorate of Hajj and Umrah, Ministry of Health, Riyadh, Saudi Arabia
| | - Ahmad Alturkistani
- Public Health Administration, Makkah Health Affairs, Ministry of Health, Makkah, Saudi Arabia
- The General Directorate of Hajj and Umrah, Ministry of Health, Riyadh, Saudi Arabia
| | - Ahmed Al-Jedai
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia
- Colleges of Medicine and Pharmacy, Al-Faisal University, Riyadh, Saudi Arabia
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Mahomed O, Jaffer MN, Parker S. Morbidity amongst South African Hajj pilgrims in 2023-a retrospective cohort study. Sci Rep 2024; 14:12622. [PMID: 38824134 PMCID: PMC11144184 DOI: 10.1038/s41598-024-62682-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 05/20/2024] [Indexed: 06/03/2024] Open
Abstract
South Africans are not accustomed to the dry arid climate and sweltering heat in Saudi Arabia. We conducted a retrospective cohort study to identify the common health conditions pre-Hajj, during the 5 days of Hajj and on return to South Africa from Hajj amongst the 2023 pilgrims. A QR code and a mobile link to a self-administered questionnaire was sent to all 3500 South African pilgrims. Five hundred and seventy-seven pilgrims returned the completed surveys. Mean age of the participants was 48 years (SD 12) with a higher female representation (3:2). Forty eight percent (279) had pre-existing chronic conditions. Forty five percent (259) reported being ill during their stay in the Kingdom, 20% (115) reported having an illness during the main 5 days, whilst 51% (293) reported having an illness within 7 days of returning to South Africa. Only six pilgrims were admitted to hospital after their return home. Respiratory tract linked symptoms were the most frequently reported (95% pre Hajj and 99% post Hajj). Participants who reported having a chronic condition (AOR 1.52 95% CI 1.09-2.11) and engaging in independent exercising prior to Hajj (AOR 1.52-1.07-2.10) were at an increased likelihood of developing an illness within 7 days of returning home. Post travel surveillance swabs to identify potential pathogens that the returning pilgrims are incubating should be explored to guide further interventions.
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Affiliation(s)
- Ozayr Mahomed
- Discipline of Public Health Medicine, University of KwaZulu-Natal Nelson Mandela School of Medicine, George Campbell Building, Howard College Campus, Durban, South Africa.
| | | | - Salim Parker
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
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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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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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Risk factors for symptoms of infection and the acquisition of pathogens among pilgrims at the Grand Magal of Touba, 2017–2021. Travel Med Infect Dis 2022; 49:102418. [DOI: 10.1016/j.tmaid.2022.102418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/28/2022] [Accepted: 07/31/2022] [Indexed: 01/07/2023]
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Mahdi HA, Rashid H, Qashqari FS, Hariri SH, Marglani OA, Barasheed O, Albutti A, Alwashmi AS, Shaban RZ, Booy R, Alfelali M. Syndromic surveillance of respiratory-tract infections and hand hygiene practice among pilgrims attended Hajj in 2021: a cohort study. BMC Infect Dis 2022; 22:578. [PMID: 35761226 PMCID: PMC9238003 DOI: 10.1186/s12879-022-07559-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/16/2022] [Indexed: 12/15/2022] Open
Abstract
Background The risk of transmission of viral respiratory tract infections (RTIs) is high in mass gatherings including Hajj. This cohort study estimated the incidence of symptomatic RTIs and hand hygiene compliance with its impact among Hajj pilgrims during the COVID-19 pandemic. Methods During the week of Hajj rituals in 2021, domestic pilgrims were recruited by phone and asked to complete a baseline questionnaire. Pilgrims were followed up after seven days using a questionnaire about the development of symptoms, and practices of hand hygiene. Syndromic definitions were used to clinically diagnose ‘possible’ influenza-like illnesses (ILI) and COVID-19 infection. Results A total of 510 pilgrims aged between 18 and 69 (median of 50) years completed the questionnaire, 280 (54.9%) of whom were female, and all of them (except for one) were vaccinated against COVID-19 with at least one dose. The mean (± SD) of pilgrims’ hand hygiene knowledge score (on a scale of 0 to 6) was 4.15 (± 1.22), and a higher level of knowledge was correlated with a higher frequency of handwashing using soap and water. Among those 445 pilgrims who completed the follow-up form, 21 (4.7%) developed one or more respiratory symptoms, of which sore throat and cough were the commonest (respectively 76.2% and 42.8%); ‘possible ILI’ and ‘possible COVID-19’ were present in 1.1% and 0.9% of pilgrims. Obesity was found to be a significant factor associated with the risk of developing RTIs (odds ratio = 4.45, 95% confidence interval 1.15–17.13). Conclusions Hajj pilgrims are still at risk of respiratory infections. Further larger and controlled investigations are needed to assess the efficacy of hand hygiene during Hajj.
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Hand Hygiene Knowledge, Perception, and Practices among Domestic Visitors to the Prophet's Mosque in Al Madinah City Amid the COVID-19 Pandemic: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020673. [PMID: 33466858 PMCID: PMC7830769 DOI: 10.3390/ijerph18020673] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 12/23/2022]
Abstract
This study aimed to assess hand hygiene knowledge, perception, and practices of visitors to the Prophet’s Mosque in Al Madinah City, Saudi Arabia. Using a self-administered electronic questionnaire, a cross-sectional survey was conducted among domestic residents, who visited the mosque between 31 July and 3 August 2020. Participants’ demographic data, hand hygiene knowledge, perception, and practices were collected. Four hundred participants aged 18–65 (median 36) years completed the survey, of which 215 (53.8%) were female. The visitors’ mean knowledge score about hand hygiene was 6.4 (± standard deviation (SD) 1.35) of total 12. Most participants (392, 98%) were aware of the role of hand hygiene in preventing Coronavirus Disease 2019 (COVID-19); nevertheless, 384 (96%) said hand hygiene lowers body immunity and 316 (79%) thought <60% alcohol is sufficient for hand disinfection. Males had a higher knowledge score than females (6.46 (±1.41) vs. 6.14 (±1.27), p = 0.02) and, visitors who had no formal education scored higher than those with post-graduate education (6.88 (±1.45) vs 5.73 (±1.12), p = 0.01). Washing hands with soap and water was the predominant method practiced after a meal (365, 91.7%), after toilet visit (354, 88.5%), after touching a surface (262, 65.7%), after waste disposal (332, 83.2%), and when hands were visibly dirty (357, 89.5%). Al Madinah visitors had moderate knowledge about hand hygiene, but demonstrated some knowledge gaps and negligence in practice that are crucial to curb the spread of COVID-19.
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