Antibiotic use for respiratory infections among Hajj pilgrims: A cohort survey and review of the literature

Hoang, Van Thuan; Nguyen, Thi-Thu-Thuy; Belhouchat, Khadidja; Meftah, Mohammed; Sow, Doudou; Benkouiten, Samir; Dao, Thi-Loi; Ly, Tran Duc Anh; Drali, Tassadit; Yezli, Saber; Alotaibi, Badriah; Raoult, Didier; Parola, Philippe; Santi, Vincent Pommier de; Gautret, Philippe

doi:10.1016/j.tmaid.2019.06.007

Cited by 23 publications

(25 citation statements)

References 31 publications

(33 reference statements)

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“…To our knowledge, no study on respiratory microbiota alteration among pilgrims during the Hajj has been conducted. Our results about the occurrence of RTI symptoms are in line with previous results obtained regarding French pilgrims [17] and others [1,20]. Notably, we observed that RTI symptoms occur soon after the pilgrims' arrival in Mecca, with most symptoms starting between 4and 13 days after arrival, corresponding to the period when pilgrims are stationed in Mecca hotels and are visiting the Grand Mosque daily, where highly crowded conditions are common [7].…”

Section: Discussionsupporting

confidence: 92%

“…We also evidenced the role of respiratory bacteria including K. pneumoniae and M. catarrhalis-S. aureus association and H. influenzaerhinovirus association in the occurrence of possible LRTI symptoms. This reinforces the need for antibiotic use in case of LRTI symptoms [17].…”

Section: Discussionsupporting

confidence: 66%

“…Influenza-like illness (ILI) was defined as the presence of cough, sore throat and subjective fever [16]. Possible LRTI was defined by presence of productive cough without nasal or throat symptoms; febrile productive cough; dyspnea or febrile dyspnea [17]. Based on the WHO classification, "underweight" was defined as having a body mass index (BMI) below 18.5, "normal" corresponded to a BMI between 18.5 and 25, "overweight" corresponded to a BMI ≥25, and "obese" referred to those with a BMI ≥30 [18].…”

Section: Participants and Study Design (Figure 1)mentioning

confidence: 99%

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The dynamics and interactions of respiratory pathogen carriage among French pilgrims during the 2018 Hajj

Hoang

Dao

et al. 2019

Emerging Microbes & Infections

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We conducted this study to describe the dynamics of the acquisition of respiratory pathogens, their potential interactions and risk factors for possible lower respiratory tract infection symptoms (LRTI) among French pilgrims during the 2018 Hajj. Each participant underwent four successive systematic nasopharyngeal swabs before and during their stay in Saudi Arabia. Carriage of the main respiratory pathogens was assessed by PCR. 121 pilgrims were included and 93.4% reported respiratory symptoms during the study period. The acquisition of rhinovirus, coronaviruses and Staphylococcus aureus occurred soon after arrival in Saudi Arabia and rates decreased gradually after days 5 and 6. In contrast, Streptococcus pneumoniae and Klebsiella pneumoniae carriage increased progressively until the end of the stay in Saudi Arabia. Haemophilus influenzae and Moraxella catarrhalis carriage increased starting around days 12 and 13, following an initial clearance. Influenza viruses were rarely isolated. We observed an independent positive mutual association between S. aureus and rhinovirus carriage and between H. influenzae and M. catarrhalis carriage. Dual carriage of H. influenzae and M. catarrhalis was strongly associated with S. pneumoniae carriage (OR = 6.22). Finally, our model showed that M. catarrhalis carriage was negatively associated with K. pneumoniae carriage. Chronic respiratory disease was associated with symptoms of LRTI. K. pneumoniae, M. catarrhalis-S. aureus and H. influenzae-rhinovirus dual carriage was associated with LRTI symptoms. Our data suggest that RTIs at the Hajj are a result of complex interactions between a number of respiratory viruses and bacteria.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 66%

Section: Participants and Study Design (Figure 1)mentioning

confidence: 99%

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The dynamics and interactions of respiratory pathogen carriage among French pilgrims during the 2018 Hajj

Hoang

Dao

et al. 2019

Emerging Microbes & Infections

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“…The profile of the Hajj pilgrims corresponds to that of individuals at risk for severe COVID. The majority of Hajj pilgrims are elderly and have a high prevalence of chronic diseases [ 47 •, 48 ]. In a large study on 783 French pilgrims from 2012 to 2017, the median of age of participants was 62 years, and more than 50% have comorbidities.…”

Section: The Risk For Covid-19 Among Hajj and Umrah Pilgrimsmentioning

confidence: 99%

Hajj and Umrah Mass Gatherings and COVID-19 Infection

et al. 2020

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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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“…The limited available literature on this topic suggests low appropriateness of antibiotic prescriptions during Hajj. Only around 40% of French pilgrims who were prescribed antibiotics in one report had an appropriate indication according to French recommendations [35]. Similarly, another study found 98.6% of patients attending an ear, nose and throat clinic during Hajj were prescribed antibiotics, even though 44.6% were diagnosed with viral infections [16].…”

Section: Discussionmentioning

confidence: 99%

Pilot Survey of Knowledge, Attitudes and Perceptions of Hajj Deployed Health Care Workers on Antibiotics and Antibiotic Prescriptions for Upper Respiratory Tract Infections: Results from Two Hajj Seasons

et al. 2020

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Antimicrobial resistance (AMR) is a global public health issue. Upper respiratory tract infections (URTIs) are common illnesses during Hajj, for which antibiotics are often inappropriately prescribed. Hajj healthcare workers’ (HCW) knowledge, attitudes and perceptions (KAP) about AMR and antibiotic use for URTIs are not known. We conducted a survey among HCWs during Hajj to explore their KAP regarding antibiotic use for URTIs in pilgrims. Electronic or paper-based surveys were distributed to HCWs during the Hajj in 2016 and 2017. A total of 85 respondents aged 25 to 63 (median 40) years completed the surveys. Most participants were male (78.8%) and were physicians by profession (95.3%). Around 85% and 19% of respondents claimed to have heard about AMR and antimicrobial stewardship programs, respectively, among whom most had obtained their knowledge during their qualification. Implementation of URTI treatment guidelines was very low. In conclusion, HCWs at Hajj have significant knowledge gaps regarding AMR, often do not use standard clinical criteria to diagnose URTIs and display a tendency to prescribe antibiotics for URTIs.

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Antibiotic use for respiratory infections among Hajj pilgrims: A cohort survey and review of the literature

Cited by 23 publications

References 31 publications

The dynamics and interactions of respiratory pathogen carriage among French pilgrims during the 2018 Hajj

The dynamics and interactions of respiratory pathogen carriage among French pilgrims during the 2018 Hajj

Hajj and Umrah Mass Gatherings and COVID-19 Infection

Pilot Survey of Knowledge, Attitudes and Perceptions of Hajj Deployed Health Care Workers on Antibiotics and Antibiotic Prescriptions for Upper Respiratory Tract Infections: Results from Two Hajj Seasons

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