Health Risks, Preventive Behaviours and Respiratory Illnesses at the 2019 Arbaeen: Implications for COVID-19 and Other Pandemics

Abstract

COVID-19 poses grave challenges for mass gatherings. One of the world’s largest annual gatherings, Arbaeen, occurs in Iraq. We studied respiratory symptoms and risk and protective factors using representative sampling of Arbaeen pilgrims in 2019 to inform prevention of COVID-19 transmission. Structured sampling was used to recruit walking pilgrims. A questionnaire asked about respiratory symptoms, risk, and preventive factors, including hygiene-related resources of toilet facilities. The commonest symptom reported by the 1842 participants (63.3% male, 36.7% female) was cough (25.6%). Eating in mawkibs (rest areas) with indoor kitchens and drinking only packaged water were associated with lower risk of cough (AOR = 0.72, CI = 0.56–0.94; AOR = 0.60; CI = 0.45–0.78, p < 0.05). Facemask use was associated with increased risk of cough (AOR = 2.71, CI = 2.08–3.53, p < 0.05). Handwashing was not protective against cough, or against (one or more of) cough, fever, or breathlessness in multivariate analysis. Toilet facilities often lacked running water (32.1%) and soap (26.1%), and had shared hand towels (17%). To reduce risk of respiratory infections including COVID-19 during Arbaeen or other mass gatherings, needs include running water, soap, and hygienic hand drying options or hand sanitiser. Education on proper handwashing and facemask approaches and monitoring around food preparation and eating spaces are needed.

Emerging pneumococcal serotypes in Iraq: scope for improved vaccine development

“…72,73 Additionally, religious mass gatherings occurring within this region act as hotspots for pathogen dissemination among pilgrims (especially those with comorbidities) during Hajj, Umrah, and Arba'een. [74][75][76][77] Thus, the active surveillance of pneumococcal serotypes prevalent within this region would help determine the effectiveness of the adopted immunization strategies and aid in developing novel measures to control disease transmission and outbreaks. Currently, the EMR has a vaccination coverage of 52% for 3 doses of PCV.…”

An appraisal of anticancer activity with structure–activity relationship of quinazoline and quinazolinone analogues through EGFR and VEGFR inhibition: A review

“…Further, development can lead to finding more potent and selective inhibitors (Table 1). Yin, Sha, et al (2015) have identified novel oxazolo [4,5]quinazolinone derivatives as potent EGFR kinase inhibitors. Most of the series' compounds displayed good inhibitory potency against EGFR kinase and selected human epidermoid (KB) and renal carcinoma (A549) cancer cell lines.…”

Infectious diseases threats at the Arba'een – a neglected but one of the largest annually recurring mass gathering religious events

“…Recent focus of these challenges has been on the importation, transmission, and globalisation of a range of emerging and re-emerging infectious diseases threats including Monkeypox, COVID-19, Influenza and antibiotic resistance (Aggrawal V et al, 2020;Goumbala N et al, 2021;Zumla A et al, 2018;Zumla A et al, 2022;Petersen E et al, 2022;Al-Ansari F et al, 2021). All mass gathering religious events involve large numbers of pilgrims living and interacting together performing religious rites in crowded conditions, exposing themselves and the local population to various bacterial and viral infections.…”

“…Whilst accurate data are unavailable in the literature, the annual numbers and flow of pilgrims for the Arba'een have been interrupted several times over the years due to political instability, safety and security issues. Since the Iraq war ended over two decades ago in 2003 the Arba'een has continued to attract a growing number of pilgrims from outside Iraq (Al-Ansari F et al, 2021). The tens of millions pilgrims impose a substantial burden on Iraq's already fragile and non-resilient health infrastructure.…”