Respiratory tract infections among French Hajj pilgrims from 2014 to 2017

Abstract

Respiratory tract infections (RTIs) are common among Hajj pilgrims, but risk factors for RTIs and respiratory pathogen acquisition during the Hajj are not clearly identified. Based on previous studies, most frequent pathogens acquired by Hajj pilgrims were investigated: rhinovirus, human coronaviruses, influenza viruses, Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella pneumoniae and Haemophilus influenzae. 485 pilgrims were included. 82.1% presented with RTIs. Respiratory chronic diseases were associated with cough, Influenza-like illness (ILI) and the acquisition of H. influenzae. Vaccination against invasive pneumococcal diseases (IPD) and influenza was associated with a decrease in the acquisition of S. pneumoniae and prevalence of ILI (aRR = 0.53, 95%CI [0.39–0.73] and aRR = 0.69, 95%CI [0.52–0.92] respectively). Individuals carrying rhinovirus and H. influenzae-S. pneumoniae together were respectively twice and five times more likely to have respiratory symptoms. Individual with H. influenzae-K. pneumoniae carriage were twice (p = 0.04) as likely to develop a cough. The use of disposable handkerchiefs was associated with a decrease in the acquisition of S. aureus (aRR = 0.75, 95%CI [0.57–0.97]). Results could be used to identify pilgrims at increased risk of RTIs and acquisition of respiratory pathogens. Results also confirm the effectiveness of influenza and IPD vaccinations in reducing ILI symptoms and acquisition of S. pneumoniae carriage respectively.

Tracking Australian Hajj Pilgrims’ Health Behavior before, during and after Hajj, and the Effective Use of Preventive Measures in Reducing Hajj-Related Illness: A Cohort Study

“…Although our results cannot be generalized to all pilgrims, this study is the first of its kind to assess pilgrims’ KAP continuously throughout the Hajj journey to understand their health behaviors, experience of using preventative measures and the development of acute respiratory infections, and other symptoms of infections. In the meantime, studies conducted in France and Malaysia have shown that compliance to some preventive measures such as hand hygiene and face mask use has increased, while the uptake of recommended vaccines including influenza and pneumococcal vaccines still remains low [ 36 , 37 , 38 ]; therefore, awareness campaigns should be continued to tackle respiratory infections including the ongoing COVID-19 pandemic that, thus far, has taken a toll of over 200,000 people across the world (as of 27 April 2020) and affected many Muslim countries including Saudi Arabia [ 39 ]. To mitigate the epidemic, the Saudi Arabian authority has already temporarily cancelled Umrah (minor pilgrimage) visit to Makkah [ 40 ]; the decision on whether this year’s Hajj pilgrimage (late July to early August) should be cancelled or not remains to be decided and may depend on the progress of the pandemic [ 41 ].…”

Hajj and Umrah Mass Gatherings and COVID-19 Infection

“…As an example, a paired survey realized among 692 international Hajj pilgrims showed that over 34% pilgrims acquired HRV after the 2013 Hajj season [ 12 ]. More recently (2014 to 2017), in a 4-year cohort of 485 French pilgrims, 26.9% participants acquired HRV after their pilgrimage [ 18 ]. The dynamic of HRV acquisition during the pilgrimage was recently described in French pilgrims [ 6 ].…”

“…Acquisition rate of HCoV 229E calculated from a large paired cohort survey (692 international pilgrims) in 2013 was 14.6% [ 12 ]. In paired cohorts of French pilgrim ( n = 485) investigated during the Hajj 2014–2017, the overall HCoV acquisition rate was 8.3% (with HCoV 229E the most frequent (6.2%)) [ 18 ] with a marked peak during the 2016 Hajj season with a 19.8% HCoV 229E acquisition rate [ 2 , 13 – 16 , 23 •].…”

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

“…A study on medical mission personnel in Haj, showed that continuous use of a facemask was not associated with lower risk of respiratory symptoms, and intermittent use more than doubled the risk [ 35 ]. A recent observational study conducted at Haj over four consecutive years (2014 to 2017) found pilgrims who reported using facemasks had a higher likelihood of influenza-like symptoms (adjusted RR, 1.42; 95% CI, 1.10 to 1.82) and of acquiring rhinovirus infection (adjusted RR, 1.30; 95% CI, 1.03 to 1.65) [ 36 ].…”