This study indicates that there are significant opportunities to improve awareness among Australian Hajj pilgrims about the importance of using preventive health measures.

Middle East respiratory syndrome coronavirus (MERS-CoV) has emerged in the Arabian Gulf region, with its epicentre in Saudi Arabia, the host of the 'Hajj' which is the world's the largest mass gathering. Transmission of MERS-CoV at such an event could lead to its rapid worldwide dissemination. Therefore, we studied the frequency of viruses causing influenza-like illnesses (ILI) among participants in a randomised controlled trial at the Hajj 2013. We recruited 1038 pilgrims from Saudi Arabia, Australia and Qatar during the first day of Hajj and followed them closely for four days. A nasal swab was collected from each pilgrim who developed ILI. Respiratory viruses were detected using multiplex RT-PCR. ILI occurred in 112/1038 (11%) pilgrims. Their mean age was 35 years, 49 (44%) were male and 35 (31%) had received the influenza vaccine pre-Hajj. Forty two (38%) pilgrims had laboratory-confirmed viral infections; 28 (25%) rhinovirus, 5 (4%) influenza A, 2 (2%) adenovirus, 2 (2%) human coronavirus OC43/229E, 2 (2%) parainfluenza virus 3, 1 (1%) parainfluenza virus 1, and 2 (2%) dual infections. No MERS-CoV was detected in any sample. Rhinovirus was the commonest cause of ILI among Hajj pilgrims in 2013. Infection control and appropriate vaccination are necessary to prevent transmission of respiratory viruses at Hajj and other mass gatherings.

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Upon return from Hajj 2014, 150 Australian pilgrims were interviewed about their understanding of the Ebola epidemic. Most (89%, 134/150) knew of the epidemic before travelling and 60% (80/134) of those knew Ebola transmits through body fluids. Pilgrims who received pre-travel health advice were more conscious of Ebola (69% vs 31%, p?=?0.01) and adhered better to hand hygiene after touching an ill person (68% vs 31%, p?<?0.01). Mass media was the main information source (78%).

Background In this large-scale cluster-randomized controlled trial (cRCT) we sought to assess the effectiveness of facemasks against viral respiratory infections. Methods and results Over three consecutive Hajj seasons (2013, 2014, 2015) pilgrims' tents in Makkah were allocated to 'facemask' or 'no facemask' group. Fifty facemasks were offered to participants in intervention tents, to be worn over four days, and none were offered to participants in control tents. All participants recorded facemask use and respiratory symptoms in health diaries. Nasal swabs were collected from the symptomatic for virus detection by reverse transcription polymerase chain reaction. Clinical symptoms and laboratory results were analyzed by 'intention-to-treat' and 'per-protocol'. A total of 7687 adult participants from 318 tents were randomized: 3864 from 149 tents to the intervention group, and 3823 from 169 tents to the control group. Participants were aged 18 to 95 (median 34, mean 37) years, with a male to

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Background: Our understanding about knowledge, attitudes and perceptions (KAP) of immigrants regarding human papillomavirus (HPV) vaccine is poor. We present the first systematic review on KAP of immigrant parents towards HPV vaccine offered to their children. Methods: Major bio-medical databases (Medline, Embase, Scopus and PsycINFO) were searched using a combination of keyword and database-specific terms. Following identification of studies, data were extracted, checked for accuracy, and synthesised. Quality of the studies was assessed using the Newcastle Ottawa Scale and the Joanna Briggs Institute Qualitative Assessment tool. Results: A total of 311 titles were screened against eligibility criteria; after excluding 292 titles/full texts, 19 studies were included. The included studies contained data on 2206 adults. Participants’ knowledge was explored in 16 studies and ranged from none to limited knowledge. Attitudes about HPV vaccination were assessed in 13 studies and were mixed: four reported negative attitudes fearing it would encourage sexual activity; however, this attitude often changed once parents were given vaccine information. Perceptions were reported in 10 studies; most had misconceptions and concerns regarding HPV vaccination mostly influenced by cultural values. Conclusion: The knowledge of HPV-related diseases and its vaccine among immigrant parents in this study was generally low and often had negative attitude or perception. A well-designed HPV vaccine health educational program on safety and efficacy of HPV vaccination targeting immigrant parents is recommended.

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