Hajj-associated acute respiratory infection among Hajjis from Riyadh


A prospective cohort study was conducted to estimate the incidence of acute respiratory infections (ARI) among hajjis registered at primary health care centres of Riyadh. Out of 1027 hajjis, 39.8% developed symptoms of ARI. The incidence of ARI was not statistically significantly associated with age, sex, educational status or smoking. The risk of illness was significantly higher among diabetics, hajjis who stayed longer in the hajj area and who prayed at Namera mosque. Use of a facemask by men, but not use of a facecover by women, was a significant protective factor against ARI.

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    • "comparing most of time use vs. sometimes use, respectively, of face mask Al-Mudameigh et al. (2003) Choudhry et al. (2006) [25] [24] Use of face mask (among male): "
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    ABSTRACT: Overcrowding during the yearly Hajj mass gatherings is associated with increased risk of spreading infectious diseases, particularly respiratory diseases. Non-pharmaceutical interventions (e.g., hand hygiene, wearing face masks, social distancing) are known to reduce the spread of respiratory viruses from person to person and are therefore recommended to pilgrims by public health agencies. The implementation of effective public health policies and recommendations involves evaluating the adherence to and effectiveness of these measures in the specific context of the Hajj. This review summarizes the evidence related to the effectiveness of non-pharmaceutical interventions in preventing the spread of respiratory infectious diseases during the Hajj. Overall, although hand hygiene compliance is high among pilgrims, face mask use and social distancing remain difficult challenges. Data about the effectiveness of these measures at the Hajj are limited, and results are contradictory, highlighting the need for future large-scale studies.
    Full-text · Article · Sep 2014 · Travel Medicine and Infectious Disease
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    ABSTRACT: The threat can no longer be ignored At the end of next month Saudi Arabia will again host the Hajj—the largest annual gathering in the world—which attracts more than two million pilgrims from almost every country on earth.1 2 For the individual pilgrim this is a deeply spiritual journey that represents the culmination of months if not years of preparation. From a public health perspective, however, such a gathering makes the possible rampant spread of the influenza virus and a global pandemic—which many experts believe is overdue—a potentially devastating prospect that has been inadequately prepared for.3 Recent work highlighting the high rates of infection and carriage of influenza virus in pilgrims returning from Mecca has emphasised the need for internationally agreed strategies to minimise the risk of a pandemic.4 5 6 Such a strategy should centre on ways to prevent transmission, but must also include facilities for prompt diagnosis and treatment of infected individuals. No such comprehensive strategy currently exists. The Hajj and its associated rites are a once in a lifetime obligation for people who have the means to undertake the journey. The Hajj attracts ever increasing numbers of men, women, and children from a diverse array of ethnic, linguistic, and social backgrounds.1 2 Because the sacred rites are undertaken at the same time, overcrowding is considerable throughout the five day Hajj period. Accommodation is, of necessity, in tents in the desert plains of Mina and Arafat, and it is not unusual for 50-100 people to share a tent overnight. Such overcrowding and continuous close contact greatly increases the spread of respiratory infections. It has been estimated that more than one in three pilgrims will experience respiratory symptoms during their stay.4 The Saudi Arabian Ministry of Health has recommended that masks be used to minimise droplet spread,7 8 but many Muslims consider covering the face during the Hajj to be prohibited. In addition, masks need to be of a high quality and changed at least every six hours to remain effective, so general compliance with this advice is unlikely. The Department of Health (for England) does not advise the use of masks, but frequent hand washing is recommended to reduce spread of the virus. Given the religious insistence on ritual purity before the five daily prayers and other acts of worship, this suggestion should be acceptable to most pilgrims and relatively easy to implement.9 Although the Saudi authorities currently recommend vaccination against influenza for pilgrims with “high risk” chronic illnesses such as pre-existing respiratory disorders, data from the United Kingdom indicate that many such high risk pilgrims remain unimmunised.10 The situation is probably far worse among the large numbers of people coming from the economically developing world. Given this fact and the risks of a pandemic originating from the Hajj, mandatory influenza vaccination for all pilgrims should be considered.11 Mandatory meningococcal vaccination was introduced after a meningococcal epidemic among pilgrims and their contacts. As pilgrims already need to seek medical attention to obtain a meningococcal vaccination, this extra vaccination should not be too inconvenient and should be readily acceptable. Neuraminidase inhibitors can reduce the duration of the illness and its spread to household contacts.12 However, two practical difficulties need to be overcome before these drugs can be made available to pilgrims. Firstly, the high prevalence of general respiratory symptoms and the absence of state-of-the-art diagnostic testing facilities make it difficult for infected people to be identified quickly.5 Early diagnosis is important for treatment to be effective, so near patient testing should be more readily available. The second difficulty lies in the cost of stock piling sufficient supplies for the numbers that may be affected and the logistical challenge of ensuring that household contacts of returning pilgrims are treated promptly. Virus surveillance studies to identify newly emerging strains are needed urgently. Currently Saudi Arabia is not among the 100 centres around the world where such structured surveillance studies are being undertaken.4 The World Health Organization is still developing its strategy to prevent a possible influenza pandemic. WHO must work with the Saudi authorities to minimise the risk of the influenza virus spreading among pilgrims (and the rest of us). A coherent international response will be needed to ensure that the resources and logistics are in place so that these strategies can be implemented.13 Footnotes ARTICLE Competing interests: None declared. References↵Gatrad AR, Sheikh A. Hajj: journey of a lifetime. BMJ 2005;330:133-7.OpenUrlFREE Full Text↵Ahmed Q, Arabi Y, Memish Z. Health risks at Hajj. Lancet 2006;367:1008-15.OpenUrlCrossRefMedlineWeb of Science↵Balkhy H, Al-Hajjar S. Avian influenza: are our feathers ruffled? Ann Saudi Med 2006;26:175-82.OpenUrlMedlineWeb of Science↵Balkhy H, Memish Z, Bafaqeer S, Almuneef M. Influenza a common viral infection among Hajj pilgrims: time for routine surveillance and vaccination. J Travel Med 2004;11:82-6.OpenUrlMedlineWeb of Science↵Al-Asmary S, Al-Shehri AS, Abou-Zeid A, Abdel-Fattah M, Hifnawy T, El-Said T. Acute respiratory tract infections among Hajj medical mission personnel, Saudi Arabia. Int J Infect Dis 2006, Aug 11; Epub ahead of print.↵El Bashir H, Haworth E, Zambon M, Shafi S, Zuckerman J, Booy R. Influenza among U.K. pilgrims to Hajj, 2003. Emerg Infect Dis 2004;10:1882-3.↵Al-Shehry AM, Al-Khan AA. Pre-Hajj health related advice, Makkah. Saudi Epidemiol Bull 1999;6:29-31.↵Choudhry AJ, Al-Mudaimegh KS, Turkistani AM, Al-Hamdan NA. Hajj-associated acute respiratory infection among hajjis from Riyadh. Eastern Med Health J 2006;12:300-9.OpenUrl↵Katme AM. Muslim teaching gives rules for when hands must be washed. BMJ 1999;319:520.OpenUrlFREE Full Text↵Shafi S, Rashid H, Ali K El-Bashir H, Haworth E, Memish ZA, Booy R. Influenza vaccine uptake among British Muslims attending Hajj, 2005 and 2006. BMJ 2006 doi: .10.1136/bmj.39051.734329.3A↵Mustafa AN, Gessner BD, Ismail R, Yussof AF, Abdullah N, Ishak I, et al. A case control study of influenza vaccine effectiveness among Malaysian pilgrims attending the Hajj in Saudi Arabia. Int J Infect Dis 2003;7:210-4.OpenUrlCrossRefMedline↵Hayden FG, Pavia AT. Antiviral management of seasonal and pandemic influenza. J Infect Dis 2006:194:S119-26.↵Leventhal A, Ramlawi A, Belbiesi A, Balicer RD. Regional collaboration in the Middle East to deal with H5N1 avian flu. BMJ 2006;333:856-8.OpenUrlFREE Full Text
    Full-text · Article · Jan 2007 · BMJ (online)
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    ABSTRACT: Hajj is a unique Islamic ritual where around 2.5 million Muslims gather annually in the Kingdom of Saudi Arabia. The objective of this work was to determine epidemiological pattern of diseases and risk behaviors of pilgrim patients during Hajj 1427 H. A cross sectional study was conducted at two randomly chosen Mina hospitals and a total of 248 patients were selected using systematic random sample method. Results show that about two-fifths (39.1%) of patients had chronic diseases and only 34.4 % received health education before Hajj. The commonest patients' complaints were cough, dyspnea and fever (28.2 %, 27.4% and 25 % respectively). Acute respiratory infections and gastrointestinal illnesses were the commonest diagnosed diseases. Analgesics and antibiotics were the most commonly prescribed drugs. Regarding risky behaviors, 24.6 % of pilgrims were unvaccinated against meningococcal meningitis, 87.9 % didn't wear protective masks and 43.1 % had their hair shaved or cut by re-used razors or scissors. Pilgrims who followed organized camps and who received health education before hajj conducted significantly lower risky behaviors compared to others. Recommendations: Intensified health education campaigns should be conducted for all pilgrims in their mother countries & KSA. Surveillance of behavioral risk factors, formulating intervention strategies and proposing new policies and regulations are urgently needed.
    Preview · Article · Feb 2008 · The Journal of the Egyptian Public Health Association
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