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Bokhary H, Rashid H, Hill-Cawthorne GA, Abd El Ghany M. The Rise of Antimicrobial Resistance in Mass Gatherings. HANDBOOK OF HEALTHCARE IN THE ARAB WORLD 2021:1199-1214. [DOI: 10.1007/978-3-030-36811-1_47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Gastrointestinal symptoms and the acquisition of enteric pathogens in Hajj pilgrims: a 3-year prospective cohort study. Eur J Clin Microbiol Infect Dis 2020; 40:315-323. [PMID: 32918166 DOI: 10.1007/s10096-020-04018-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
The acquisition of enteric pathogens and risk factors for Hajj-associated diarrhea in Hajj pilgrims is poorly documented. Pilgrims from Marseille participating in the Hajj in 2016-2018 underwent successive systematic rectal swabbing before and after their travel. Carriage of the main enteric pathogens was assessed by real-time PCR. Baseline demographics, adherence to individual preventive measures, gastrointestinal symptoms, and treatments were recorded. A total of 376 pilgrims were included. The median age was 62.0 years. During the Hajj, 18.6% presented at least one gastrointestinal symptom, 13.8% had diarrhea, and 36.4% had acquired at least one enteric pathogen. Enteropathogenic Escherichia coli (EPEC) and Enteroaggregative E. coli (EAEC) were the pathogens most frequently acquired by pilgrims (17.6% and 14.4%, respectively). Being female was associated with increased frequency of gastrointestinal symptoms during the pilgrimage (aOR = 2.38, p = 0.004). Enterohemorrhagic Escherichia coli (EHEC) acquisition was associated with a four-fold higher risk of reporting at least one gastrointestinal symptom and diarrhea (aOR = 3.68 and p = 0.01 and aOR = 3.96 and p = 0.01, respectively). Pilgrims who suffered from diarrhea were more likely to wash their hands more often (aOR = 2.07, p = 0.03) and to be either overweight (aOR = 2.71, p = 0.03) or obese (aOR = 2.51, p = 0.05). Enteric bacteria such as E. coli that are frequently associated with traveler's diarrhea due to the consumption of contaminated food and drink were frequently found in pilgrims. Respecting strict measures regarding food and water quality during the Hajj and adherence to preventive measures such as good personal hygiene and environmental management will help reduce the burden of gastrointestinal infections at the event.
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Bokhary H, Rashid H, Hill-Cawthorne GA, Abd El Ghany M. The Rise of Antimicrobial Resistance in Mass Gatherings. HANDBOOK OF HEALTHCARE IN THE ARAB WORLD 2020:1-16. [DOI: 10.1007/978-3-319-74365-3_47-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/15/2019] [Indexed: 09/01/2023]
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Karampourian A, Ghomian Z, Khorasani-Zavareh D. Exploring challenges of health system preparedness for communicable diseases in Arbaeen mass gathering: a qualitative study. F1000Res 2018; 7:1448. [PMID: 30473777 PMCID: PMC6234742 DOI: 10.12688/f1000research.15290.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Infectious diseases are common problems in mass gatherings, especially when there is a lack of health system preparedness. Since Iran is one of the most important countries on the walking path of Arbaeen and has a vital role in providing health services to pilgrims, the experiences of health challenges by participants is of key importance. The aim of this study is to explore stakeholders' experiences on the health system's preparedness and challenges, and to provide suggestions for preventing infectious diseases during the Arbaeen mass gathering. Methods: A qualitative research method was used with a conventional content analysis approach. The number of participants was 17, including 13 executive managers and 4 health policymakers who entered the study among participants. Semi-structured interviews were used to generate the data. Interviews were analyzed by means of content analysis after face-to-face interviews. Results: Data analysis resulted in the extraction of four main themes and 11 sub-themes. Health infrastructure defects in Iraq has three sub-themes (health abandonment in Iraq, the weaknesses in health culture and problems related to the health system); poor control of the causative factors of infectious diseases has three sub-themes (the underlying factors of the prevalence of contagious diseases, health system response to communicable diseases and ignoring the risks of the Arbaeen ceremony); the low perception of risk in pilgrims has three sub-themes (lack of awareness in pilgrims, fatalism in pilgrims and unhygienic belief in pilgrims); and the ineffectiveness of health education has two sub-themes (training shortage in the targeted group and educational content problems) that shows participant's experiences of the health system's challenges for coping with infectious diseases during the Arbaeen ceremony. Conclusion: Pilgrim-based training, planning and controlling other challenges may change these threats to opportunities and improve the health of participants of the mass gathering of Arbaeen in the region.
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Affiliation(s)
- Arezou Karampourian
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, 198353-5511, Iran
| | - Zohreh Ghomian
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, 198353-5511, Iran
| | - Davoud Khorasani-Zavareh
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, 198353-5511, Iran
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, 198353-5511, Iran
- Department of Clinical Sciences and Education, Karolinska Institute, Stockholm, 202100-2973, Sweden
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Abstract
Purpose of Review Mass gatherings (MGs) are characterized by a high concentration of people at a specific time and location. Infectious diseases are of particular concern at MGs. The aim of this review was to summarize findings in the field of infectious diseases with a variety of pathogens associated with international MGs in the last 5 years. Recent Findings In the context of Hajj, one of the largest religious MGs at Mecca, Saudi Arabia, respiratory tract infections are the leading cause of infectious diseases in pilgrims with a prevalence of 50–93%. The most commonly acquired respiratory viruses were human rhinovirus, followed by human coronaviruses and influenza A virus, in decreasing order. Haemophilus influenzae, Staphylococcus aureus, and Streptococcus pneumoniae were the predominant bacteria. The prevalence of Hajj-related diarrhea ranged from 1.1 to 23.3% and etiologies included Salmonella spp., and Escherichia coli, with evidence of acquisition of antimicrobial-resistant bacteria. In other MGs such as Muslim, Christian, and Hindu religious events, sports events, and large-scale open-air festivals, outbreaks have been reported less frequently. The most common outbreaks at these events involved diseases preventable by vaccination, notably measles and influenza. Gastrointestinal infections caused by a variety of pathogens were also recorded. Summary Because social distancing and contact avoidance are difficult measures to implement in the context of many MGs, individual preventive measures including vaccination, use of face mask, disposable handkerchief and hand hygiene may be recommended. Nevertheless, the effectiveness of these measures has been poorly investigated in the context of MGs.
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Affiliation(s)
- Van-Thuan Hoang
- IRD, AP-HM, SSA, VITROME, Institut Hospitalo-Universitaire Méditerranée Infection, Aix Marseille University, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France.,Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Philippe Gautret
- IRD, AP-HM, SSA, VITROME, Institut Hospitalo-Universitaire Méditerranée Infection, Aix Marseille University, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France.
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Soltan Dallal MM, Motalebi S, Masoomi Asl H, Rahimi Forushani A, Kalantar E. Burden of Food-Related Illness Caused by Resistant Salmonella spp. and Shigella spp.: Harbingers of Multistate Outbreaks in 2012 and 2013. INTERNATIONAL JOURNAL OF ENTERIC PATHOGENS 2015. [DOI: 10.17795/ijep29276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Gautret P, Benkouiten S, Sridhar S, Al-Tawfiq JA, Memish ZA. Diarrhea at the Hajj and Umrah. Travel Med Infect Dis 2015; 13:159-66. [PMID: 25765485 DOI: 10.1016/j.tmaid.2015.02.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 02/20/2015] [Accepted: 02/22/2015] [Indexed: 10/23/2022]
Abstract
This systematic review aims to summarize the incidence and etiology of diarrheal illness among pilgrims attending the Hajj and Umrah. Gastroenteritis and diarrhea have been potential threats during previous Hajj pilgrimages. The last cases of Hajj related cholera were reported in 1989. Currently, respiratory tract infections account for the majority of health problems during the Hajj. This shift in epidemiology reflects the improvement of sanitary conditions in Saudi Arabia in general, and at religious sites in particular. Nevertheless, gastrointestinal diseases, food-poisoning outbreaks, and diarrhea continue to occur among pilgrims. Available studies about diarrhea among Hajj pilgrims indicate a mean prevalence of 2% with the highest prevalence of 23% among a group of French pilgrims in 2013. There is an obvious lack of information about the etiology of diarrheal disease at the Hajj. Further studies addressing this issue in hospitalized patients as well as prospective cohort studies would be of interest. During the Hajj, hand washing is regularly carried out by pilgrims under a ritual purification, often called ablution. We recommend implementation of effective hand hygiene practices focusing on the regular use of alcohol-based hand rubs, as they require less time than traditional hand washing, act more rapidly, and contribute to sustained improvement in compliance associated with decreased infection rates.
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Affiliation(s)
- Philippe Gautret
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, 13005 Marseille, France.
| | - Samir Benkouiten
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, 13005 Marseille, France
| | - Shruti Sridhar
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; 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, IN, USA
| | - Ziad A Memish
- Ministry of Health, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Memish ZA, Zumla A, Alhakeem RF, Assiri A, Turkestani A, Al Harby KD, Alyemni M, Dhafar K, Gautret P, Barbeschi M, McCloskey B, Heymann D, Al Rabeeah AA, Al-Tawfiq JA. Hajj: infectious disease surveillance and control. Lancet 2014; 383:2073-2082. [PMID: 24857703 PMCID: PMC7137990 DOI: 10.1016/s0140-6736(14)60381-0] [Citation(s) in RCA: 212] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Religious festivals attract a large number of pilgrims from worldwide and are a potential risk for the transmission of infectious diseases between pilgrims, and to the indigenous population. The gathering of a large number of pilgrims could compromise the health system of the host country. The threat to global health security posed by infectious diseases with epidemic potential shows the importance of advanced planning of public health surveillance and response at these religious events. Saudi Arabia has extensive experience of providing health care at mass gatherings acquired through decades of managing millions of pilgrims at the Hajj. In this report, we describe the extensive public health planning, surveillance systems used to monitor public health risks, and health services provided and accessed during Hajj 2012 and Hajj 2013 that together attracted more than 5 million pilgrims from 184 countries. We also describe the recent establishment of the Global Center for Mass Gathering Medicine, a Saudi Government partnership with the WHO Collaborating Centre for Mass Gatherings Medicine, Gulf Co-operation Council states, UK universities, and public health institutions globally.
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Affiliation(s)
- Ziad A Memish
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; WHO Collaborating Centre for Mass Gatherings Medicine, Riyadh, Saudi Arabia; Al-Faisal University, Riyadh, Saudi Arabia; Ministry of Health, Riyadh, Saudi Arabia.
| | - Alimuddin Zumla
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; Division of Infection and Immunity, University College London, London, UK; University College London Hospitals NHS Foundation Trust, London, UK
| | - Rafat F Alhakeem
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; Ministry of Health, Riyadh, Saudi Arabia
| | | | | | | | | | | | - Philippe Gautret
- Aix Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Inserm, and Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Maurizio Barbeschi
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; Preparedness, Surveillance and Response, Global Capacity Alert and Response, World Health Organization, Geneva, Switzerland
| | - Brian McCloskey
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; WHO Collaborating Centre on Mass Gatherings and High Visibility/High Consequence Events, London, UK
| | - David Heymann
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; Chatham House, London, UK; London School of Hygiene & Tropical Medicine, London, UK
| | - Abdullah A Al Rabeeah
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; Ministry of Health, Riyadh, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Saudi Aramco Medical Services Organization, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA
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