Syndromic surveillance of respiratory-tract infections and hand hygiene practice among pilgrims attended Hajj in 2021: a cohort study

Abstract

Background The risk of transmission of viral respiratory tract infections (RTIs) is high in mass gatherings including Hajj. This cohort study estimated the incidence of symptomatic RTIs and hand hygiene compliance with its impact among Hajj pilgrims during the COVID-19 pandemic. Methods During the week of Hajj rituals in 2021, domestic pilgrims were recruited by phone and asked to complete a baseline questionnaire. Pilgrims were followed up after seven days using a questionnaire about the development of symptoms, and practices of hand hygiene. Syndromic definitions were used to clinically diagnose ‘possible’ influenza-like illnesses (ILI) and COVID-19 infection. Results A total of 510 pilgrims aged between 18 and 69 (median of 50) years completed the questionnaire, 280 (54.9%) of whom were female, and all of them (except for one) were vaccinated against COVID-19 with at least one dose. The mean (± SD) of pilgrims’ hand hygiene knowledge score (on a scale of 0 to 6) was 4.15 (± 1.22), and a higher level of knowledge was correlated with a higher frequency of handwashing using soap and water. Among those 445 pilgrims who completed the follow-up form, 21 (4.7%) developed one or more respiratory symptoms, of which sore throat and cough were the commonest (respectively 76.2% and 42.8%); ‘possible ILI’ and ‘possible COVID-19’ were present in 1.1% and 0.9% of pilgrims. Obesity was found to be a significant factor associated with the risk of developing RTIs (odds ratio = 4.45, 95% confidence interval 1.15–17.13). Conclusions Hajj pilgrims are still at risk of respiratory infections. Further larger and controlled investigations are needed to assess the efficacy of hand hygiene during Hajj.

Low Prevalence of Syndromic Respiratory Tract Infections among Returning Hajj Pilgrims Amidst the COVID-19 Pandemic: A Post-Hajj Survey

“…However, a cohort study during the same Hajj year showed greater prevalence rates of syndromic RTIs: 4.7% of the cohorts experienced RTI symptoms, and, respectively, 1.1% and 0.9% were suspected of having ILI and COVID-19. These lower rates were observed in this survey despite fewer pilgrims having university-level or higher education than those in the previous study (58.2% vs. 76.5%), and fewer were vaccinated against influenza (48.7% vs. 58.2%) and COVID-19 (88.7% vs. 92.5%) [15]. In contrast, previous studies found that the level of education was associated with higher compliance with preventive measures [21][22][23].…”

“…Data are scarce on the post-Hajj prevalence of RTIs, and to the best of our knowledge, no study has assessed the prevalence of symptomatic RTIs among pilgrims during Hajj amidst the COVID-19 pandemic. A study conducted by our team during the peak period of Hajj in 2021 demonstrates the need for a post-Hajj surveillance study [15]. To this end, this manuscript aims to report the point prevalence of syndromic RTIs among domestic Hajj pilgrims who returned home after the pilgrimage in 2021 and assesses the risk of RTIs among pilgrims' contacts.…”

Hand Hygiene Knowledge and Practices Among Visitors to the Holy Masjid (Masjid Al-Haram) During the Month of Ramadan in 2023

“…Crowding and a variety of health risks, such as trauma and injury, can render MGs dangerous [ 1 , 3 , 5 ]. Additionally, the high concentration of people at specific locations for a set period increases the risk of spreading infectious diseases, including viral respiratory tract infections [ 3 , 4 , 8 ]. To control and prevent pulmonary system infections during MG events, regularly practicing proper hand hygiene (HH) is highly advised [ 3 , 4 , 8 ].…”

“…Additionally, the high concentration of people at specific locations for a set period increases the risk of spreading infectious diseases, including viral respiratory tract infections [ 3 , 4 , 8 ]. To control and prevent pulmonary system infections during MG events, regularly practicing proper hand hygiene (HH) is highly advised [ 3 , 4 , 8 ]. Good HH practice is considered one of the most effective strategies to halt the spread of infectious diseases.…”

Syndromic surveillance during 2022 Uganda Martyrs’ commemoration

“…Participatory surveillance enhanced through utilization of digital technologies during mass gatherings has been demonstrated during the 2014 FIFA World Cup [ 9 ] and 2016 Olympic Games [ 10 ]. Following the COVID-19 pandemic, syndromic surveillance for respiratory tract infections was conducted among pilgrims who attended Hajj in 2021 [ 11 ].…”