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Alandijany TA. Respiratory viral infections during Hajj seasons. J Infect Public Health 2024; 17 Suppl 1:42-48. [PMID: 37085376 DOI: 10.1016/j.jiph.2023.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/23/2023] Open
Abstract
Respiratory viral infections pose a public health concern during mass gathering (MG) events. Sustainable and continuous surveillance of respiratory viruses remains a priority to early identify and prevent potential outbreaks. This article reviews recent literature addressed the prevalence and diversity of circulating respiratory viruses during Hajj pilgrimage, one of the largest planned religious MG events held annually in Saudi Arabia. The variation between studies with respect to study design, sample size, time of sample collection (pre-, during, and pos-Hajj), type of participants (e.g., symptomatic vs. a symptomatic pilgrims), and laboratory procedure was highlighted. The majority of these studies were conducted on the 2019 Hajj season or earlier, prior to the emergence of COVID-19 which had significant impact on the past three Hajj seasons (2020, 2021, and 2022). A summary about key aspects related to organization of Hajj during COVID-19 pandemic and the implementation of exceptional infection control strategies is provided.
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Affiliation(s)
- Thamir A Alandijany
- Special Infectious Agents Unit BSL-3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia; Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
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El-Kafrawy SA, Alsayed SM, Faizo AA, Bajrai LH, Uthman NA, Alsaeed MS, Hassan AM, Alquthami KM, Alandijany TA, Zumla A, Azhar EI. Genetic diversity and molecular analysis of human influenza virus among pilgrims during Hajj. Heliyon 2024; 10:e23027. [PMID: 38163192 PMCID: PMC10755270 DOI: 10.1016/j.heliyon.2023.e23027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 11/16/2023] [Accepted: 11/24/2023] [Indexed: 01/03/2024] Open
Abstract
The risk of transmission of respiratory tract infections is considerably enhanced at mass gathering (MG) religious events. Hajj is an annual Islamic MG event with approximately 3 million Muslim pilgrims from over 180 countries concentrated in Makkah, Saudi Arabia. This study aimed to investigate the genetic diversity of influenza viruses circulating among pilgrims during the Hajj pilgrimage. We performed a cross-sectional analytical study where nasopharyngeal swabs (NPs) from pilgrims with respiratory tract illnesses presenting to healthcare facilities during the 2019 Hajj were screened for influenza viruses. Influenza A subtypes and influenza B lineages were determined by multiplex RT-PCR for positive influenza samples. The phylogenetic analysis was carried out for the hemagglutination (HA) gene. Out of 185 nasopharyngeal samples, 54 were positive for the human influenza virus. Of these, 27 were influenza A H1N1 and 19 H3N2, 4 were untypable influenza A, and 4 were influenza B. Phylogenetic analysis revealed that the H1N1 and H3N2 strains differentiated into different and independent genetic groups and formed close clusters with selected strains of influenza viruses from various locations. To conclude, this study demonstrates a high genetic diversity of circulating influenza A subtypes among pilgrims during the Hajj Season. There is a need for further larger studies to investigate in-depth the genetic characteristics of influenza viruses and other respiratory viruses during Hajj seasons.
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Affiliation(s)
- Sherif A. El-Kafrawy
- Special Infectious Agents Unit BSL-3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Salma M. Alsayed
- Special Infectious Agents Unit BSL-3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Arwa A. Faizo
- Special Infectious Agents Unit BSL-3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Leena H. Bajrai
- Special Infectious Agents Unit BSL-3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Norah A. Uthman
- Special Infectious Agents Unit BSL-3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Moneerah S. Alsaeed
- Special Infectious Agents Unit BSL-3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Ahmed M. Hassan
- Special Infectious Agents Unit BSL-3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | | | - Thamir A. Alandijany
- Special Infectious Agents Unit BSL-3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Alimuddin Zumla
- Division of Infection and Immunity, Centre for Clinical Microbiology, University College London Royal Free Campus, London WC1E 6DE, UK
- NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London W1T 7DN, UK
| | - Esam I. Azhar
- Special Infectious Agents Unit BSL-3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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Mahdi HA, Alluhidan M, Almohammed AB, Alfelali M, Shaban RZ, Booy R, Rashid H. Epidemiological Differences in Hajj-Acquired Airborne Infections in Pilgrims Arriving from Low and Middle-Income versus High-Income Countries: A Systematised Review. Trop Med Infect Dis 2023; 8:418. [PMID: 37624356 PMCID: PMC10459586 DOI: 10.3390/tropicalmed8080418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/04/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023] Open
Abstract
This systematised review aims to compare the epidemiological patterns of Hajj-acquired airborne infections among pilgrims from low and middle-income countries (LMIC) versus those from high-income countries (HIC). A PubMed search was carried out for all published articles before February 2023, using a combination of MeSH terms and text words. The Newcastle-Ottawa Scale (NOS) was used to assess data quality. From a total of 453 titles identified, 58 studies were included in the review (LMIC = 32, and HIC = 26). In the pooled sample, there were 27,799 pilgrims aged 2 days to 105 years (male: female = 1.3:1) from LMIC and 70,865 pilgrims aged 2 months to 95 years (male: female = 1:1) from HIC. Pilgrims from both HIC and LMIC had viral and bacterial infections, but pilgrims from HIC tended to have higher attack rates of viral infections than their LMIC counterparts. However, the attack rates of bacterial infections were variable: for instance, pilgrims from LMIC seemed to have higher rates of meningococcal infections (0.015-82% in LMIC vs. 0.002-40% in HIC) based on the study population, but not Mycobacterium tuberculosis (0.7-20.3% in LMIC vs. 38% in HIC). Targeted measures are needed to prevent the spread of airborne infections at Hajj.
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Affiliation(s)
- Hashim A. Mahdi
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia
- Department of Public Health, College of Health Sciences, Saudi Electronic University, Jeddah 23442, Saudi Arabia
| | - Mohammed Alluhidan
- General Directorate for National Health Economics and Policy, Saudi Health Council, Riyadh 13315, Saudi Arabia
| | | | - Mohammad Alfelali
- Family and Community Medicine Department, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 25732, Saudi Arabia
| | - Ramon Z. Shaban
- New South Wales Biocontainment Centre, New South Wales Ministry of Health, Westmead, NSW 2151, Australia
- Faculty of Medicine and Health Susan Wakil School of Nursing, The University of Sydney, Sydney, NSW 2006, Australia
- Public Health Unit, Centre for Population Health, Western Sydney Local Health District, North Parramatta, NSW 2151, Australia
- Sydney Infectious Diseases Institute, The University of Sydney, Westmead, NSW 2145, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia
- Sydney Infectious Diseases Institute, The University of Sydney, Westmead, NSW 2145, Australia
| | - Harunor Rashid
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia
- Sydney Infectious Diseases Institute, The University of Sydney, Westmead, NSW 2145, Australia
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Hui DS, Zumla A. Mass gathering events and transmission of respiratory tract infections: updates pre and post COVID-19 lockdown. Curr Opin Pulm Med 2023; 29:133-137. [PMID: 36876655 PMCID: PMC10090332 DOI: 10.1097/mcp.0000000000000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
PURPOSE OF REVIEW This article reviews the epidemiology and transmission of respiratory tract infections (RTIs) during mass gathering events (MGEs) before and during the COVID-19 pandemic. RECENT FINDINGS RTIs of viral cause such as influenza, rhinovirus and coronaviruses (229E, HKU1, OC43) are common in MGEs. No cases of MERS-CoV have yet been identified in pilgrims during Hajj, despite the fact that MERS-CoV continues to circulate in the Middle East. Due to the COVID-19 pandemic, organizers of mass gathering religious and sporting events have implemented risk-based infection control measures and lockdowns that limited transmission of RTIs. SUMMARY Large-scale RTI outbreaks at MGEs are uncommon due to more robust public health planning, prevention, risk assessment and improved health infrastructures in host countries during the COVID-19 pandemic.
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Affiliation(s)
- David S.C. Hui
- Department of Medicine & Therapeutics and Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, and NIHR Biomedical Research Centre, University College London Hospitals, London, UK
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Agustiningsih A, Indalao IL, Pangesti KA, Sukowati CHC, Ramadhany R. Molecular Characterization of Influenza A/H3N2 Virus Isolated from Indonesian Hajj and Umrah Pilgrims 2013 to 2014. Life (Basel) 2023; 13:life13051100. [PMID: 37240745 DOI: 10.3390/life13051100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
The Hajj and Umrah are the annual mass gatherings of Muslims in Saudi Arabia and increase the transmission risk of acute respiratory infection. This study describes influenza infection among pilgrims upon arrival in Indonesia and the genetic characterization of imported influenza A/H3N2 virus. In total, 251 swab samples with influenza-like illness were tested using real-time RT-PCR for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and influenza viruses. Complete sequences of influenza A/H3N2 HA and NA genes were obtained using DNA sequencing and plotted to amino acid and antigenicity changes. Phylogenetic analysis was performed using a neighbour-joining method including the WHO vaccine strains and influenza A/H3N2 as references. The real-time RT-PCR test detected 100 (39.5%) samples positive with influenza with no positivity of MERS-CoV. Mutations in the HA gene were mainly located within the antigenic sites A, B, and D, while for the NA gene, no mutations related to oseltamivir resistance were observed. Phylogenetic analysis revealed that these viruses grouped together with clades 3C.2 and 3C.3; however, they were not closely grouped with the WHO-recommended vaccine (clades 3C.1). Sequences obtained from Hajj and Umrah pilgrims were also not grouped together with viruses from Middle East countries but clustered according to years of collection. This implies that the influenza A/H3N2 virus mutates continually across time.
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Affiliation(s)
- Agustiningsih Agustiningsih
- Eijkman Research Center for Molecular Biology, National Research and Innovation Agency of Indonesia (BRIN), B.J. Habibie Building, Jl. M.H. Thamrin No. 8, Jakarta Pusat, DKI, Jakarta 10340, Indonesia
| | - Irene Lorinda Indalao
- Ministry of Health of the Republic of Indonesia, Jl. H.R. Rasuna Said Blok X.5 Kav. 4-9, Jakarta Selatan, DKI, Jakarta 12950, Indonesia
| | - Krisnanur A Pangesti
- Ministry of Health of the Republic of Indonesia, Jl. H.R. Rasuna Said Blok X.5 Kav. 4-9, Jakarta Selatan, DKI, Jakarta 12950, Indonesia
| | - Caecilia H C Sukowati
- Eijkman Research Center for Molecular Biology, National Research and Innovation Agency of Indonesia (BRIN), B.J. Habibie Building, Jl. M.H. Thamrin No. 8, Jakarta Pusat, DKI, Jakarta 10340, Indonesia
- Fondazione Italiana Fegato ONLUS, AREA Science Park, Basovizza, 34049 Trieste, Italy
| | - Ririn Ramadhany
- Ministry of Health of the Republic of Indonesia, Jl. H.R. Rasuna Said Blok X.5 Kav. 4-9, Jakarta Selatan, DKI, Jakarta 12950, Indonesia
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Mercier A, Méheut A, Alidjinou EK, Lazrek M, Faure K, Hober D, Engelmann I. Respiratory virus detection in returning travelers and pilgrims from the Middle East. Travel Med Infect Dis 2023; 51:102482. [PMID: 36280020 PMCID: PMC9584832 DOI: 10.1016/j.tmaid.2022.102482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/16/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pilgrims travelling to Saudi Arabia are commonly infected with respiratory viruses. Since the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) emerged in 2012, patients with acute respiratory symptoms returning from an endemic area can be suspected to be infected by this virus. METHODS 98 patients suspected to have MERS-CoV infection from 2014 to 2019 were included in this retrospective cohort study. Upper and lower respiratory tract samples were tested by real-time RT-PCR for the detection of MERS-CoV and other respiratory viruses. Routine microbiological analyses were also performed. Patient data were retrieved from laboratory and hospital databases retrospectively. RESULTS All patients with suspected MERS-CoV infection travelled before their hospitalization. Most frequent symptoms were cough (94.4%) and fever (69.4%). 98 specimens were tested for MERS-CoV RNA and none of them was positive. Most frequently detected viruses were Enterovirus/Rhinovirus (40/83; 48.2%), Influenzavirus A (34/90; 37.8%) and B (11/90; 12.2%), H-CoV (229E and OC43 10/83; 12% and 7/83; 8.4%, respectively). CONCLUSION From 2014 to 2019, none of 98 patients returning from endemic areas was MERS-CoV infected. However, infections with other respiratory viruses were frequent, especially with Enterovirus/Rhinoviruses and Influenzaviruses.
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Affiliation(s)
- Ambroise Mercier
- Univ Lille, CHU Lille, Laboratoire de Virologie ULR3610, F-59037, Lille, France
| | - Antoine Méheut
- CHU Lille, Service des Maladies Infectieuses et Tropicales, Lille, France, F-59037, Lille, France
| | | | - Mouna Lazrek
- Univ Lille, CHU Lille, Laboratoire de Virologie ULR3610, F-59037, Lille, France
| | - Karine Faure
- CHU Lille, Service des Maladies Infectieuses et Tropicales, Lille, France, F-59037, Lille, France,Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000, Lille, France,Service de Maladies Infectieuses, CHU Lille, F-59000, Lille, France
| | - Didier Hober
- Univ Lille, CHU Lille, Laboratoire de Virologie ULR3610, F-59037, Lille, France
| | - Ilka Engelmann
- Univ Lille, CHU Lille, Laboratoire de Virologie ULR3610, F-59037, Lille, France,Corresponding author. Laboratoire de Virologie, CHU Montpellier, Hôpital Saint-Eloi, 80 avenue Augustin Fliche, 34295 Montpellier, France
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Elekhnawy E, Negm WA, El-Sherbeni SA, Zayed A. Assessment of drugs administered in the Middle East as part of the COVID-19 management protocols. Inflammopharmacology 2022; 30:1935-1954. [PMID: 36018432 PMCID: PMC9411846 DOI: 10.1007/s10787-022-01050-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/03/2022] [Indexed: 02/06/2023]
Abstract
The pandemic spread of coronavirus (COVID-19) has been reported first at the end of 2019. It continues disturbing various human aspects with multiple pandemic waves showing more fatal novel variants. Now Egypt faces the sixth wave of the pandemic with controlled governmental measures. COVID-19 is an infectious respiratory disease-causing mild to moderate illness that can be progressed into life-threatening complications based on patients- and variant type-related factors. The symptoms vary from dry cough, fever to difficulty in breathing that required urgent hospitalization. Most countries have authorized their national protocols for managing manifested symptoms and thus lowering the rate of patients' hospitalization and boosting the healthcare systems. These protocols are still in use even with the development and approval of several vaccines. These protocols were instructed to aid home isolation, bed rest, dietary supplements, and additionally the administration of antipyretic, steroids, and antiviral drugs. The current review aimed to highlight the administered protocols in the Middle East, namely in Egypt and the Kingdom of Saudi Arabia demonstrating how these protocols have shown potential effectiveness in treating patients and saving many soles.
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Affiliation(s)
- Engy Elekhnawy
- Pharmaceutical Microbiology Department, Faculty of Pharmacy, Tanta University, Elguish Street (Medical Campus), Tanta, 31527 Egypt
| | - Walaa A. Negm
- Pharmacognosy Department, Faculty of Pharmacy, Tanta University, Elguish Street (Medical Campus), Tanta, 31527 Egypt
| | - Suzy A. El-Sherbeni
- Pharmacognosy Department, Faculty of Pharmacy, Tanta University, Elguish Street (Medical Campus), Tanta, 31527 Egypt
| | - Ahmed Zayed
- Pharmacognosy Department, Faculty of Pharmacy, Tanta University, Elguish Street (Medical Campus), Tanta, 31527 Egypt
- Institute of Bioprocess Engineering, Technical University of Kaiserslautern, Gottlieb-Daimler-Straße 49, 67663 Kaiserslautern, Germany
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UEFA Euro 2020: lessons from the first multi-city international mass gathering during the COVID-19 pandemic. Epidemiol Infect 2022; 150:e182. [PMID: 36394345 PMCID: PMC9987015 DOI: 10.1017/s095026882200156x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Mass gatherings (MG) present a number of challenges to public health authorities and governments across the world with sporting events, tournaments, music festivals, religious gatherings and all other MG having historically posed a risk to the spread and amplification of a range of infectious diseases. Transmission of gastrointestinal, respiratory, waterborne and sexually transmitted infectious diseases pose a particular risk: all have been linked to MG events [-]. Infection risk often depends on the nature of the mass gathering, and on the profile and behaviour of its participants. The interaction between environmental, psychological, biological and social factors plays a vital part. The risk of outbreaks particularly as a result of respiratory transmission remains high at MG, with the majority of outbreaks over the last two decades resulting from a variety of respiratory and vaccine preventable pathogens [-]. Concerns about the spread of infectious diseases at MG are often focussed on crowding, lack of sanitation and the mixing of population groups from different places. Sporting events, which have in recent decades become more complex and international in nature, pose a challenge to the control of communicable disease transmission []. Despite this, large scale outbreaks at sporting events have been rare in recent decades, particularly since the rise of more robust public health planning, prevention, risk assessment and improved health infrastructures in host countries [].
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El-Kafrawy SA, Alsayed SM, Alandijany TA, Bajrai LH, Faizo AA, Al-Sharif HA, Hassan AM, Alquthami KM, Al-Tawfiq JA, Zumla A, Azhar EI. High genetic diversity of human rhinovirus among pilgrims with acute respiratory tract infections during the 2019 Hajj pilgrimage season. Int J Infect Dis 2022; 121:130-137. [PMID: 35577249 DOI: 10.1016/j.ijid.2022.05.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES Acute respiratory tract infections (ARIs) due to human rhinoviruses (HRVs) are common in pilgrims during the annual Hajj pilgrimage. The objective of this study was to investigate the genetic diversity of HRV among pilgrims with respiratory symptoms during Hajj 2019. METHODS HRV infection was detected using multiplex real-time reverse transcription polymerase chain reaction. Cycle sequencing was performed on positive samples and the sequences were subjected to phylogenetic analysis. RESULTS A total of 19 HRV-positive respiratory samples were sequenced. All three serotypes of HRV were identified: HRV-A (13; 68.42%) was more common than HRV-B (2; 10.53%) and HRV-C (4; 21.05%). HRV-A species were found to be of genotypes A101, A21, A30, A57, A23, A60, and A11. HRV-B species belonged to genotypes B4 and B84, and HRV-C species were of genotypes C15, C3, and C56. CONCLUSION Sequencing studies of respiratory tract viruses in pilgrims are important. We provide preliminary evidence of high diversity of HRV genotypes circulating in pilgrims in a restricted area during Hajj. This requires further clinical and sequencing studies of viral pathogens in larger cohorts of overseas and local pilgrims.
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Affiliation(s)
- Sherif A El-Kafrawy
- Special Infectious Agents Unit BSL-3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Salma M Alsayed
- Special Infectious Agents Unit BSL-3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; Department of Nursing, Faculty of Al-Qunfudah Health Sciences, Umm Al-Qura University, Makkah, 28821, Saudi Arabia
| | - Thamir A Alandijany
- Special Infectious Agents Unit BSL-3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Leena H Bajrai
- Special Infectious Agents Unit BSL-3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; Department of Nursing, Faculty of Al-Qunfudah Health Sciences, Umm Al-Qura University, Makkah, 28821, Saudi Arabia; Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Arwa A Faizo
- Special Infectious Agents Unit BSL-3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Hessa A Al-Sharif
- Special Infectious Agents Unit BSL-3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Ahmed M Hassan
- Special Infectious Agents Unit BSL-3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Khalid M Alquthami
- Al-Noor Specialist Hospital, Ministry of Health, Makkah, 24241, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Infectious Disease Division, Johns Hopkins University, Baltimore, MD, USA
| | - Alimuddin Zumla
- Special Infectious Agents Unit BSL-3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; Division of Infection and Immunity, Centre for Clinical Microbiology, University College London Royal Free Campus, London, WC1E 6DE, UK; NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, W1T 7DN, UK
| | - Esam I Azhar
- Special Infectious Agents Unit BSL-3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, 21589, Saudi Arabia.
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Shatizadeh Malekshahi S, Khani F, Shafiei-Jandaghi NZ, Shadab A, Mokhtari-Azad T, Yavarian J. Prevalence and Genotypes of Human Rhinoviruses among Iranian Hajj Pilgrims with Severe Acute Respiratory Infection. TANAFFOS 2022; 21:448-454. [PMID: 37583781 PMCID: PMC10423871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 06/27/2022] [Indexed: 08/17/2023]
Abstract
Background Hajj is one of the main challenges of public health and infection control. Hajj-associated respiratory tract infections are very common during the pilgrimage. Studies have shown that human rhinovirus (HRV) is one of the most common causes of respiratory illnesses among pilgrims. The aim of this study was to investigate the prevalence and genotypes of HRV among Iranian pilgrims with severe acute respiratory infection (SARI) during the 2017 Hajj season. Materials and Methods Throat swabs or washes were collected from 104 pilgrims with SARI and transported to the National Influenza Center, School of Public Health, Tehran University of Medical Sciences. Specimens were screened for HRV by Nested PCR with primers for 5'UTR, and virus genotypes were determined using PCR with VP4-VP2 primers and sequencing method. Results Twenty-one cases were positive for HRV (20.19 %). The HRV species and types of 8 positive samples were: HRV-A21 (1/8, 12.5%), followed by HRV-B91 (3/8, 37.5%) and HRV-C (4/8, 50%) un-typed. Conclusion This study showed that HRV has a high prevalence in Iranian Hajj pilgrims. As there is no vaccine or antiviral therapy for HRV, prevention methods are the best way for infection control.
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Affiliation(s)
| | - Fariba Khani
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Azadeh Shadab
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Talat Mokhtari-Azad
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Jila Yavarian
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Tehran University of Medical Sciences, Tehran, Iran
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Huang W, Chai GT, Thong BYH, Chan M, Ang B, Chow A. Comparing hospital-resource utilization by an enhanced pneumonia surveillance programme for COVID-19 with pre-pandemic pneumonia admissions - a Singaporean hospital's experience. J Med Microbiol 2021; 70. [PMID: 34898420 PMCID: PMC8744277 DOI: 10.1099/jmm.0.001452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. During the early days of coronavirus disease 2019 (COVID-19) in Singapore, Tan Tock Seng Hospital implemented an enhanced pneumonia surveillance (EPS) programme enrolling all patients who were admitted from the Emergency Department (ED) with a diagnosis of pneumonia but not meeting the prevalent COVID-19 suspect case definition.Hypothesis/Gap Statement. There is a paucity of data supporting the implementation of such a programme.Aims. To compare and contrast our hospital-resource utilization of an EPS programme for COVID-19 infection detection with a suitable comparison group.Methodology. We enrolled all patients admitted under the EPS programme from TTSH's ED from 7 February 2020 (date of EPS implementation) to 20 March 2020 (date of study ethics application) inclusive. We designated a comparison cohort over a similar duration the preceding year. Relevant demographic and clinical data were extracted from the electronic medical records.Results. There was a 3.2 times higher incidence of patients with an admitting diagnosis of pneumonia from the ED in the EPS cohort compared to the comparison cohort (P<0.001). However, there was no significant difference in the median length of stay of 7 days (P=0.160). Within the EPS cohort, stroke and fluid overload occur more frequently as alternative primary diagnoses.Conclusions. Our study successfully evaluated our hospital-resource utilization demanded by our EPS programme in relation to an appropriate comparison group. This helps to inform strategic use of hospital resources to meet the needs of both COVID-19 related services and essential 'peace-time' healthcare services concurrently.
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Affiliation(s)
- Wenhui Huang
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore
| | - Gin Tsen Chai
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore.,Lee Kong Chian School of Medicine, 11 Mandalay Road, 308232, Singapore
| | | | - Mark Chan
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore
| | - Brenda Ang
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore
| | - Angela Chow
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore.,Lee Kong Chian School of Medicine, 11 Mandalay Road, 308232, Singapore
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12
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Rahman SM, Ratrout N, Assi K, Al-Sghan I, Gazder U, Reza I, Reshi O. Transformation of urban mobility during COVID-19 pandemic - Lessons for transportation planning. JOURNAL OF TRANSPORT & HEALTH 2021; 23:101257. [PMID: 34580629 PMCID: PMC8459165 DOI: 10.1016/j.jth.2021.101257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 08/20/2021] [Accepted: 09/06/2021] [Indexed: 05/29/2023]
Abstract
INTRODUCTION The coronavirus disease (COVID-19) pandemic is a global threat that started in Wuhan, China, in 2019 and spread rapidly to the globe. To reduce the spread of the COVID-19, different non-pharmacological control measures have been conducted in different countries, which include social distancing, distance working, and stay-at-home mandates. These control measures had affected global transportation and mobility significantly. This study investigated the short-term changes in urban mobility, tropospheric air pollution, and fuel consumption in two major cities of Saudi Arabia, namely, Riyadh and Jeddah. METHODS In this study, the dynamics of the number of trips and trip purposes in different provinces of the country were analyzed, focusing on the pandemic period and the lockdown program. These changes impacted fuel consumption and, consequently, air pollutants. The quantity of fuel consumption and its trend was projected considering a few possible fuel consumption and emission scenarios. It is also expected that fuel price plays a role in fuel consumption. The spatial and temporal distributions of the remote sensed tropospheric Nitrogen Dioxide (NO2) levels in different provinces were presented to depict the short 19 and long-term impact on the air quality due to the changes in mobility. RESULTS The significant reduction in urban mobility has been observed since the beginning of the first partial curfew in March 2020 compared to that in 2019. The air pollutant levels (such as NO2) in 2020 after the pandemic were generally less than those of 2019. The fuel consumption has been following a decreasing trend in 2020 starting from January due to dynamic fuel price and the additional influence of pandemic. Based on the current online shopping pattern, it is argued that there will be some permanent behavioral changes in urban mobility, which will decrease some shopping trips at least immediately after the recovery from the pandemic. CONCLUSIONS This study concluded that the availability of global urban mobility data, remote sensed based tropospheric air pollution data, and global fuel consumption database are important sources of information to investigate the impact of COVID pandemic, especially for the developing countries which suffer from scarcity of pertinent urban mobility information. It seems that, at least in the study area, the spread of COVID-19 is a complex phenomenon in which several exogenous factors, in addition to the curfew protocols, affect the spread of the virus.
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Affiliation(s)
- Syed Masiur Rahman
- Center of Environment and Water, Research Institute, King Fahd University of Petroleum and Minerals, Dhahran 31261, Saudi Arabia
| | - Nedal Ratrout
- Civil and Environmental Engineering Department, King Fahd University of Petroleum and Minerals, Dhahran 31261, Saudi Arabia
- Interdisciplinary Research Center for Smart Mobility and Logistics, King Fahd University of Petroleum and Minerals, Dhahran 31261, Saudi Arabia
| | - Khaled Assi
- Civil and Environmental Engineering Department, King Fahd University of Petroleum and Minerals, Dhahran 31261, Saudi Arabia
- Interdisciplinary Research Center for Smart Mobility and Logistics, King Fahd University of Petroleum and Minerals, Dhahran 31261, Saudi Arabia
| | - Ibrahim Al-Sghan
- Civil and Environmental Engineering Department, King Fahd University of Petroleum and Minerals, Dhahran 31261, Saudi Arabia
- Interdisciplinary Research Center for Smart Mobility and Logistics, King Fahd University of Petroleum and Minerals, Dhahran 31261, Saudi Arabia
| | - Uneb Gazder
- Civil Engineering Department, Bahrain University, Manama 32038, Bahrain
| | - Imran Reza
- Civil and Environmental Engineering Department, King Fahd University of Petroleum and Minerals, Dhahran 31261, Saudi Arabia
| | - Omer Reshi
- Center of Environment and Water, Research Institute, King Fahd University of Petroleum and Minerals, Dhahran 31261, Saudi Arabia
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13
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Johari J, Hontz RD, Pike BL, Husain T, Chong CK, Rusli N, Sulaiman LH, Verasahib K, Mohd Zain R, Azman AS, Khor CS, Nor'e SS, Tiong V, Lee HY, Teoh BT, Sam SS, Khoo JJ, Abd Jamil J, Loong SK, Yaacob CN, Mahfodz NH, Azizan NS, Che Mat Seri NAA, Mohd-Rahim NF, Hassan H, Yahaya H, Garcia-Rivera JA, AbuBakar S. Multiyear prospective cohort study to evaluate the risk potential of MERS-CoV infection among Malaysian Hajj pilgrims (MERCURIAL): a study protocol. BMJ Open 2021; 11:e050901. [PMID: 34446498 PMCID: PMC8395290 DOI: 10.1136/bmjopen-2021-050901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Middle East respiratory syndrome (MERS) is a viral respiratory infection caused by the MERS-CoV. MERS was first reported in the Kingdom of Saudi Arabia in 2012. Every year, the Hajj pilgrimage to Mecca attracts more than two million pilgrims from 184 countries, making it one of the largest annual religious mass gatherings (MGs) worldwide. MGs in confined areas with a high number of pilgrims' movements worldwide continues to elicit significant global public health concerns. MERCURIAL was designed by adopting a seroconversion surveillance approach to provide multiyear evidence of MG-associated MERS-CoV seroconversion among the Malaysian Hajj pilgrims. METHODS AND ANALYSIS MERCURIAL is an ongoing multiyear prospective cohort study. Every year, for the next 5 years, a cohort of 1000 Hajj pilgrims was enrolled beginning in the 2016 Hajj pilgrimage season. Pre-Hajj and post-Hajj serum samples were obtained and serologically analysed for evidence of MERS-CoV seroconversion. Sociodemographic data, underlying medical conditions, symptoms experienced during Hajj pilgrimage, and exposure to camel and untreated camel products were recorded using structured pre-Hajj and post-Hajj questionnaires. The possible risk factors associated with the seroconversion data were analysed using univariate and multivariate logistic regression. The primary outcome of this study is to better enhance our understanding of the potential threat of MERS-CoV spreading through MG beyond the Middle East. ETHICS AND DISSEMINATION This study has obtained ethical approval from the Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia. Results from the study will be submitted for publication in peer-reviewed journals and presented in conferences and scientific meetings. TRIAL REGISTRATION NUMBER NMRR-15-1640-25391.
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Affiliation(s)
- Jefree Johari
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Brian L Pike
- U.S. Naval Medical Research Center - Asia, Singapore
| | - Tupur Husain
- U.S. Naval Medical Research Center - Asia, Singapore
| | | | | | | | | | | | | | - Chee Sieng Khor
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Siti-Sarah Nor'e
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Vunjia Tiong
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Hai Yen Lee
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Boon-Teong Teoh
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sing Sin Sam
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Jing-Jing Khoo
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Juraina Abd Jamil
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Shih-Keng Loong
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Che Norainon Yaacob
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Nur-Hidayana Mahfodz
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Noor Syahida Azizan
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Nurul-Farhana Mohd-Rahim
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Habibi Hassan
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Hasmawati Yahaya
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Sazaly AbuBakar
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
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14
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Novel Respiratory Viruses in the Context of Mass-Gathering Events: A Systematic Review to Inform Event Planning from a Health Perspective. Prehosp Disaster Med 2021; 36:599-610. [PMID: 34261546 DOI: 10.1017/s1049023x21000662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Mass-gathering events (MGEs) occur regularly throughout the world. As people congregate at MGEs, there is an increased risk of transmission of communicable diseases. Novel respiratory viruses, such as Severe Acute Respiratory Syndrome Coronavirus-1 (SARS-CoV-1), Influenza A Virus Subtype H1N1 Strain 2009 (H1N1pdm09), Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), or Coronavirus Disease 2019 (COVID-19), may require specific infection prevention and control strategies to minimize the risk of transmission when planning MGEs. This literature review aimed to identify and analyze papers relating to novel respiratory viruses with pandemic potential and to inform MGE planning. METHOD This paper used a systematic literature review method. Various health care databases were searched using keywords relating to MGEs and novel respiratory viruses. Information was extracted from identified papers into various tables for analysis. The analysis identified infection prevention and control strategies used at MGEs to inform planning before, during, and following events. RESULTS In total, 27 papers met the criteria for inclusion. No papers were identified regarding SARS-CoV-1, while the remainder reported on H1N1pdm09 (n = 9), MERS-CoV (n = 15), and SARS-CoV-2 (n = 3). Various before, during, and after event mitigation strategies were identified that can be implemented for future events. CONCLUSIONS This literature review provided an overview of the novel respiratory virus epidemiology at MGEs alongside related public health mitigation strategies that have been implemented at these events. This paper also discusses the health security of event participants and host communities in the context of cancelling, postponing, and modifying events due to a novel respiratory virus. In particular, ways to recommence events incorporating various mitigation strategies are outlined.
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15
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Abstract
The current frequency of COVID-19 in a pandemic era ensures that co-infections with a variety of co-pathogens will occur. Generally, there is a low rate of bonafide co-infections in early COVID-19 pulmonary infection as currently appreciated. Reports of high co-infection rates must be tempered by limitations in current diagnostic methods since amplification technologies do not necessarily confirm live pathogen and may be subject to considerable laboratory variation. Some laboratory methods may not exclude commensal microbes. Concurrent serodiagnoses have long been of concern for accuracy in these contexts. Presumed virus co-infections are not specific to COVID-19. The association of influenza viruses and SARS-CoV-2 in co-infection has been considerably variable during influenza season. Other respiratory virus co-infections have generally occurred in less than 10% of COVID-19 patients. Early COVID-19 disease is more commonly associated with bacterial co-pathogens that typically represent usual respiratory micro-organisms. Late infections, especially among severe clinical presentations, are more likely to be associated with nosocomial or opportunistic pathogens given the influence of treatments that can include antibiotics, antivirals, immunomodulating agents, blood products, immunotherapy, steroids, and invasive procedures. As anticipated, hospital care carries risk for multi-resistant bacteria. Overall, co-pathogen identification is linked with longer hospital stay, greater patient complexity, and adverse outcomes. As for other viral infections, a general reduction in the use of empiric antibiotic treatment is warranted. Further insight into co-infections with COVID-19 will contribute overall to effective antimicrobial therapies and disease control.
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Affiliation(s)
- Nevio Cimolai
- Faculty of Medicine, The University of British Columbia, Vancouver, Canada.,Children's and Women's Health Centre of British Columbia, 4480 Oak Street, Vancouver, B.C. V6H3V4 Canada
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16
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Prevalence of Influenza Among Hajj Pilgrims: A Systematic Review and Meta-Analysis. Disaster Med Public Health Prep 2021; 16:1221-1228. [PMID: 33757612 DOI: 10.1017/dmp.2020.472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Respiratory transmission, especially in mass gatherings, is considered one of the main ways of influenza transmission. The Hajj ceremony, as one of the largest gatherings worldwide, can increase the distribution of influenza infection. Thus, the present study aimed to evaluate the incidence of influenza among Hajj pilgrims. METHODS In this present systematic review and meta-analysis, all English studies published by 2019 were extracted from several databases such as the Web of Science, PubMed, Scopus, Cochrane Library, Science Direct, and Google Scholar. Finally, the data were extracted using a pre-prepared checklist and then analyzed by fixed and random effects model tests in the meta-analysis, Cochran, meta-regression, and Begg's test. RESULTS Eighteen studies with a sample size of 62 431 were entered into the meta-analysis process. The overall prevalence of influenza, in addition to the prevalence of types A, B, and C influenza, was estimated at 5.9 (95% CI: 4.3-8.0), 3.6 (95% CI: 2.6-4.9), 2.9 (95% CI: 2.8-3.1), and 0.9% (95% CI: 0.5-1.5), respectively. CONCLUSIONS In general, influenza remains widespread regardless of vaccinating pilgrims and following health protocols. Therefore, it is recommended that comprehensive management and educational approaches be used to reduce the prevalence of influenza and its adverse consequences among the pilgrims.
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Pattern of Respiratory Viruses among Pilgrims during 2019 Hajj Season Who Sought Healthcare Due to Severe Respiratory Symptoms. Pathogens 2021; 10:pathogens10030315. [PMID: 33800223 PMCID: PMC8001913 DOI: 10.3390/pathogens10030315] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/28/2021] [Accepted: 02/28/2021] [Indexed: 12/01/2022] Open
Abstract
The aim of our study was to define the spectrum of viral infections in pilgrims with acute respiratory tract illnesses presenting to healthcare facilities around the holy places in Makkah, Saudi Arabia during the 2019 Hajj pilgrimage. During the five days of Hajj, a total of 185 pilgrims were enrolled in the study. Nasopharyngeal swabs (NPSs) of 126/185 patients (68.11%) tested positive for one or more respiratory viruses by PCR. Among the 126 pilgrims whose NPS were PCR positive: (a) there were 93/126 (74%) with a single virus infection, (b) 33/126 (26%) with coinfection with more than one virus (up to four viruses): of these, 25/33 cases had coinfection with two viruses; 6/33 were infected with three viruses, while the remaining 2/33 patients had infection with four viruses. Human rhinovirus (HRV) was the most common detected viruses with 53 cases (42.06%), followed by 27 (21.43%) cases of influenza A (H1N1), and 23 (18.25%) cases of influenza A other than H1N1. Twenty-five cases of CoV-229E (19.84%) were detected more than other coronavirus members (5 CoV-OC43 (3.97%), 4 CoV-HKU1 (3.17%), and 1 CoV-NL63 (0.79%)). PIV-3 was detected in 8 cases (6.35%). A single case (0.79%) of PIV-1 and PIV-4 were found. HMPV represented 5 (3.97%), RSV and influenza B 4 (3.17%) for each, and Parechovirus 1 (0.79%). Enterovirus, Bocavirus, and M. pneumoniae were not detected. Whether identification of viral nucleic acid represents nasopharyngeal carriage or specific causal etiology of RTI remains to be defined. Large controlled cohort studies (pre-Hajj, during Hajj, and post-Hajj) are required to define the carriage rates and the specific etiology and causal roles of specific individual viruses or combination of viruses in the pathogenesis of respiratory tract infections in pilgrims participating in the annual Hajj. Studies of the specific microbial etiology of respiratory track infections (RTIs) at mass gathering religious events remain a priority, especially in light of the novel SARS-CoV-2 pandemic.
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18
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Abstract
PURPOSE OF REVIEW Mass gathering events bring people from across all continents increasing the risk of spread of aerosol transmissible respiratory tract infections. Respiratory tract infections for instance in pilgrims attending the world's largest recurring annual pilgrimage, the Hajj are common. We review recent literature on viral and bacterial infectious diseases with special focus on the Hajj. RECENT FINDINGS The prevalence of bacterial and viral infections continue to increase, because of the acquisition of rhinovirus, coronaviruses (229E, HKU1, OC43), influenza A H1N1, Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus during Hajj. Whilst MERS-CoV continues to circulate in the Middle East, no cases of MERS-CoV have yet been identified in pilgrims during Hajj. SUMMARY Respiratory tract infections are a major cause of morbidity in pilgrims attending mass gathering events. The management of severe respiratory infections should consider investigation and empirical coverage for the most likely agents based on syndromic surveillance data from hosting country and /or other relevant exposure history during events. Pneumococcal and Pertussis vaccines should be recommended for Hajj pilgrims.
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19
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Algaissi AA, Alharbi NK, Hassanain M, Hashem AM. Preparedness and response to COVID-19 in Saudi Arabia: Building on MERS experience. J Infect Public Health 2020; 13:834-838. [PMID: 32451260 PMCID: PMC7211706 DOI: 10.1016/j.jiph.2020.04.016] [Citation(s) in RCA: 184] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/24/2020] [Accepted: 04/29/2020] [Indexed: 12/11/2022] Open
Abstract
Nearly four months have passed since the emergence of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), which caused the rapidly spreading Coronavirus Disease 2019 (COVID-19) pandemic. To date, there have been more than 2.3 million confirmed cases and more than 160,000 deaths globally caused by COVID-19. Chinese health authorities, where the virus emerged, have taken prompt strict public health measures to control and prevent the spread of the outbreak. In Saudi Arabia, unprecedented precautionary strict measures were applied to prevent virus entry to the country or to mitigate its impact when it arrives. Here, we review the response of Saudi Arabia to COVID-19 pandemic and how did the experience learned from the Middle East respiratory syndrome coronavirus (MERS-CoV) epidemic since 2012 has helped the country to be better prepared for the current COVID-19 pandemic. We also discuss the country readiness, improvement in research and development, and the unprecedented rapid precautionary measures that have been taken by the Saudi government thus far.
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Affiliation(s)
- Abdullah A Algaissi
- Department of Medical Laboratories Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; Medical Research Center, Jazan University, Jazan, Saudi Arabia
| | - Naif Khalaf Alharbi
- Department of Infectious Disease Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mazen Hassanain
- Department of Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Anwar M Hashem
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; Vaccines and Immunnotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.
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20
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Hashem AM, Al-Subhi TL, Badroon NA, Hassan AM, Bajrai LHM, Banassir TM, Alquthami KM, Azhar EI. MERS-CoV, influenza and other respiratory viruses among symptomatic pilgrims during 2014 Hajj season. J Med Virol 2019; 91:911-917. [PMID: 30729547 PMCID: PMC7166944 DOI: 10.1002/jmv.25424] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 12/24/2022]
Abstract
More than two million Muslims visit Makkah, Saudi Arabia, annually to perform the religious rituals of Hajj where the risk of spreading respiratory infections is very common. The aim here was to screen symptomatic pilgrims for Middle East respiratory syndrome coronavirus (MERS-CoV) and other viral etiologies. Thus, 132 nasopharyngeal samples were collected from pilgrims presenting with acute respiratory symptoms at the healthcare facilities in the holy sites during the 5 days of the 2014 Hajj season. Samples were tested using real-time reverse transcription polymerase chain reactions and microarray. Demographic data including age, sex, and country of origin were obtained for all participants. While we did not detect MERS-CoV in any of the samples, several other viruses were detected in 50.8% of the cases. Among the detected viruses, 64.2% of the cases were due to a single-virus infection and 35.8% were due to the coinfections with up to four viruses. The most common respiratory virus was influenza A, followed by non-MERS human coronaviruses, rhinoviruses, and influenza B. Together, we found that it was not MERS-CoV but other respiratory viruses that caused acute respiratory symptoms among pilgrims. The observed high prevalence of influenza viruses underscores the need for more effective surveillance during the Hajj and adoption of stringent vaccination requirements from all pilgrims.
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Affiliation(s)
- Anwar M Hashem
- Special Infectious Agent Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Tagreed L Al-Subhi
- Special Infectious Agent Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nassrin A Badroon
- Special Infectious Agent Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed M Hassan
- Special Infectious Agent Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Leena Hussein M Bajrai
- Special Infectious Agent Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | | | - Esam I Azhar
- Special Infectious Agent Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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