Impact of the hajj on pneumococcal transmission

Abstract

Over two million Muslim pilgrims assemble annually in Mecca and Medina, Saudi Arabia, to complete the Hajj. The large number of people in a crowded environment increases the potential for pneumococcal carriage amplification. We evaluated pneumococcal carriage prevalence with four cross-sectional studies conducted at beginning-Hajj (Mecca) and end-Hajj (Mina) during 2011 and 2012. A questionnaire was administered and a nasopharyngeal swab was collected. The swab was tested for pneumococcus, serotype and antibiotic resistance. A total of 3203 subjects (1590 at beginning-Hajj and 1613 at end-Hajj) originating from 18 countries in Africa or Asia were enrolled. The overall pneumococcal carriage prevalence was 6.0%. There was an increase in carriage between beginning-Hajj and end-Hajj cohorts for: overall carriage (4.4% versus 7.5%, prevalence ratio (PR) 1.7, 95% CI 1.3-2.3), and carriage of 23-valent pneumococcal polysaccharide vaccine serotypes (2.3% versus 4.1%, PR 1.8, 95% CI 1.2-2.7), 13-valent pneumococcal conjugate vaccine (PCV) serotypes (1.1% versus 3.6%, PR 3.2, 95% CI 1.9-5.6), 10-valent PCV serotypes (0.6% versus 1.6%, PR 2.6, 95% CI 1.2-5.3), antibiotic non-susceptible isolates (2.5% versus 6.1%, PR 2.5, 95% CI 1.7-3.6) and multiple non-susceptible isolates (0.6% versus 2.2%, PR 3.8, 95% CI 1.8-7.9). Fifty-two different serotypes were identified, most commonly serotypes 3 (17%), 19F (5%) and 34 (5%). These results suggest that the Hajj may increase pneumococcal carriage-particularly conjugate vaccine serotypes and antibiotic non-susceptible strains, although the exact mechanism remains unknown. The Hajj may therefore provide a mechanism for the global distribution of pneumococci.

Potential risk for drug resistance globalization at the Hajj

“…Pilgrims acquired antibiotic non-susceptible Streptococcus pneumoniae at a rate of 6.1% compared with 2.5% pretravel and had increased acquisition of multiple drug-resistant S. pneumoniae from 0.6% to 2.2% [21]. It has been reported that as many as one-third of pilgrims acquire S. pneumoniae during the Hajj [22].…”

Streptococcus pneumoniae acquisition among vaccinated Malaysian hajj pilgrims and its associated factors

“…Performing Hajj rituals is a risk factor for pneumococcal acquisition [2,14]. There is currently limited microbiological data regarding the prevalence and causes of respiratory infection during Hajj.…”

“…Overcrowding situations was a risk factor for transmission of infections especially for organisms that were transmitted via airborne and droplets. Streptococcus pneumoniae was among the most common organism isolated from respiratory tract among hajj pilgrims with respiratory tract infections [2]. In a recent study, almost 20% of pilgrims had acquired S. pneumoniae nasal colonization post hajj [3].…”

Exploring Australian Hajj Tour Operators’ Knowledge and Practices Regarding Pilgrims’ Health Risks: A Qualitative Study (Preprint)

“…This challenge is not only for Saudi Arabia but also internationally with the risk of pilgrims importing infectious diseases into their home countries when they return [2]. Respiratory tract infections, including influenza and pneumonia, are the leading health risks at Hajj [3][4][5][6]. Emerging infections like Middle East respiratory syndrome coronavirus (MERS-CoV) pose additional threats to disease control [7,8].…”