Impact of the Hajj on pneumococcal carriage and the effect of various pneumococcal vaccines

Edouard, Sophie; Al‐Tawfiq, Jaffar A.; Memish, Ziad A.; Yezli, Saber

doi:10.1016/j.vaccine.2018.09.017

Cited by 14 publications

(13 citation statements)

References 45 publications

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“…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]. We also confirmed that an overall increase in the carriage of respiratory viruses and bacteria can be seen when comparing pre-travel samples and post-Hajj samples, as previously documented [7,12,20,[27][28][29]. Higher acquisition rates were observed for rhinovirus with a nine-fold increase when comparing pre-travel to post-Hajj carriage and for S. pneumoniae with a seven-fold increase, but an increase was observed for all pathogens tested in this study.…”

Section: Discussionsupporting

confidence: 87%

“…Nasopharyngeal colonization is likely to be a reservoir for respiratory pathogens resulting in interhuman transmission between pilgrims during close contact experienced during the Hajj ritual. Furthermore, antibiotic use or vaccines, which target specific pathogen species, may alter polymicrobial interactions in the nasopharynx and have unanticipated consequences [12,13]. To our knowledge, the dynamics and interaction between the main respiratory pathogens acquired during the Hajj pilgrimage have not been specifically investigated, to date.…”

Section: Introductionmentioning

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: 87%

Section: Introductionmentioning

confidence: 99%

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

Hoang

Dao

et al. 2019

Emerging Microbes & Infections

Self Cite

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“…Notably, we observed that RTI symptoms occur soon after the pilgrims' arrival in Mecca, with most symptoms starting between 4 to 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]. We also confirmed that an overall increase in the carriage of respiratory viruses and bacteria can be seen when comparing pre-travel samples and post-Hajj samples, as previously documented [7,12,[19][20][21][22]. Higher acquisition rates were observed for rhinovirus with a ninefold increase when comparing pre-travel to post-Hajj carriage and for S. pneumoniae with a seven-fold increase, but an increase was observed for all pathogens tested in this study.…”

Section: Discussionsupporting

confidence: 87%

“…Nasopharyngeal colonisation is likely to be a reservoir for respiratory pathogens resulting in interhuman transmission between pilgrims during close contact experienced during the Hajj ritual. Furthermore, antibiotic use or vaccines, which target specific pathogen species, may alter polymicrobial interactions in the nasopharynx and have unanticipated consequences [12,13]. To our knowledge, the dynamics and interaction between the main respiratory pathogens acquired during the Hajj pilgrimage have not been specifically investigated, to date.…”

Section: Introductionmentioning

confidence: 99%

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

Hoang

Dao

et al. 2019

Preprint

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Respiratory tract infections are frequent among Hajj pilgrims. 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. Pilgrims from Marseille who were participating in the Hajj were recruited. 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. Polymicrobial carriage was observed in 73.8% samples. 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, 95%CI [2.04-19.01]). 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. Author summaryDespite the recommendation to take individual preventive measures to prevent respiratory tract infections, these infections remain common among Hajj pilgrims. Respiratory pathogens acquired during the Hajj are usually studied individually, although in their natural environment they often compete or coexist with multiple microbial species. A better understanding of polymicrobial interactions in the nasopharynx among Hajj pilgrims is important. Our study describes the dynamics of the acquisition of respiratory pathogens and their potential interactions among pilgrims during the Hajj.We found that polymicrobial carriage was observed in most individuals and that some pathogens associated positively while other did not. Some pathogen associations correlated with symptoms of lower respiratory tract infections.

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“…10,68 Recom mended vaccines include influenza vaccine and pneumococcal vaccine. 84,85 Since the inclusion of the quadrivalent meningococcal vaccine in 2001, 85 no major meningo coccal meningitis outbreaks related to hajj have been identified. [85][86][87] However, concern that new serogroups of N meningitidis (eg, B and X), which are not covered in the current quadrivalent vaccine targeting serogroups A, C, W135, and Y, could be a cause of future epidemics is increasing.…”

Section: Infectious Diseases At the Hajjmentioning

confidence: 99%

Mass gatherings medicine: public health issues arising from mass gathering religious and sporting events

Memish

Steffen

White³

et al. 2019

The Lancet

232

184

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Mass gathering events are associated with major public health challenges. The 2014 Lancet Series on the new discipline of mass gatherings medicine was launched at the World Health Assembly of Ministers of Health in Geneva in May, 2014. The Series covered the planning and surveillance systems used to monitor public health risks, public health threats, and experiences of health-care providers from mass gathering events in 2012 and 2013. This follow-up Review focuses on the main public health issues arising from planned mass gathering events held between 2013 and 2018. We highlight public health and research data on transmission of infectious diseases and antibioticresistant bacteria, mass casualty incidents, and non-communicable diseases, including thermal disorders. In the events discussed in this Review, the combination of a large influx of people, many from countries with outbreakprone infectious diseases, with a high degree of crowd interactions imposed substantial burdens on host countries' health systems. The detection and transmission of antibiotic-resistant bacteria in pilgrims attending the Kumbh Mela and the Hajj raise concern of possible globalisation from mass-gathering religious events. Priorities for further investments and opportunities for research into prevention, surveillance, and management of these public health issues are discussed. Search strategy and selection criteriaWe searched PubMed, Embase, Cochrane Library, and Google Scholar for English language papers that were published from a.zumla@ucl.ac.uk disorders. Priorities for further investments and oppor tunities for research into prevention, surveillance, and management of communicable and noncom municable diseases, thermal disorders, and mass casualty incidents are discussed.

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Impact of the Hajj on pneumococcal carriage and the effect of various pneumococcal vaccines

Abstract: The studies analyzed in this review showed an increased carriage of pneumococcus in post-Hajj pilgrims compared to pre-Hajj pilgrims, including vaccine serotypes. Further studies are needed to investigate the possible relationships between carriage, disease and vaccine in pilgrims.

Cited by 14 publications

References 45 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

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

Mass gatherings medicine: public health issues arising from mass gathering religious and sporting events

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