Shafaqna English– Médecine et maladies infectieuses has published the paper “Hajj-associated infections” written by A. Salmon-Rousseaua, E. Piednoira, V. Cattoirb, and A. de La Blanchardièrea in 2016.
According to Shafaqna, this paper reviews the epidemiology and prevention of Hajj-associated infectious diseases. High temperatures, coincident with the start of the flu season in the Northern hemisphere, a long barefoot walk, tent-type accommodation, communal toilet facilities, absence of food control, and sharing of razors are the factors leading to transmission of various infections. Infections are the leading cause of hospital admission, which often occurs in the home country of pilgrims.
The epidemiology of Hajj-associated infectious diseases, health recommendations for travelers to Saudi Arabia for the Hajj, and the findings are provided here:
- Health-related risks during the Hajj are two-fold: non-communicable diseases and infectious diseases.
- Ischemic heart disease is a non-communicable disease and is the second cause of hospital admission (12%) during the Hajj after pneumonia. Trauma is the third cause (9%).
- The long hours of walking, waiting or travelling, disrupted daily rhythms, pushing and crowd movements, and poor compliance with the use of seatbelts in vehicles may contribute to the physical exhaustion of already weakened people, along with sometimes fatal falls.
- Heat exhaustion and heatstroke are leading causes of morbidity and mortality, especially in the summer because of the absence of air conditioning, arduous physical rituals, reduced shade, and inadequate fluid intake. Men are more exposed because they do not have the right to cover their heads.
- Overcrowding in a confined area increases the risk of infection.
- Infections of the respiratory tract are the most frequently reported complaints among Hajj pilgrims. The severity and clinical spectrum of disease vary from mild inconvenience to severe pneumonia resulting in hospitalization and even death.
- Acute upper respiratory tract infections (AURI) are common illnesses during the Hajj. Typical symptoms contain coughing, sputum production, sore throat, hoarseness of voice, rhinorrhea, fever, and malaise. AURI may be complicated by exacerbations of asthma, chronic obstructive pulmonary disease, sinusitis, and pneumonia. The most common cause of AURI is influenza viruses.
- The magnitude of viral illnesses occurring during the Hajj has the potential for triggering an influenza pandemic.
- Mycobacterium tuberculosis, Gram-negative rods, S. pneumoniae, and atypical bacteria were the most common pathogens for patients with no response to first-line therapy and requiring hospital admission during the 1994 pilgrimage (28%, 26%, 10% and 6%, respectively). Multiple risk factors may explain this high rate of tuberculosis: pilgrims originating from endemic countries, overcrowding and decreased cell-mediated immunity because of old age, exhaustion, and under nourishment.
- Water-associated diseases are less often observed owing to improved water supply or disposal of wastewater. In addition, Saudi Arabia does not allow pilgrims to bring food and insists that they do not consume food from street vendors who officiate near the holy places.
- Hepatitis A (HAV) is common during the Hajj for pilgrims under the age of 60 travelling from low endemic areas. Transmission generally occurs through the feco-oral route and spreads from person-to-person because of overcrowding and poor personal hygiene or via ingestion of contaminated water or food.
- Because Muslim men shave their heads at the end of the Hajj, risk of bloodborn infections is increased. Official regulations mandate the testing of barbers for hepatitis B (HBV), C (HCV), and HIV, and the use of disposable razorblades. However, unlicensed barbers operate on the roadside during the Hajj, with non-sterile blades that are re-used on various customers.
- Pilgrims walk barefoot in certain holy areas. The most common skin diseases are Eczema, intertrigo, and pyoderma.
- Emerging infectious diseases such as dengue fever, Alkhumra hemorrhagic fever (AHF), Rift Valley fever (RFV), and Middle East Respiratory Syndrome Coronavirus (MERS-CoV) have been observed in Saudi Arabia. Respiratory tract infections, ENT infections, influenza, pyogenic pneumonia, whooping cough, and tuberculosis are most frequently observed during the Hajj.
- Prevention is based on compulsory meningococcal vaccination, vaccination against seasonal influenza and pneumococcal infections for pilgrims at high risk of contracting the infection, and on vaccination against hepatitis A. Updating immunization for diphtheria/tetanus/poliomyelitis/pertussis and measles/mumps is also crucial and pilgrims must comply with hygiene precautions.
Source: EM Consulte