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ABSTRACT: Background: Trials using facemasks to prevent influenza have been inconclusive because of small sample sizes. The Hajj pilgrimage in Mecca provides an excellent opportunity to test the effectiveness of masks against laboratory-proven influenza and other viruses, where the incidence of these infections is high.
Objectives: To assess the effectiveness of face masks in the prevention of transmission of influenza-like illness (ILI) among Australian Hajj pilgrims a pilot trial was conducted at the Hajj 2011.
Methods: During the first day of Hajj (4 November 2011), tents were randomly assigned to ‘mask’ or ‘control’ (no mask). Pilgrims who developed symptoms of ILI for ≤3 days were recruited as ‘index cases’; healthy pilgrims who slept closely to them were recruited as ‘close contacts’. Simple surgical facemasks were provided to the index cases and their close contacts in the ‘mask’ tents, whereas no masks were provided to the ‘control tents’. Pilgrims in both groups were provided diaries to record their respiratory symptoms. Nasal or pharyngeal swabs were collected from the index cases and close contacts who developed symptoms suggestive of ILI for point-of-care and molecular tests.
Results: Twenty two tents were randomized to ‘mask’ (n=12) or ‘control’ (n=10). A total of 164 pilgrims were recruited: 75 in ‘mask’ and 89 in ‘control’ group. In the ‘mask’ group 25 (33.3%) were males with the median age being 48 (range 19-80) years. In the ‘control’ tents 46 (51.7%) were males with the median age being 42 (range 17-72) years. Mask use compliance was 76% in the ‘mask’ group and 12.4% in the ‘control’ group. Based on ILI criteria, less number of contacts were symptomatic in the ‘mask’ tents compared to the ‘control’ tents (30.6% [11/36] versus 52.8% [28/53], p= 0.04). However, laboratory results show that only 4 contacts in ‘mask’ tents had proven viral infection (rhinovirus in 3, both influenza and rhinovirus in one) while only 2 contacts in ‘control’ tents had viral infection (rhinovirus in both).
Conclusion: Not surprisingly, the result of this pilot trial is inconclusive, but it shows that a large trial to assess the effectiveness of mask use at Hajj is feasible.
13th Conference of the International Society of Travel Medicine, Maastricht, The Netherlands; 05/2013
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Clinical Infectious Diseases 01/2012; 54(1):151-3. · 9.15 Impact Factor
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Journal of the Royal Society of Medicine 03/2010; 103(3):79-80. · 1.41 Impact Factor
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ABSTRACT: Influenza and meningococcal disease are two serious diseases that are especially linked. Outbreaks of influenza have been frequently associated with secondary outbreaks of meningococcal disease. Travellers such as Hajj pilgrims are at particular risk, the most recent meningococcal outbreaks being in 2000 and 2001, while concern is rising that the annual pilgrimage, centred as it presently is on winter, may even become the epicentre of an avian influenza pandemic. Routine vaccination of pilgrims against meningococcal disease using a 4-valent product has been in place since 2002 with good effect, but influenza vaccine is not yet routinely required for all pilgrims despite the high proportion afflicted. Meningococcal polysaccharide vaccines are effective in older children and adults and this cheaper product can play a role in the short term management of meningococcal outbreaks due to serogroups A, C, W135 or Y. The impressively fast development of a C conjugate vaccine in the late 1990s was a credit to the close collaboration of pharma, academia and the executive. A similar alignment could accelerate the production of an efficacious and cost-effective H5N1 influenza vaccine through direct transparent competition with head-to-head randomised, double-blinded controlled trials. Both organisms have a propensity to mutate and adapt to immune pressure. There are lessons to be learnt from how we manage each for the control of the other.
Travel Medicine and Infectious Disease 08/2009; 7(4):253-6. · 1.50 Impact Factor
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ABSTRACT: While an increased risk of hepatitis is associated with travel, the risk of hepatitis associated with the Islamic Hajj pilgrimage to Mecca, Saudi Arabia has not been carefully quantified. Conditions unique to this gathering can pose the risk of both enteral and parenteral viral hepatitis. During this congregation, pilgrims stay in tents shared by 100 or more people often living on foods from street vendors and sharing common toilet facilities that can expose them to both hepatitis A and E. To mark the end of the festival, head shaving or trimming by fellow pilgrims or street barbers, who often re-use their razor may expose them to hepatitis B or C. Pilgrims are also at risk of cuts to the hands and feet while sacrificing cattle and walking barefooted, which may further increase the risk of parenteral viral hepatitis. Emerging diseases such as Alkhumra virus and Rift Valley fever, which may cause hepatitis, are also potentially important for the Hajj pilgrims. Improved health education to increase awareness about the risk of these diseases and appropriate immunisations, particularly hepatitis A and B vaccines, could play an important role.
Travel Medicine and Infectious Disease 08/2009; 7(4):239-46. · 1.50 Impact Factor
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ABSTRACT: Background: The QuickVue influenza test, a rapid diagnostic method, detects influenza antigen by immunochromatographic assay. In a nested case-control study, the presence of viral RNA on the QuickVue test strip was checked using reverse transcriptase-polymerase chain reaction (RT-PCR).
Methods: QuickVue test strips from 30 patients who attended the Hajj pilgrimage in Mecca, confirmed to have influenza by RT-PCR on nasal swabs collected in lysis buffer, were selected as cases, and another 30 strips from influenza-negative patients were chosen as controls after matching for age, sex, and risk factors of influenza. Test strips from both cases and controls were subjected to RT-PCR testing 9 months after bedside testing.
Results: Eight cases (27%) and 1 control (3%) were positive for influenza by the QuickVue test at point of care (P = 0.03). Later, when the test strips were subjected to RT-PCR, 6 of 8 influenza-positive QuickVue strips detected the presence of influenza RNA, and the only positive strip from the controls was also confirmed to have influenza. Thus, the presence of influenza was confirmed in 8 of 9 QuickVue positive strips with substantial agreement between bedside QuickVue testing and subsequent RT-PCR testing on the strips (κ coefficient, 0.8; 95% confidence interval, 0.6-1). Conversely, there was only slight agreement between RT-PCR on lysis buffer and RT-PCR on QuickVue strips (κ coefficient, 0.2; 95% confidence interval, 0.03-0.3).
Conclusion: Our pilot study demonstrated that the QuickVue test strips if saved rather than discarded can be used to reevaluate discordant results.
Point of Care The Journal of Near-Patient Testing & Technology 02/2009; 8(1):1-3.
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The Lancet Infectious Diseases 10/2008; 8(9):526-7. · 17.39 Impact Factor
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ABSTRACT: In pilgrims returning to the UK from the Hajj in 2005 and 2006, protection from PCR-confirmed influenza by influenza vaccine was estimated using verified vaccination histories from those with symptoms consistent with influenza. Of 538 patients whose nasal swabs were analysed and immunisation histories confirmed 115 (21%) were in a high-risk group for influenza; half of these (58/115) were immunised against influenza, compared with a fifth (90/423) of those not at high risk. Five percent of vaccinated 'at risk' pilgrims compared with 14% of unvaccinated (RR 0.37, 95% CI 0.1-1.4) had confirmed influenza. Rates of influenza in vaccinated and unvaccinated 'not at risk' pilgrims were similar (10% vs. 11%). Seasonal influenza vaccine was insignificantly protective against influenza in Hajj pilgrims.
Vaccine 09/2008; 26(37):4809-12. · 3.77 Impact Factor
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The Lancet Infectious Diseases 05/2008; 8(4):215. · 17.39 Impact Factor
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ABSTRACT: A 10-year invasive pneumococcal disease (IPD) enhanced surveillance project in the Oxfordshire region of the UK between 1996 and 2005 identified a total of 2691 Streptococcus pneumoniae isolates from all ages that provided a comprehensive description of pneumococcal epidemiology. All isolates were serotyped and those from children under 5 years of age were genotyped and a matched case-control study using adults hospitalized between 1995 and 2000 was performed to estimate the effectiveness of the pneumococcal polysaccharide vaccine in the local population. Fifty-one serotypes were isolated, with different age distributions. The overall incidence of IPD was 9.2 cases per 100 000 population per annum [95 % confidence interval (CI), 8.6-9.9] and that of meningitis was 0.7 per 100 000 population per annum (95 % CI 0.5-0.9). After adjusting for age, serotype 1 was found to be less likely to be associated with meningitis versus other IPD, compared with the most common serotype 14, whereas serotype 12F was more likely to cause meningitis than other IPD. There were significant temporal changes in IPD incidence of four serotypes, with decreases in serotypes 1, 12F and 14 and increases in serotype 8. A possible novel variant (from serotype 6A to 6B) was found using multilocus sequence typing analysis. From the matched case-control study of adults, the pneumococcal polysaccharide vaccine effectiveness was estimated to be 43 % (2-68 %), which did not change significantly after adjustment for pre-existing co-morbidities. The data provide a baseline against which the impact of the pneumococcal conjugate vaccine introduced in the UK in 2006 could be measured.
Journal of Medical Microbiology 05/2008; 57(Pt 4):480-7. · 2.50 Impact Factor
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Archives of Internal Medicine 04/2008; 168(6):666-7. · 11.46 Impact Factor
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International Journal of Infectious Diseases 02/2008; 12(1):102-3. · 1.94 Impact Factor
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ABSTRACT: The potential for spread of infectious diseases associated with mass gatherings is well recognised. Hajj, the unique annual mass gathering of over 2 million Muslims from all over the world, presents enormous challenges to the authorities in Saudi Arabia. They have a comprehensive programme updated annually, to ensure that all aspects of Hajj rituals are conducted safely and without major incident. The inevitable overcrowding in a confined area of such large numbers increases the risk of respiratory infections. Of these 'Hajj cough' is the most frequently reported complaint and is caused by a variety of viruses and bacteria. The outbreaks of meningococcal W135 strains in 2000 and 2001 with the associated high mortality showed the potential for international spread at mass gatherings. Collaboration between health policy makers and community leaders in the UK resulted in a rapid and impressive reduction of these infections. On-going disease surveillance and data analysis is necessary to better understand health risks and strengthen evidence base for health policy and prevention. The battle against spread of travel-related infections is a shared responsibility. Countries sending pilgrims should co-ordinate preventive measures by healthcare professionals and community groups. A multi-pronged approach involving awareness programme for pilgrims and their health advisers, supported by rapid diagnosis, timely treatment, prevention by vaccine, community measures, infection prevention and control practices are necessary. The benefits from such measures go beyond the Hajj to protect health and reduce inequalities. Establishing an international centre for public health relating to the Hajj will enable co-ordinating international health action and appropriate intervention.
Journal of infection and public health. 01/2008; 1(1):27-32.
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ABSTRACT: Muslim pilgrims going on the Hajj are at risk of influenza. The treatment and prevention of influenza with antiviral drugs depends on rapid diagnosis using a near-patient test such as the QuickVue influenza test. The suitability of this test among pilgrims has not been studied in the past and this study assesses the usefulness of the test for diagnosing influenza among those attending the Hajj.
The sensitivity and specificity of the QuickVue test were measured against reverse transcriptase polymerase chain reaction by undertaking the tests on nasal swab samples from pilgrims.
The sensitivity and specificity of the QuickVue test were 22% and 99%, respectively, and its likelihood ratio for a positive and a negative test were 22 and 0.79 in that order.
The QuickVue influenza test using nasal swabs is poorly sensitive for diagnosing influenza among Hajj pilgrims. Given its high specificity and an even higher likelihood ratio for a positive test it may still be a very useful tool for influenza surveillance at the Hajj.
Travel Medicine and Infectious Disease 10/2007; 5(5):310-3. · 1.50 Impact Factor
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ABSTRACT: Every year 1% of British Muslims travel to Saudi Arabia on the Hajj pilgrimage. High rates of influenza have been reported among pilgrims,1
2 and the Saudi Arabian Ministry of Health recommends that all pilgrims should receive influenza vaccination before travelling. We determined the uptake of influenza vaccination among British Hajj pilgrims who attended the British Hajj Delegation Clinic in Mecca and mobile clinics set up by us in Mina in 2005 and 2006.
In 2005, 196 pilgrims were recruited and in 2006, 146 (age …
BMJ (Clinical research ed.). 01/2007; 333(7580):1220.
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Emerging infectious diseases 11/2004; 10(10):1882-3. · 6.17 Impact Factor
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ABSTRACT: For two successive years, 2000 and 2001, there was a world-wide outbreak of W135 meningococcal disease amongst pilgrims who attended the Hajj and in their contacts after returning home.
Beginning January 2002, we offered meningococcal quadrivalent polysaccharide vaccine (against serogroups A, C, Y and W135) to pilgrims and collected a throat swab for meningococcal W135 carriage before and after their pilgrimage.
The overall Neisseria meningitidis carriage pre-Hajj was 8.3% and 6.3% post-Hajj. We found W135 carriage rates of 0.8% before and 0.6% after Hajj, respectively. 21% (36/174) of the pilgrims were treated with antibiotics for respiratory illness.
The carriage of meningococcus W135 among UK pilgrims who visited the Hajj in 2002 was low. This contrasts with another study suggesting pilgrims frequently acquired N. meningitidis W135 carriage during 2001 Hajj. The use of the quadrivalent vaccine may account for this difference.
Travel Medicine and Infectious Disease 03/2004; 2(1):13-5. · 1.50 Impact Factor
