Risk factors for symptoms of infection and the acquisition of pathogens among pilgrims at the Grand Magal of Touba, 2017–2021

Environmental surface sampling of respiratory and gastrointestinal pathogens during the 2022-2023 Grand Magal of Touba

BACKGROUND

The Grand Magal of Touba (GMT) pilgrimage is known to be associated with risks of infection, but no studies on the role microbial contamination of the environment has been conducted yet.

MATERIALS AND METHODS

We sampled pilgrims and surfaces in the houses where they were accommodated during the 2022-2023 GMT. Respiratory and gastrointestinal pathogens were tested by qPCR.

RESULTS

Of the 152 surfaces sampled, 10.5 % tested positive for Streptococcus pneumoniae, 5.9 % for Staphylococcus aureus, 16.4 % for SARS-CoV-2 (Severe acute respiratory syndrome Coronavirus 2), 3.9 % for Klebsiella pneumoniae, and 0.6 % for rhinovirus. Only Escherichia coli was positive out of all the gastrointestinal pathogens tested, with enteropathogenic E. coli (EPEC) (23.7 %), and enteroaggregative E. coli (EAEC) (22.4 %) being the most frequent. Of 71 pilgrims tested, 66.2 % acquired a respiratory pathogen, including 16.9 % Haemophilus spp., 7.0 % SARS-CoV-2, 11.3 % Streptococcus pneumoniae, 5.6 % Staphylococcus aureus, 1.4 % rhinovirus, and 2.8 % influenza virus. A further 23.9 % acquired a gastrointestinal pathogen, including EAEC (18.3 %), EPEC (2.8 %), Giardia lamblia (5.6 %) and EIEC/Shigella (2.8 %).

CONCLUSION

These preliminary results showed a good correlation between results of surface sampling and human infection for SARS-CoV-2 and EAEC. SARS-CoV-2 surface sampling could be used as a surveillance tool during the GMT. Further larger-scale studies are needed to confirm these preliminary findings.

Sacred journeys and pilgrimages: health risks associated with travels for religious purposes

BACKGROUND

Pilgrimages and travel to religious mass gatherings (MGs) are part of all major religions. This narrative review aims to describe some characteristics, including health risks, of the more well-known and frequently undertaken ones.

METHODS

A literature search was conducted using keywords related to the characteristics (frequency of occurrence, duration, calendar period, reasons behind their undertaking and the common health risks) of Christian, Muslim, Hindu, Buddhist and Jewish religious MGs.

RESULTS

About 600 million trips are undertaken to religious sites annually. The characteristics vary between religions and between pilgrimages. However, religious MGs share common health risks, but these are reported in a heterogenous manner. European Christian pilgrimages reported both communicable diseases, such as norovirus outbreaks linked to the Marian Shrine of Lourdes in France, and non-communicable diseases (NCDs). NCDs predominated at the Catholic pilgrimage to the Basilica of Our Lady of Guadalupe in Mexico, which documented 11 million attendees in 1 week. The Zion Christian Church Easter gathering in South Africa, attended by ~10 million pilgrims, reported mostly motor vehicle accidents. Muslim pilgrimages such as the Arbaeen (20 million pilgrims) and Hajj documented a high incidence of respiratory tract infections, up to 80% during Hajj. Heat injuries and stampedes have been associated with Hajj. The Hindu Kumbh Mela pilgrimage, which attracted 100 million pilgrims in 2013, documented respiratory conditions in 70% of consultations. A deadly stampede occurred at the 2021 Jewish Lag BaOmer MG.

CONCLUSION

Communicable and NCD differ among the different religious MGs. Gaps exists in the surveillance, reporting and data accessibility of health risks associated with religious MGs. A need exists for the uniform implementation of a system of real-time monitoring of diseases and morbidity patterns, utilizing standardized modern information-sharing platforms. The health needs of pilgrims can then be prioritized by developing specific and appropriate guidelines.

Prevalence of Respiratory Pathogens in Nasopharyngeal Swabs of Febrile Patients with or without Respiratory Symptoms in the Niakhar Area of Rural Senegal

Acute respiratory tract infections are one of the leading causes of morbidity and mortality worldwide. More data are needed on circulating respiratory microorganisms in different geographical areas and ecosystems. We analyzed nasopharyngeal swabs from 500 febrile patients living in the Niakhar area (Senegal), using FTDTM multiplex qPCR and simplex qPCR to target a panel of 25 microorganisms. We detected at least one microorganism for 366/500 patients (73.2%), at least one virus for 193/500 (38.6%), and at least one bacterium for 324/500 (64.8%). The most frequently detected microorganisms were Streptococcus pneumoniae (36.8%), Haemophilus influenzae (35.8%), adenovirus (11.8%), influenza viruses (6.4%), rhinovirus (5.0%), SARS-CoV-2 (4.0%), and RSV (4.0%). The main microorganisms significantly associated with respiratory symptoms, with a p-value ≤ 0.05, were influenza virus (11.9% in patients with respiratory symptoms versus 2.9% in patients without), RSV (6.5% versus 2.6%), metapneumovirus (5.4% versus 1.3%), HPIVs (7.6% versus 1.0%), S. pneumoniae (51.9% versus 28.0%), and H. influenzae (54.6% versus 24.5%). Co-infections were significantly associated with respiratory symptoms (65.4% versus 32.9%). All the epidemiological data show a high level of circulation of respiratory pathogens among febrile patients, including those preventable by vaccination such as S. pneumoniae, raising the question of the serotypes currently circulating. Furthermore, the availability of affordable real-time etiological diagnostic tools would enable management to be adapted as effectively as possible.

Evidence for transmission of SARS-CoV-2 at religious mass gatherings: A systematic review

Background

Transmission of SARS-CoV-2 at major mass gatherings (MGs) has been observed during the COVID-19 pandemic.

Methods

In this systematic review done according to the PRISMA guidelines, PubMed and Scopus databases were searched for relevant studies to describe the epidemiology of SARS-CoV-2 in relation to major religious MGs including the Grand Magal of Touba (GMT), Hajj, Umrah, Kumbh Mela, Arbaeen and Lourdes pilgrimage during the COVID-19 pandemic.

Results

Ten articles met the inclusion criteria and were included.No cases of SARS-CoV-2 were detected at 2020 and 2021 GMT or at the 2020 Hajj. In a small study, 7 % of tested individuals were positive after the 2022 GMT. SARS-CoV-2 prevalence during the 2021-2022 Hajj and Umrah seasons varied from 0 to 15 % in different studies. At the 2021 Kumbh Mela, 0.4 million COVID-19 cases were diagnosed among returning pilgrims across India and 1 % tested positive during a one-day survey conducted on participants. During the 2021 Arbaeen pilgrimage, 3 % pilgrims were tested positive. No relevant data were found in relation to SARS-CoV-2 transmission at the 2021 Arbaeen and Lourdes pilgrimages.

Conclusion

The transmission of the SARS-CoV-2 virus during religious MG events depends on many factors such as: the number and density of pilgrims, the intensity of circulation of the virus in the hosting country and in countries sending international participants at the time of the event, the transmissibility of virus variants at the time of the event, the various preventive measures adopted, and the immune status of the pilgrims.

Epidemiology of bacterial resistance at the Grand Magal of Touba in Senegal

BACKGROUND

The Grand Magal of Touba (GMT) associates with risks of infection, but no study on the circulation of resistant bacteria has yet been conducted.

MATERIALS AND METHODS

qPCR was performed on rectal samples from GMT pilgrims between 2018 and 2021, before and after their participation in the gathering. Rectal samples from between 2018 and 2020 were also cultured on specific media, and antibiotic susceptibility testing was performed.

RESULTS

Forty-one of the 296 (13.8%) pilgrims had at least one gastrointestinal symptom and 91/290 (31.4%) acquired pathogenic bacteria, mostly Escherichia coli. A total of 54.7% of pilgrims reported washing their hands more frequently than usual and 89.2% used soap. One hundred and five (36.2%) acquired at least one resistance gene, notably CTX-M A (21.0%), SHV (16.5%) and TEM (8.2%). The strains isolated by culture were mostly E. coli. These bacteria were found to be sensitive to carbapenems and resistant to amoxicillin and amoxicillin-clavulanic acid. The acquisition of enteroaggregative E. coli was independently associated with CTX-M A and TEM acquisition.

CONCLUSION

Pilgrims presented a risk for acquisition of CTX-M A after the GMT. Surveillance of the prevalence of resistant bacteria and the occurrence of associated clinical infections among pilgrims are necessary in the future.

Influenza at the 2021 Grand Magal of Touba and possible spread to rural villages in South Senegal - a genomic epidemiological study

OBJECTIVES

Influenza is frequent among pilgrims participating in the Grand Magal de Touba (GMT), in Senegal, with a potential to spread to contacts when they return home.

METHODS

Ill pilgrims consulting at a health care center in Mbacké city close to Touba during the 2021 GMT, pilgrims returning to Dielmo and Ndiop villages, and patients who did not travel to Touba and consulted at health care centers in these two villages in 2021 were tested for the influenza virus by polymerase chain reaction on nasopharyngeal samples. Next-generation sequencing and comparative and phylogenetic analyses of influenza A virus genomes were performed.

RESULTS

A total of 62 of 685 patients tested positive for influenza A virus, including 34 of 53 who were consulted in Mbacké in late September, six of 129 pilgrims who returned home in early October, and 20 of 42 villagers from October 3 to 29. A total of 27 genomes were obtained. Four clusters were observed based on the phylogenetic analyses, suggesting that Mbacké patients and returned pilgrims may have shared closely related viral strains with patients inhabiting the villages who did not participate in the GMT.

CONCLUSIONS

Villagers in Ndiop and Dielmo may have been infected with viral strains originating from the GMT and possibly imported by pilgrims who returned from the GMT.

Circulation of SARS-CoV-2 virus among pilgrims at the 2022 Grand Magal of Touba

Among pilgrims departing from two villages in South Senegal who participated to the event, 45% had respiratory symptoms and 7% acquired SARS-CoV-2 nasopharyngeal carriage. Among patients with respiratory symptoms sampled at a health care centre close to Touba, 5% tested positive. In contrast, no SARS-CoV-2 infection was observed in 2020–21.

PCR investigation of infections in patients consulting at a healthcare centre over a four-year period during the Grand Magal of Touba

BACKGROUND

Respiratory and gastrointestinal symptoms and febrile illness are the most common complaints among ill pilgrims attending the Grand Magal of Touba (GMT) in Senegal.

METHODS

Patients presenting with respiratory or gastrointestinal symptoms or febrile systemic illnesses were recruited between 2018 and 2021 at a healthcare centre close to Touba. Respiratory, gastrointestinal and blood samples were tested for potential pathogens using qPCR.

RESULTS

538 patients were included. 45.5% of these were female, with a median age of 17 years. Of the 326 samples collected from patients with a cough, 62.8% tested positive for at least one virus, including influenza viruses (33.1%). A high positivity rate of bacterial carriage was observed for Haemophilus influenzae (72.7%), Streptococcus pneumoniae (51.2%) and Moraxella catarrhalis (46.0%). Of the 95 samples collected from patients with diarrhoea, 71.3% were positive, with high rates of bacterial carriage, ranging from 4.2% for Tropheryma whipplei to 45.3% for Entero-pathogenic Escherichia coli. Of the 141 blood samples collected from patients with fever, 31.9% were positive including Plasmodium falciparum (21.3%), Borrelia sp. (5.7%) and dengue virus (5.0%).

CONCLUSION

This study provides insight into the aetiology of most common infections at the GMT on which to base therapeutic options.