Respiratory pathogens among ill pilgrims and the potential benefit of using point-of-care rapid molecular diagnostic tools during the Hajj

Abstract

We investigated respiratory pathogens among ill Hajj pilgrims from Marseille. We also discuss the potential role of point-of-care (POC) rapid molecular diagnostic tools for this purpose. Clinical data were collected using a standardised questionnaire. Influenza A and B viruses, human rhinovirus and human coronaviruses, Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae and Klebsiella pneumoniae were investigated using real-time PCR in respiratory samples obtained during travel, at the onset of symptoms. 207 participants were included. A cough, expectoration, rhinitis and a sore throat were the most frequent respiratory symptoms, followed by loss of voice and dyspnoea. 38.7% and 25.1% of pilgrims reported a fever and influenza-like symptoms, respectively. 59.4% pilgrims received antibiotics. Rhinovirus (40.6%) was the most frequent pathogen, followed by S. aureus (35.8%) and H. influenzae (30.4%). Virus and bacteria co-infections were identified in 28.5% of participants. 25.1% pilgrims who were positive for respiratory bacteria did not receive antibiotic treatment. In the context of the Hajj pilgrimage, it is important to detect infections that can be easily managed with appropriate treatment, and those that can affect prognosis, requiring hospitalisation. POC rapid molecular diagnostic tools could be used for patient management at small Hajj medical missions and to rationalise antibiotic consumption among Hajj pilgrims.

Epidemiological Differences in Hajj-Acquired Airborne Infections in Pilgrims Arriving from Low and Middle-Income versus High-Income Countries: A Systematised Review

“…The most commonly reported chronic medical conditions among pilgrims from LMIC were chronic lung and cardiovascular diseases; noting that, the highest proportions of these conditions (71% and 43%, respectively) were observed in one study that studied a highly selective cohort of pilgrims admitted to ICU with severe sepsis and septic shock [ 16 ]. On the other hand, the most frequently observed chronic medical conditions among pilgrims arriving from HIC were variable, with diabetes ranging from 1% among pilgrims from Australia [ 34 ] to 32% among pilgrims from France [ 62 ], and hypertension ranging from 9% among pilgrims from Turkey [ 59 ] to 28% among pilgrims from France [ 62 ].…”

“…The uptake rates of the pneumococcal vaccine in LMIC varied between 1% and 4% among Hajj pilgrims during the year 2013 [ 38 , 39 ]. Regarding HIC, a study conducted among French pilgrims between 2014 and 2018 revealed that 31% of them received the vaccine before embarking on their Hajj journey [ 62 ]; in contrast, a separate study conducted on French pilgrims in 2013 reported that 51% of them had received the vaccine [ 60 ].…”

“…In terms of quality assessment of the included studies, most LMIC and HIC studies were average in quality, as defined by a NOS score of total stars of between three and five; however, four LMIC studies [ 37 , 38 , 39 , 54 ] and nine HIC studies [ 31 , 33 , 34 , 56 , 60 , 61 , 62 , 65 , 67 ] received a good quality rating of between six and nine stars ( Table 4 ).…”