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Thabit AK, Alfardus N, Eljaaly K, Alshennawi M. Antimicrobial utilization in Hajj 2022: An evaluation of quality indicators. J Infect Public Health 2024; 17 Suppl 1:62-67. [PMID: 37271688 DOI: 10.1016/j.jiph.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/20/2023] [Accepted: 05/18/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND The mass gathering in Hajj (Islamic pilgrimage) makes the spread of infectious diseases inevitable. Antibiotics are frequently prescribed during this season. We aimed to measure antimicrobial utilization during the 2022 Hajj and evaluate the practice using quality indicators. METHODS Antimicrobial utilization by Hajj medical facilities (77 primary clinics and 7 hospitals) was measured using the anatomic therapeutic classification defined daily dose (DDD) and DDD/1,000-inhabitant/day (DID), where inhabitants were the Hajj 2022 pilgrims (n = 899,353). Quality indicators included percentages of consumption of different antibiotic classes of the total consumption of antibacterials for systemic use in DID. RESULTS During Hajj, there was 87,173 outpatient visits and 740 hospitalizations (215 critically ill). Amoxicillin was the most prescribed antibiotic (DID=11.708) followed by azithromycin (DID=7.395). Penicillins fell in the second quartile (i.e., highly prescribed) with a quality indicator value (J01_CE%) of 48.149. The consumption of other antibacterials, including fluoroquinolones, fell in the first quartile (<25%). The overall ratio of broad- to narrow-spectrum antibiotic prescribing (J01_B/N) was 1.49. CONCLUSION Although the prescribing of β-lactams over fluoroquinolones indicates a good practice, clinicians should be reminded that most infections spreading in mass gatherings are viral; hence, do not require antibiotics. Implementation of antimicrobial stewardship is recommended to improve antimicrobial utilization.
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Affiliation(s)
- Abrar K Thabit
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Nawal Alfardus
- General Administration of Pharmaceutical Care, Ministry of Health, Riyadh, Saudi Arabia
| | - Khalid Eljaaly
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Alshennawi
- General Administration of Pharmaceutical Care, Ministry of Health, Riyadh, Saudi Arabia
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Sarkar S, Negi PS. Mental health benefits of pilgrimage. Asian J Psychiatr 2024; 95:103977. [PMID: 38452633 DOI: 10.1016/j.ajp.2024.103977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Siddharth Sarkar
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Parvender S Negi
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
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Mendoza Martínez MG, Guadarrama Orozco J, Peláez Ballestas I. Pilgrimage in pediatric palliative care: The journey of caregivers. Soc Sci Med 2024; 343:116508. [PMID: 38242031 DOI: 10.1016/j.socscimed.2023.116508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/30/2023] [Accepted: 12/10/2023] [Indexed: 01/21/2024]
Abstract
Admission of terminally ill patients into pediatric palliative care remains a challenge in Mexico and Latin America, despite the multiple benefits of early transfer. In this context the trajectories in search of health care of patients and caregivers have not been documented. Therefore, the objective of this study was to describe and analyze the experiences of primary caregivers and family members of pediatric patients in the palliative care unit of a Children's Hospital in Mexico, between October 19, 2019, and January 19, 2022. We used the framework of health pilgrimage, which comprises the transformative search of healing for patients, focusing on health barriers and the necessary displacement in search of care. With information obtained through interviews, we reconstructed the pilgrimages in search of health care navigating the Mexican healthcare system. Furthermore, we describe the experience of the primary caregiver accompanying the sick child during their journey to palliative care. We recount the adverse factors associated with this pilgrimage, such as the emotional and socioeconomic impact on primary and secondary caregivers.
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Affiliation(s)
| | - Jessica Guadarrama Orozco
- Department of Palliative Care and Quality of Life. Hospital Infantil de México "Federico Gomez", Mexico City, Mexico.
| | - Ingris Peláez Ballestas
- Rheumatology Department. Hospital General de Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico.
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Niu S. Between Sacredness and Public Health: Global Religious Sacred Places and the Fight Against COVID-19. J Relig Health 2024; 63:666-684. [PMID: 37582854 DOI: 10.1007/s10943-023-01879-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/17/2023]
Abstract
This paper aims to explore the diverse impacts of religious sacred places on specific spheres of contemporary international relations, particularly in the context of public health governance as well as the fight against COVID-19. The spread of disease or germs and viruses within the context of pilgrimage, the healing purposes associated with such practices, as well as historical conquests of sacred places have attracted the attention of ancient physicians and modern scientists. In the nineteenth century, many Abrahamic religions sought to strengthen their influence in the Holy Land, particularly in the sacred city of Jerusalem. As part of their efforts, they focused on constructing modern hospitals, which became a means of religious competition over the region. From the perspective of the specific relationship between the sacred places and the public health governance system in the modern age, sacred places continue to succeed in animal management (native animals and sacrifice animals), water source management (sacred water and holy rivers), and management of sanitary quarantine (the extension of homeland health security defense), which have present positive effects. Based on the literature review, case analysis and interdisciplinary research methods, several findings have emerged regarding the global fight against COVID-19 since early 2020. Mecca-Medina, Jerusalem-Bethlehem, Rome-Vatican, Santiago de Compostela, Qom, and other religious sacred cities have faced huge pandemic pressures. These cities have played unique roles in protecting the health of pilgrims and have implemented measures to reduce the number and scale of pilgrimages in response to the global mobility challenges posed by the pandemic.
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Affiliation(s)
- Song Niu
- Middle East Studies Institute, Shanghai International Studies University, Shanghai, China.
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Ademe SM. Domestic religious pilgrimage in Ethiopia: Validating Ethiopian orthodox Tewahido church monasteries sacredness through the name of Jerusalem and its significance. Heliyon 2023; 9:e20991. [PMID: 37954392 PMCID: PMC10632418 DOI: 10.1016/j.heliyon.2023.e20991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 11/14/2023] Open
Abstract
Ethiopian Orthodox Tewahido Christians have a long history of pilgrimage. The Ethiopian Orthodox pilgrims' journey to Jerusalem, in particular, was very well known and ancient. However, when Jerusalem was under the control of Muslim leaders, Ethiopian Orthodox Tewahido Christian pilgrims used domestic pilgrimage as an alternative to the pilgrimage to Jerusalem. The fall of Jerusalem at the hands of Muslim leaders and the recurrent problems of pilgrims while they travelled to the sacred places of Jerusalem were the turning points for the proliferation of holy places in Ethiopia. King Lalibela was a man of great inspiration regarding domestic pilgrimage (the journey to sacred places in Ethiopia). The domestic pilgrimage, initiated by King Lalibela to replace Jerusalem in Ethiopia, reached its climax in medieval Ethiopian history. This study explores how the Ethiopian Orthodox Tewahido Church (EOTC) validated and authenticated Ethiopian monasteries and other holy places' sacredness by the name of Jerusalem to develop and encourage domestic pilgrimage. It also shows the significance or implications of domestic pilgrimage in building good social values such as peaceful coexistence, kindness, compassion, and social harmony among diverse communities. By taking Debre-Libanos Monastery (DLM) and Gishen Debre Kerbe (GDK) as the litmus tests, this study shows that religious promises (Qalikidanoch) written in hagiographies and other writings of the EOTC are the main ways for validating and authenticating Ethiopian monasteries sacredness. The religious promises promote and sanctify monasteries and other pilgrims' destinations. It initiates pilgrims to enter the seven-day prayer (Subae) and celebrate the saints' feasts. The practices and various experiences in the monasteries make pilgrims humble and kind, as well as teach them to develop the values of social harmony and peaceful coexistence. Apart from tourism attractions, therefore, these monasteries have a great possibility of significance for realizing good social values such as national unity, kindness, tolerance, social harmony, and peaceful coexistence. Thus, domestic pilgrimage should be encouraged, as Ethiopia is in the throes of ethnic divisions and the destructive effects ethnicization.
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Affiliation(s)
- Solomon Molla Ademe
- Department of Political Science and International Relations, Woldia University, Ethiopia
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Quaium A, Al-Nabhan NA, Rahaman M, Salim SI, Toha TR, Noor J, Hossain M, Islam N, Mostak A, Islam MS, Mushfiq MM, Jahan I, Islam AAA. Towards associating negative experiences and recommendations reported by Hajj pilgrims in a mass-scale survey. Heliyon 2023; 9:e15486. [PMID: 37144197 PMCID: PMC10151350 DOI: 10.1016/j.heliyon.2023.e15486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/09/2023] [Accepted: 04/11/2023] [Indexed: 05/06/2023] Open
Abstract
The annual Hajj presents diversified negative experiences to millions of pilgrims worldwide. The negative experiences and recommendations to overcome them as per pilgrims' feedback are yet to be analyzed from an aggregated perspective in the literature, which we do in this paper. To do so, first, we perform a large-scale survey (n=988) using our comprehensive questionnaire. Then, we perform both quantitative (e.g., clustering) and qualitative (e.g., thematic) analyses on the survey data. Our quantitative analysis reveals up to seven clusters of negative experiences. Further, going beyond the quantitative analysis, our qualitative analysis reveals 21 types of negative experiences, 20 types of recommendations, and nine themes connecting the negative experiences and recommendations. Accordingly, we reveal associations among the negative experiences and recommendations based on the themes in thematic analysis and present the associations through a tripartite graph. However, we have some limitations in this study, such as fewer female and young participants. In future, we plan to collect more responses from female and young participants and extend our work by analyzing linkages in the tripartite graph by augmenting the edges within the graph with appropriate weights. Overall, the findings of this study are expected to facilitate the prioritization of tasks for the management personnel in charge of the Hajj pilgrimage.
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Affiliation(s)
- Adnan Quaium
- Next-generation Computing (NeC) Research Group, Department of Computer Science and Engineering, Bangladesh University of Engineering and Technology, Dhaka, 1000, Bangladesh
- Department of Electrical and Electronic Engineering, Ahsanullah University of Science and Technology, Dhaka, 1208, Bangladesh
| | | | - Masfiqur Rahaman
- Next-generation Computing (NeC) Research Group, Department of Computer Science and Engineering, Bangladesh University of Engineering and Technology, Dhaka, 1000, Bangladesh
- Corresponding author.
| | - Saiful Islam Salim
- Next-generation Computing (NeC) Research Group, Department of Computer Science and Engineering, Bangladesh University of Engineering and Technology, Dhaka, 1000, Bangladesh
| | - Tarik Reza Toha
- Next-generation Computing (NeC) Research Group, Department of Computer Science and Engineering, Bangladesh University of Engineering and Technology, Dhaka, 1000, Bangladesh
| | - Jannatun Noor
- Next-generation Computing (NeC) Research Group, Department of Computer Science and Engineering, Bangladesh University of Engineering and Technology, Dhaka, 1000, Bangladesh
| | - Mainul Hossain
- Next-generation Computing (NeC) Research Group, Department of Computer Science and Engineering, Bangladesh University of Engineering and Technology, Dhaka, 1000, Bangladesh
- Computing for Sustainability and Social Good (C2SG) Group, Department of Electrical and Electronic Engineering, School of Data and Sciences, BRAC University, Dhaka, 22222, Bangladesh
| | - Nafisa Islam
- Department of Civil Engineering, Bangladesh University of Engineering and Technology, Dhaka, 1000, Bangladesh
| | - Aaiyeesha Mostak
- Next-generation Computing (NeC) Research Group, Department of Computer Science and Engineering, Bangladesh University of Engineering and Technology, Dhaka, 1000, Bangladesh
| | - Md Shihabul Islam
- Next-generation Computing (NeC) Research Group, Department of Computer Science and Engineering, Bangladesh University of Engineering and Technology, Dhaka, 1000, Bangladesh
| | - Md. Masum Mushfiq
- Next-generation Computing (NeC) Research Group, Department of Computer Science and Engineering, Bangladesh University of Engineering and Technology, Dhaka, 1000, Bangladesh
| | - Ishrat Jahan
- Next-generation Computing (NeC) Research Group, Department of Computer Science and Engineering, Bangladesh University of Engineering and Technology, Dhaka, 1000, Bangladesh
| | - A.B.M. Alim Al Islam
- Next-generation Computing (NeC) Research Group, Department of Computer Science and Engineering, Bangladesh University of Engineering and Technology, Dhaka, 1000, Bangladesh
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Romero-Mendoza M, Peláez-Ballestas I, Almanza-Avendaño AM, Figueroa E. Structural violence and the need for compassionate use of methadone in Mexico. BMC Public Health 2022; 22:606. [PMID: 35351061 PMCID: PMC8962103 DOI: 10.1186/s12889-022-12955-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Epidemiological data from Mexico have documented an increase in heroin use in the last decade. However, there is no comprehensive care strategy for heroin users, especially those who have been accused of a crime. The objective of this study was to describe the heroin and methadone use of intravenous heroin users of both sexes who have been in jail, to offer evidence for the formulation of health policy. METHODS This study used an ethnographic approach, with open-ended interviews carried out from 2014 to the present. Heroin users of both sexes attending a private methadone clinic in Mexico City were invited to participate. The sample was non-probabilistic. All interviews were audiotaped and transcribed, and narratives were analyzed using thematic analysis. RESULTS Participants in this study were 33 users of heroin, two of them women, who had been in prison. They ranged in age from 33 to 62 years, had used heroin for a period of 13-30 years, and were from three states: Michoacan, Oaxaca, and Mexico City. Three principal categories of analysis were structured: 1. Pilgrimage for help (dynamics of the drama of suffering, pain, and time through health care spaces); 2) methadone use as self-care; and 3) accessibility to methadone treatment. The impossibility of access to methadone treatment is a condition which motivates users in their journey. The dynamics of methadone use are interpreted as a form of self-care and care to avoid substance use. Reducing the psychological, physical, and harmful effects of the substance allows them to perform daily activities. The inability to access treatment leads to a significant effect on users who experience structural violence. CONCLUSION Compassionate methadone treatment and holistic attention should be considered as a way to meet patients' needs and mitigate their suffering, based on public health policy that allows for human rights-based care.
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Affiliation(s)
- Martha Romero-Mendoza
- Instituto Nacional de Psiquiatría Ramón de La Fuente Muñiz, Camino a Xochimilco 101, Col, San Lorenzo Huipulco, CDMX, 144370, Tlalpan, Mexico City, Mexico.
| | - Ingris Peláez-Ballestas
- Hospital General de México Dr. Eduardo Liceaga, Dr. Balmis 148, Col. Doctores, CDMX, 06720, Cuauhtémoc, Mexico City, Mexico
| | - Ariagor Manuel Almanza-Avendaño
- Facultad de Ciencias Humanas, Universidad Autónoma de Baja California, Calz. Castellón S/N, Esperanza Conjunto Urbano, 21350, Mexicali, BC, Mexico
| | - Emilia Figueroa
- Clínica Integral de Tratamiento Contra Las Adicciones, Adolfo Prieto 1338, Col. Del Valle, Benito Juárez, CDMX, 03100, Mexico City, Mexico
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Rahtz E, Warber SL, Goldingay S, Dieppe P. Transcendent Experiences Among Pilgrims to Lourdes: A Qualitative Investigation. J Relig Health 2021; 60:3788-3806. [PMID: 34170474 PMCID: PMC8227356 DOI: 10.1007/s10943-021-01306-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 05/28/2023]
Abstract
Millions of pilgrims visit Lourdes each year, often seeking revitalisation rather than miraculous cures. We sought to understand the phenomenon of transcendent experiences. We spoke with 67 pilgrims including assisted pilgrims, young volunteers and medical staff. About two in five reported a transcendent experience: some felt they had communicated or had close contact with a divine presence, while others reported a powerful experience of something intangible and otherworldly. Transcendent experiences are an important feature of pilgrimage to Lourdes and the place offers the faithful a means of connecting with the divine, with nature and with the self.
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Affiliation(s)
- Emmylou Rahtz
- The European Centre for Environment and Human Health, The University of Exeter Medical School, Royal Cornwall Hospital, Truro, Cornwall, TR1 3HD, UK.
| | - Sara L Warber
- The European Centre for Environment and Human Health, The University of Exeter Medical School, Royal Cornwall Hospital, Truro, Cornwall, TR1 3HD, UK
- Department of Family Medicine, University of Michigan Medical School, 1018 Fuller St, Ann Arbor, MI, 48104-1213, USA
| | - Sarah Goldingay
- Department of Drama, University of Exeter, Alexander Building, Thornlea, New North Road, Exeter, EX4 4LA, Devon, UK
| | - Paul Dieppe
- The University of Exeter Medical School, South Cloisters, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, Devon, UK
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Abstract
Lourdes, France, is a major site of pilgrimage, particularly for Roman Catholics with illness. The direct impact of pilgrimage on pilgrim quality of life (QOL) has not previously been measured. The present study aimed to measure the impact of pilgrimage to Lourdes on QOL in self-defined "sick pilgrims". The standardised EuroQol EQ-5D-5L questionnaire measured two aspects of QOL, namely a Visual Analogue Scale (VAS) score of self-rated health and an Index Value Score (IVS) of the five dimensions of QOL, in a group of pilgrims, before (Q1), immediately after (Q2) and two months after (Q3) return from pilgrimage to Lourdes. A total of 93 pilgrims responded at time Q1, 71 at Q2 and 64 at Q3. The VAS scores of self-rated health showed statistically significant improvement at Q2 (p = 0.04), although this was not sustained at Q3. The IVS Scores showed no significant differences at Q2 or Q3. However, at Q2, 67.6% of pilgrims reported their self-rated QOL as "much better" or "better", and this was maintained in 54.7% at Q3. Pilgrims identified "spiritual and religious aspects of pilgrimage", "a sense of togetherness" and "spiritual healing" as having the most significant impact on their QOL. The Lourdes pilgrimage had a statistically significant positive impact on the immediate post-pilgrimage VAS scores of QOL of "sick pilgrims", but this was not sustained two months following pilgrimage. The IVS scores were unchanged. Pilgrims identified beneficial holistic, spiritual and communal aspects of the pilgrimage experience.
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Lami F, Amiri M, Majeed Y, Barr KM, Nsour MA, Khader YS. Real-Time Surveillance of Infectious Diseases, Injuries, and Chronic Conditions During the 2018 Iraq Arba'een Mass Gathering. Health Secur 2021; 19:280-287. [PMID: 33945332 DOI: 10.1089/hs.2020.0074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Arba'een pilgrimage in Iraq is now the largest annual gathering in a single place worldwide. To monitor and address the health needs of pilgrims in field clinics near the pilgrimage route, a syndromic surveillance system was designed and implemented by Global Health Development/Eastern Mediterranean Public Health Network in collaboration with Iraq Ministry of Health. This study aimed to analyze the effectiveness of the surveillance system and the data it gathered in evaluating the burden of common acute and infectious conditions, chronic conditions, and trauma and injuries during the Arba'een pilgrimage in 2018. Data were collected at 152 field clinics located across 11 governorates in Iraq at strategic points along the Arba'een pilgrimage route from all governorates to Karbala between October 8 and November 3, 2018. A team of 24 surveillance supervisors trained, oversaw, and provided technical support for 304 data collectors. The data collectors recorded data from 338,399 patients (42.5% female and 57.5% male) in the span of 26 days. The vast majority of patients were from Iraq (n = 294,260, 87.6%) and Iran (n = 34,691, 10.3%). Of the 338,399 patients whose data were recorded by the surveillance system, 246,469 (72.8%) reported acute and infectious conditions, 202,032 (59.70%) reported chronic conditions, and 6,737 (2.0%) reported traumas and injuries. Many patients reported several conditions in multiple categories. The most prevalent acute condition treated was influenza-like illness, identified through patients exhibiting a combination of fever and cough symptoms. Findings from this study will help inform future planning efforts so healthcare workers can be better prepared for treating such cases at mass gatherings. With the latest challenges posed by the COVID-19 pandemic, preparations for a possible future outbreak of the novel coronavirus are also discussed. The information from this study serves as a foundation to inform and optimize future planning of wide-scale surveillance efforts and address challenges in health service delivery and health security.
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Affiliation(s)
- Faris Lami
- Faris Lami, PhD, is an Associate Professor, Department of Community Medicine, College of Medicine, Baghdad University, Bab Al Muadham, Baghdad, Iraq. Mirwais Amiri, MD, MPH, is Research and Policy Team Leader and Mohannad Al Nsour, MD, MSc, PhD, is Executive Director; both at Center of Excellence for Applied Epidemiology Global Health Development, Amman, Jordan. Yasir Majeed, MD, is Director, Field Epidemiology Training Program, Public Health Directorate, Ministry of Health, Baghdad, Iraq. Kira M. Barr is a Graduate Student, Epidemiology, Ohio State University, Columbus, OH. Yousef S. Khader, ScD, is a Professor, Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mirwais Amiri
- Faris Lami, PhD, is an Associate Professor, Department of Community Medicine, College of Medicine, Baghdad University, Bab Al Muadham, Baghdad, Iraq. Mirwais Amiri, MD, MPH, is Research and Policy Team Leader and Mohannad Al Nsour, MD, MSc, PhD, is Executive Director; both at Center of Excellence for Applied Epidemiology Global Health Development, Amman, Jordan. Yasir Majeed, MD, is Director, Field Epidemiology Training Program, Public Health Directorate, Ministry of Health, Baghdad, Iraq. Kira M. Barr is a Graduate Student, Epidemiology, Ohio State University, Columbus, OH. Yousef S. Khader, ScD, is a Professor, Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yasir Majeed
- Faris Lami, PhD, is an Associate Professor, Department of Community Medicine, College of Medicine, Baghdad University, Bab Al Muadham, Baghdad, Iraq. Mirwais Amiri, MD, MPH, is Research and Policy Team Leader and Mohannad Al Nsour, MD, MSc, PhD, is Executive Director; both at Center of Excellence for Applied Epidemiology Global Health Development, Amman, Jordan. Yasir Majeed, MD, is Director, Field Epidemiology Training Program, Public Health Directorate, Ministry of Health, Baghdad, Iraq. Kira M. Barr is a Graduate Student, Epidemiology, Ohio State University, Columbus, OH. Yousef S. Khader, ScD, is a Professor, Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Kira M Barr
- Faris Lami, PhD, is an Associate Professor, Department of Community Medicine, College of Medicine, Baghdad University, Bab Al Muadham, Baghdad, Iraq. Mirwais Amiri, MD, MPH, is Research and Policy Team Leader and Mohannad Al Nsour, MD, MSc, PhD, is Executive Director; both at Center of Excellence for Applied Epidemiology Global Health Development, Amman, Jordan. Yasir Majeed, MD, is Director, Field Epidemiology Training Program, Public Health Directorate, Ministry of Health, Baghdad, Iraq. Kira M. Barr is a Graduate Student, Epidemiology, Ohio State University, Columbus, OH. Yousef S. Khader, ScD, is a Professor, Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohannad Al Nsour
- Faris Lami, PhD, is an Associate Professor, Department of Community Medicine, College of Medicine, Baghdad University, Bab Al Muadham, Baghdad, Iraq. Mirwais Amiri, MD, MPH, is Research and Policy Team Leader and Mohannad Al Nsour, MD, MSc, PhD, is Executive Director; both at Center of Excellence for Applied Epidemiology Global Health Development, Amman, Jordan. Yasir Majeed, MD, is Director, Field Epidemiology Training Program, Public Health Directorate, Ministry of Health, Baghdad, Iraq. Kira M. Barr is a Graduate Student, Epidemiology, Ohio State University, Columbus, OH. Yousef S. Khader, ScD, is a Professor, Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yousef S Khader
- Faris Lami, PhD, is an Associate Professor, Department of Community Medicine, College of Medicine, Baghdad University, Bab Al Muadham, Baghdad, Iraq. Mirwais Amiri, MD, MPH, is Research and Policy Team Leader and Mohannad Al Nsour, MD, MSc, PhD, is Executive Director; both at Center of Excellence for Applied Epidemiology Global Health Development, Amman, Jordan. Yasir Majeed, MD, is Director, Field Epidemiology Training Program, Public Health Directorate, Ministry of Health, Baghdad, Iraq. Kira M. Barr is a Graduate Student, Epidemiology, Ohio State University, Columbus, OH. Yousef S. Khader, ScD, is a Professor, Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Abstract
Purpose of Review We discuss the risk of COVID-19 in religious mass gathering events including Hajj and Umrah pilgrimages. Recent Findings The risk of transmission of respiratory viruses including COVID-19 is particularly high due to the overcrowding conditions at the Hajj and Umrah. The profile of the Hajj pilgrims who tend to be older and with multiple comorbidities corresponds to that of individuals at risk for severe COVID-19. In order to avoid a COVID-19 outbreak with potential spreading to many countries through returning pilgrims, Saudi Arabia suspended the Umrah, and access to the 2020 Hajj was very limited. Summary A clear relation between early suspension of religious mass gatherings and lower occurrence of COVID-19 transmission in countries that took such measures promptly was noticed. There are lessons to national and international health organizations for other mass gatherings in the context of the pandemic.
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Affiliation(s)
- Van-Thuan Hoang
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France.,Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Philippe Gautret
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Ziad A Memish
- Director Research and Innovation Center, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia.,Al-Faisal University, Riyadh, Saudi Arabia.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Jaffar A Al-Tawfiq
- Specialty Internal Medicine and Quality Division, Dhahran Health Center, Johns Hopkins Aramco Healthcare, P.O. Box 76, Room A-428-2, Building 61, Dhahran, 31311 Saudi Arabia.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
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Pollard TM, Guell C, Morris S. Communal therapeutic mobility in group walking: A meta-ethnography. Soc Sci Med 2020; 262:113241. [PMID: 32777672 DOI: 10.1016/j.socscimed.2020.113241] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/05/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
Increased attention to links between walking, health and wellbeing have contributed to a growth in the number of walking groups meeting on a regular basis to offer short, social walks. Walking group interventions are known to increase physical activity and to have wide-ranging health benefits, and there is evidence that drop out is generally low. The aim of this paper is to synthesise qualitative research on experiences and perceptions of group walking in order to develop a new conceptual understanding of the group walking experience. We conducted a systematic search of the literature and identified 22 such studies which we synthesised using meta-ethnography. Included studies were conducted in the UK, USA, Australia and Ireland. Most reported research was undertaken with outdoor walking groups, some of which catered specifically for people who shared a disease experience or a disability. A smaller number of studies examined indoor mall walking groups, while two looked at perceptions of non-participants of group walking as a potential activity. From the original constructs identified in the papers we derived five higher order constructs: seeking and enjoying health and fitness, attachment to walking, providing purpose and confidence, mobile companionship and a peaceful and contemplative shared respite from everyday life. We argue that participating in a walking group provides a set of experiences that together constitute a specific form of shared or communal therapeutic mobility that is not simply the accumulation of the constructs we have outlined. Rather, we suggest that an initial instrumental and disciplinary focus on health and fitness is transformed through the experience of group walking into a shared meaningful and enjoyable practice; an emergent communal therapeutic mobility, which recruits and retains large numbers of group walkers. However, this communal therapeutic mobility is not equally accessible to all.
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Alsahafi AJ, Cheng AC. Health care workers' awareness and infection control practices about Ebola virus disease in Hajj 2015. J Infect Public Health 2019; 12:720-5. [PMID: 30981653 DOI: 10.1016/j.jiph.2019.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/24/2019] [Accepted: 03/25/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Saudi Arabia being a major pilgrimage center with an annual turnover of millions of pilgrims from all over the world has a high risk for transmission of infections; Ebola virus disease (EVD) being one of them. Health care workers (HCWs) are particularly vulnerable to these infections. The objectives of this research were to assess the overall knowledge and infection control practices of HCWs about EVD, and to evaluate and compare the role of pre deployment Hajj training of HCWs assigned Hajj duties with those HCWs who did not receive this training. METHODS Through a comparative cross sectional study design a randomly selected representative sample of HCWs who performed Hajj duties in 2015 were compared with those who were not part of Hajj. Participants were taken from different Makkah and Jeddah region hospitals. A validated self-administered questionnaire was used to assess EVD awareness of 1216 HCWs. Chi square test was applied to check the association between the two groups using SPSS 22. RESULTS Overall, medical practitioners had a higher level of knowledge (76.5%) about EVD (in-terms of average correct answers) compared to nurses (59.6%) and other HCWs (56.7%). There was relatively poor knowledge about the EVD management, the Ebola cases fatality rate and the risk of the health care workers from this infectious disease. However, it was obvious that the HCWs who performed Hajj duties and underwent pre-deployment training had more knowledge and better practices about EVD compared to the Non Hajj HCWs and the difference was statistically significant (p < 0.001). CONCLUSION This study concludes that even though the HCWs were well aware about EVD but there was a lack of practice. As infection control routine trainings are limited, gaps have been identified in knowledge and practice of infection control.
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Abstract
It appears that the El Camino pilgrimage route has become a long-distance trek and endurance test of the individual. The continuously increasing number of hikers demands more attention by travel medicine professionals. Analysis of the age groups of the pilgrims over recent years shows that the number of young pilgrims (< 30 years) is decreasing, but the number of middle-aged people (30-60 years) is slightly increasing, while the number of elderly people (> 60 years) is considerably increased. The leading cause of fatalities during the pilgrimage is ACS. The majority of the cardiac problems occur among the elderly people. The second most common cause of death is a traffic accident, and the third and fourth causes are a fatal exacerbation of the pilgrim's pre-existing disease and illnesses caused by the extreme temperature (hot and cold environment alike). The aforementioned data suggest that pre-travel advice should be an indispensable part of the preparation for the El Camino peregrination, especially for the patient with chronic disease and elderly people.
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Affiliation(s)
- Peter Felkai
- Travel Medicine Chair, Internal Medicine Faculty, Debrecen University, Medical School, Szentendrei ut 301, Budapest, 1039, Hungary.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Sokhna C, Mboup BM, Sow PG, Camara G, Dieng M, Sylla M, Gueye L, Sow D, Diallo A, Parola P, Raoult D, Gautret P. Communicable and non-communicable disease risks at the Grand Magal of Touba: The largest mass gathering in Senegal. Travel Med Infect Dis 2017; 19:56-60. [PMID: 28847495 DOI: 10.1016/j.tmaid.2017.08.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/01/2017] [Accepted: 08/23/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND An estimated 4-5 million individuals gather each year in the holy city of Touba, Senegal during the Grand Magal religious pilgrimage. Pilgrims come from across Senegal and the surrounding countries, as well as from countries outside Africa. It is the largest mass gathering (MG) of the Mouride community and the largest Muslim religious MG in West Africa. METHOD A cross-sectional study was conducted on all patients who attended a public healthcare structure during the November 2015 Grand Magal. RESULT Data were collected on a total of 32,229 healthcare contacts. The most frequent reasons for consultation were trauma, followed by fatigue and heatstroke. Infectious diseases were also prevalent with, notably, a high rate of febrile systemic illnesses and malaria, diarrheal diseases, and respiratory tract infections. Such results are likely to be linked to overcrowding and climatic conditions, the relative lack of sanitary facilities, and limited medical resources available during the event. CONCLUSION The context of the Grand Magal MG is unique, given its location in a tropical developing country and its international component which may favor the globalization of locally endemic diseases. As such, it warrants investment in modern methods for public health surveillance and planning of the event.
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Affiliation(s)
- Cheikh Sokhna
- URMITE, Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, France
| | | | | | | | | | | | | | - Doudou Sow
- URMITE, Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, France; Unversité Cheikh Anta Diop de Dakar, Senegal
| | - Aldiouma Diallo
- URMITE, Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, France
| | - Philippe Parola
- URMITE, Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, France
| | - Didier Raoult
- URMITE, Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, France
| | - Philippe Gautret
- URMITE, Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, France.
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Memish ZA, Al-Tawfiq JA, Almasri M, Azhar EI, Yasir M, Al-Saeed MS, Ben Helaby H, Borrow R, Turkistani A, Assiri A. Neisseria meningitidis nasopharyngeal carriage during the Hajj: A cohort study evaluating the need for ciprofloxacin prophylaxis. Vaccine 2017; 35:2473-2478. [PMID: 28343777 DOI: 10.1016/j.vaccine.2017.03.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/04/2017] [Accepted: 03/06/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The annual Muslim pilgrimage has the potential of increase risk for acquisition of Neisseria meningitidis. Here, we evaluate the Hajj impact on the prevalence of N. meningitidis carriage in a paired and non-paired cohort of pilgrims. Secondary objectives were to calculate the compliance with recommended vaccination. METHODS This is a prospective paired (arriving and departing), non-paired arriving and non-paired departing cohort study with the collection of nasopharyngeal samples at the start and the end of the Hajj. RESULTS The study included unpaired arriving pilgrims at King Abdul Aziz International Airport (N=1055), unpaired departing cohort (N=373), and a paired cohort (N=628) who were tested on arrival and departure. Meningococcal vaccination was received by all pilgrims, 98.2% received quadrivalent polysaccharide vaccine (ACWY), and 1.8% received meningococcal quadrivalent conjugate vaccine (MCV4). Only 1.61% and 23.03% received pneumococcal and influenza vaccines, respectively. Of the 1055 arriving unpaired pilgrim, 36 (3.4%) tested positive for nasopharyngeal carriage of N. meningitidis, and 24 (66.7%) of these were serogroup B, the remainder were non-groupable. Haemophilus influenza was detected among 45 (4.3%), and 11 (1%) carriers were positive for both N. meningitidis and H. influenzae. Out of 373 in the unpaired departing cohort, 6 (1.61%) tested positive for N. meningitidis, and 34 (9.1%) were positive for H. influenzae. Of the 628 paired cohort pilgrims, 36 (5.7%) pilgrims were positive for N. meningitidis at arrival and 16 (2.5%) pilgrims were positive after the hajj. CONCLUSION This the largest study of the epidemiology of N. meningitidis among pilgrims. The study showed a significant difference in the carriage between pilgrims from high endemicity and other pilgrims with a predominance of serogroup B. The continued use of ciprofloxacin as prophylactic antibiotics should be reconsidered as well as the consideration to add serogroup B as a required vaccination.
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Affiliation(s)
- Ziad A Memish
- Ministry of Health, Riyadh, Saudi Arabia; Alfaisal University, College of Medicine, Riyadh, Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA.
| | - Jaffar A Al-Tawfiq
- Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Esam I Azhar
- Special Infectious Agents 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
| | - Muhammad Yasir
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Muneera S Al-Saeed
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Huda Ben Helaby
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK
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Koul PA, Mir H, Saha S, Chadha MS, Potdar V, Widdowson MA, Lal RB, Krishnan A. Influenza not MERS CoV among returning Hajj and Umrah pilgrims with respiratory illness, Kashmir, north India, 2014-15. Travel Med Infect Dis 2016; 15:45-47. [PMID: 27932291 PMCID: PMC6057869 DOI: 10.1016/j.tmaid.2016.12.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 12/03/2016] [Accepted: 12/03/2016] [Indexed: 11/29/2022]
Abstract
Background The increasing reports of Middle East Respiratory Syndrome (MERS) caused by MERS coronavirus (MERS-CoV) from many countries emphasize its importance for international travel. Muslim pilgrimages of Hajj and Umrah involve mass gatherings of international travellers. We set out to assess the presence of influenza and MERS-CoV in Hajj/Umrah returnees with acute respiratory infection. . Methods Disembarking passengers (n = 8753) from Saudi Arabia (October 2014 to April 2015) were interviewed for the presence of respiratory symptoms; 977 (11%) reported symptoms and 300 (age 26–90, median 60 years; 140 male) consented to participate in the study. After recording clinical and demographic data, twin swabs (nasopharyngeal and throat) were collected from each participant, pooled in viral transport media and tested by real-time RT PCR for MERS-CoV and influenza A and B viruses and their subtypes. Results The participants had symptoms of 1–15 days (median 5d); cough (90%) and nasal discharge (86%) being the commonest. None of the 300 participants tested positive for MERS-CoV; however, 33 (11%) tested positive for influenza viruses (A/H3N2 = 13, A/H1N1pdm09 = 9 and B/Yamagata = 11). Eighteen patients received oseltamivir. No hospitalizations were needed and all had uneventful recovery. Conclusion Despite a high prevalence of acute respiratory symptoms, MERS coV was not seen in returning pilgrims from Hajj and Umrah. However detection of flu emphasises preventive strategies like vaccination.
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Affiliation(s)
- Parvaiz A Koul
- Department of Internal & Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences (SKIMS), Srinagar, J&K, India.
| | - Hyder Mir
- Department of Internal & Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences (SKIMS), Srinagar, J&K, India
| | - Siddhartha Saha
- Influenza Division, US Centers for Disease Control & Prevention (CDC), India Office, New Delhi, India
| | | | | | - Marc-Alain Widdowson
- Influenza Division, US Centers for Disease Control & Prevention (CDC), Atlanta, GA, USA
| | - Renu B Lal
- Influenza Division, US Centers for Disease Control & Prevention (CDC), India Office, New Delhi, India
| | - Anand Krishnan
- Center for Community Medicine, All India Institute of Medical Sciences, (AIIMS), New Delhi, India
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Abstract
BACKGROUND The Hajj is the largest annual mass gathering event in the world, thus favoring the transmission of various infections: 183 different nationalities, high temperatures, coincidence with the start of the flu season in the Northern hemisphere, a long barefoot walk, tent-type accommodation, communal toilet facilities, absence of food control, and sharing of razors. Infections are the first cause of hospital admission, which often occurs in the home country of pilgrims. METHODS Literature review on PubMed from 1952 to November 2015 on the epidemiology and prevention of infections contracted during the Hajj, using the keywords "Hajj" and "infections". RESULTS Respiratory tract infections, ENT infections, influenza, pyogenic pneumonia, whooping cough, and tuberculosis are most frequently observed during the Hajj. Outbreaks of meningococcal meningitis have been reported in pilgrims and their contacts. Waterborne infections such as gastroenteritis and hepatitis A are common, despite the improvement of health conditions. Pyoderma and furuncles are also frequently observed. Recently, dengue fever, Alkhumra hemorrhagic fever, and Rift Valley fever have emerged but no case of MERS-coronavirus, appeared in Saudi Arabia in 2012, have yet been observed during the 2012-2014 Hajj. CONCLUSION Prevention is based on compulsory meningococcal vaccination, vaccination against seasonal influenza and pneumococcal infections for pilgrims at high risk of contracting the infection, and on vaccination against hepatitis A. Updating immunization for diphtheria/tetanus/poliomyelitis/pertussis and measles/mumps is also crucial and pilgrims must comply with hygiene precautions.
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Affiliation(s)
- A Salmon-Rousseau
- Service des maladies infectieuses et tropicales, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France.
| | - E Piednoir
- Service des maladies infectieuses et tropicales, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France.
| | - V Cattoir
- Service de microbiologie, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France.
| | - A de La Blanchardière
- Service des maladies infectieuses et tropicales, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France.
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Atabani SF, Wilson S, Overton-Lewis C, Workman J, Kidd IM, Petersen E, Zumla A, Smit E, Osman H. Active screening and surveillance in the United Kingdom for Middle East respiratory syndrome coronavirus in returning travellers and pilgrims from the Middle East: a prospective descriptive study for the period 2013-2015. Int J Infect Dis 2016; 47:10-4. [PMID: 27117200 PMCID: PMC7110479 DOI: 10.1016/j.ijid.2016.04.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/18/2016] [Indexed: 12/03/2022] Open
Abstract
The Middle East respiratory syndrome coronavirus (MERS-CoV) remains a threat to global health security, and continuous surveillance for the virus in returning pilgrims or travellers from the Middle East is required. The UK is home to over two million Muslims. Around 25 000 UK pilgrims visit Mecca and Medina each year for the Hajj and Umrah pilgrimages. During the years 2013–2015, 214 UK patients who had travelled to the Middle East fulfilled the criteria of the MERS-CoV case definition algorithm and were tested for MERS-CoV infection. No MERS-CoV cases were detected over the period of Hajj seasons 2013, 2014, and 2015. A viral aetiology was detected in 50% of cases. Rhinovirus and influenza A, detected in equal proportions, were the most common viruses detected. Heightened awareness and rapid screening are essential parts of sustained surveillance to prevent outbreaks of MERS-CoV.
Background Over 25 000 pilgrims from the UK visit Saudi Arabia every year for the Umrah and Hajj pilgrimages. The recent outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) in South Korea and the continuing reports of MERS-CoV cases from Saudi Arabia highlight the need for active surveillance for MERS-CoV in returning pilgrims or travellers from the Middle East. Public Health England Birmingham Laboratory (PHEBL) is one of a few selected UK public health laboratories responsible for MERS-CoV screening in travellers returning to the UK from the Middle East who present to hospital with severe respiratory symptoms. The results of the PHEBL MERS-CoV screening and surveillance over the past 3 years is presented. Methods UK travellers/pilgrims who returned from the Middle East and presented to a hospital with respiratory symptoms were studied over the period February 1, 2013 to December 31, 2015. Patients with respiratory symptoms, who satisfied the Public Health England MERS-CoV case algorithm, were tested for MERS-CoV and other respiratory tract viruses on admission to hospital. Results Two hundred and two patients suspected of having MERS-CoV were tested. None of them had a laboratory-confirmed MERS-CoV infection. A viral aetiology was detected in half (50.3%) of the cases, with rhinoviruses, influenza A (H1N1 and H3N2), and influenza B being most frequent. Peak testing occurred following the annual Hajj season and in other periods of raised national awareness. Conclusions Respiratory tract infections in travellers/pilgrims returning to the UK from the Middle East are mainly due to rhinoviruses, influenza A, and influenza B. Whilst MERS-CoV was not detected in the 202 patients studied, heightened awareness of the possibility of MERS-CoV and continuous proactive surveillance are essential to rapidly identify cases of MERS-CoV and other seasonal respiratory tract viruses such as avian influenza, in patients presenting to hospital. Early identification and isolation may prevent outbreaks in nosocomial settings.
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Affiliation(s)
- Sowsan F Atabani
- Public Health England Birmingham Laboratory, National Infection Service, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK.
| | - Steven Wilson
- Public Health England Birmingham Laboratory, National Infection Service, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK
| | - Clare Overton-Lewis
- Public Health England Birmingham Laboratory, National Infection Service, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK
| | - Judith Workman
- Public Health England Birmingham Laboratory, National Infection Service, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK
| | - I Michael Kidd
- Department of Virology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Eskild Petersen
- Aarhus University, Aarhus, Denmark; The Royal Hospital, Muscat, Oman
| | - Alimuddin Zumla
- Division of Infection and Immunity, University College London, London, and UK National Institute for Health Research Biomedical Research Centre, UCL Hospitals National Health Service Foundation Trust, London, UK
| | - Erasmus Smit
- Public Health England Birmingham Laboratory, National Infection Service, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK
| | - Husam Osman
- Public Health England Birmingham Laboratory, National Infection Service, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK
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Gautret P, Steffen R. Communicable diseases as health risks at mass gatherings other than Hajj: what is the evidence? Int J Infect Dis 2016; 47:46-52. [PMID: 26987476 DOI: 10.1016/j.ijid.2016.03.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/07/2016] [Accepted: 03/09/2016] [Indexed: 01/06/2023] Open
Abstract
Mass gatherings are characterized by the concentration of people temporally and spatially, and may lead to the emergence of infectious diseases due to enhanced transmission between attendees. This is well-demonstrated in the context of the Hajj and Umrah pilgrimages in Saudi Arabia. The goal of this review was to present the available evidence on outbreaks associated with a variety of pathogens, or also the lack thereof, as assessed by thorough surveillance at any mass gatherings with the exception of those in Saudi Arabia. A systematic search for relevant articles in the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Sixty-eight studies were identified. Although outbreaks have not been reported frequently in or after mass gatherings outside the Hajj and Umrah pilgrimages, they have sometimes occurred at Muslim, Christian, and Hindu religious events, at sports events, and at large-scale open air festivals. In this review it was found that the most common outbreaks at these mass gatherings involved vaccine preventable diseases, mainly measles and influenza, but also mumps and hepatitis A. Meningococcal disease has rarely been recorded. Additionally it was found that the transmission of various communicable diseases that may not be prevented by vaccination has been recorded in association with mass gatherings. These were mainly gastrointestinal infections, caused by a variety of pathogens. It was also noted that some outbreaks occurring at mass gatherings have resulted in the international spread of communicable diseases.
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Affiliation(s)
- Philippe Gautret
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, F-13005 Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France.
| | - Robert Steffen
- Epidemiology, Biostatistics and Prevention Institute, World Health Organization Collaborating Centre for Traveller's Health, University of Zurich, Zurich, Switzerland
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Gautret P, Benkouiten S, Griffiths K, Sridhar S. The inevitable Hajj cough: Surveillance data in French pilgrims, 2012-2014. Travel Med Infect Dis. 2015;13:485-489. [PMID: 26464001 PMCID: PMC7110682 DOI: 10.1016/j.tmaid.2015.09.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 09/17/2015] [Accepted: 09/22/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Respiratory tract infections are the most common infection affecting Hajj pilgrims, and the ''Hajj cough'' is considered by pilgrims almost de rigueur. METHODS French pilgrims were recruited between January 2012-December 2014 and information on demographics, medical history, compliance with preventive measures and health problems during travel were collected. RESULTS A total of 382 pilgrims were included with 39.3% aged ≥65 years and 55.1% suffering from a chronic disease, most frequently hypertension and diabetes. The prevalence of cough was 80.9% and a high proportion presented with associated sore throat (91.0%), rhinitis (78.7%) and hoarseness (63.0%). Myalgia was reported in 48.3% of cases and subjective fever in 47.3%. The incubation time of respiratory symptoms was 7.7 days (range 0-25 days) and 51.9% of pilgrims presenting with a cough during their stay were still symptomatic on return. Among pilgrims with a cough, 69.4% took antibiotics. The prevalence of cough was significantly higher among females than men, but age, chronic conditions and preventive measures had no significant effect. CONCLUSIONS The Hajj cough is highly common, likely a result of crowded conditions at religious places. Pilgrims should be advised to carry symptomatic relief for the Hajj cough such as cough suppressant, soothing throat lozenges and paracetamol. Use of antibiotics should be discouraged.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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, Yezli S, Almasri M, Assiri A, Turkestani A, Findlow H, Bai X, Borrow R. Meningococcal serogroup A, C, W, and Y serum bactericidal antibody profiles in Hajj pilgrims. Int J Infect Dis 2014; 28:171-5. [PMID: 25307887 DOI: 10.1016/j.ijid.2014.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 09/17/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The religious seasons of Hajj and Umra in the Kingdom of Saudi Arabia (KSA) have historically been associated with epidemics of meningococcal disease. Due to the effective preventive measures taken in recent years, including vaccination, no meningococcal outbreaks have been reported during Hajj or were Hajj-associated. However, little is known about the immunological profile of pilgrims. The aim of this study was to assess the immunological profile of pilgrims on arrival in KSA against the four meningococcal serogroups, A, C, W, and Y, contained within the quadrivalent vaccine. METHODS Following consent, socio-demographic factors and health-related information was collected from pilgrims arriving at King Abdul Aziz International Airport and a blood sample taken. Antibodies were quantified by serum bactericidal antibody assay using baby rabbit complement (rSBA) against the four meningococcal serogroups, A, C, W, and Y. RESULTS Serum samples were collected from 796 pilgrims; rSBA results were obtained for all four serogroups for 741 of these samples. A total of 48 (6.5%) Hajjis had previously attended Hajj, ranging from 1 to 14 times (median 2 times); 98.2% had received meningococcal quadrivalent vaccine in the last 3 years. Of the 13 who had not, all originated from Bangladesh, with four reporting no previous meningococcal vaccination and nine reporting having received the vaccination more than 3 years ago. For serogroup A, only one pilgrim from Indonesia had an rSBA titre <8. For serogroups C, W, and Y, the percentages of pilgrims with rSBA titres <8 were 9.9%, 17.4%, and 9.4%, respectively. Of note was the high prevalence of non-complement-mediated lysis in pilgrims originating from Nigeria (28/47; 59.6%) and Afghanistan (21/47; 44.7%), but not the other countries. This may be a reflection of the type and pattern of antibiotic usage among these communities. CONCLUSION The vast majority of pilgrims are vaccinated and protected against meningococcal serogroups A, C, W, and Y.
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Affiliation(s)
- Ziad A Memish
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia.
| | - Saber Yezli
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Malak Almasri
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah Assiri
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | | | - Helen Findlow
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Xilian Bai
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Ray Borrow
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK
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Abstract
The importation of infectious diseases during a mass gathering may result in outbreaks. Infectious diseases associated with mass gatherings vary depending on the type and location of the mass gathering. The annual Hajj to Makkah in Saudi Arabia is one of the largest annual religious mass gatherings in the world. Preparation for the Hajj encompasses multiple sectors to develop comprehensive plans. These plans include risk assessment, utilizing existing medical infrastructure, developing electronic and paper-based surveillance activity, and the use of information technology. In this review, we describe key features of the preparedness for the 2014 Hajj and Umra, review the recent impact of emerging viruses such as Ebola in West Africa and the Middle East respiratory syndrome coronavirus (MERS-CoV) in affected countries, and highlight the updated requirements and the required vaccines.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indiana, USA
| | - Ziad A Memish
- Ministry of Health and Al-Faisal University, PO Box 54146, Riyadh, 11514, Saudi Arabia.
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Abstract
The holy month of Ramadan is one of the five pillars of Islam. During this month, fasting Muslims refrain from eating, drinking, smoking, and sex from dawn until sunset. Although the Quran exempts sick people from the duty of fasting, it is not uncommon for many heart disease patients to fast during Ramadan. Despite the fact that more than a billion Muslims worldwide fast during Ramadan, there is no clear consensus on its effects on cardiac disease. Some studies have shown that the effects of fasting on stable patients with cardiac disease are minimal and the majority of patients with stable cardiac illness can endure Ramadan fasting with no clinical deterioration. Fasting during Ramadan does not seem to increase hospitalizations for congestive heart failure. However, patients with decompensated heart failure or those requiring large doses of diuretics are strongly advised not to fast, particularly when Ramadan falls in summer. Patients with controlled hypertension can safely fast. However, patients with resistant hypertension should be advised not to fast until their blood pressure is reasonably controlled. Patients with recent myocardial infarction, unstable angina, recent cardiac intervention or cardiac surgery should avoid fasting. Physician advice should be individualized and patients are encouraged to seek medical advice before fasting in order to adjust their medications, if required. The performance of the Hajj pilgrimage is another pillar of Islam and is obligatory once in the lifetime for all adult Muslims who are in good health and can afford to undertake the journey. Hajj is a physically, mentally, emotionally, and spiritually demanding experience. Medical checkups one or two months before leaving for Hajj is warranted, especially for those with chronic illnesses such as cardiovascular disease. Patients with heart failure, uncontrolled hypertension, serious arrhythmias, unstable angina, recent myocardial infarction, or cardiac surgery should be considered unfit for undertaking the Hajj pilgrimage.
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