The dynamics and interactions of respiratory pathogen carriage among French pilgrims during the 2018 Hajj

Abstract

We conducted this study to describe the dynamics of the acquisition of respiratory pathogens, their potential interactions and risk factors for possible lower respiratory tract infection symptoms (LRTI) among French pilgrims during the 2018 Hajj. Each participant underwent four successive systematic nasopharyngeal swabs before and during their stay in Saudi Arabia. Carriage of the main respiratory pathogens was assessed by PCR. 121 pilgrims were included and 93.4% reported respiratory symptoms during the study period. The acquisition of rhinovirus, coronaviruses and Staphylococcus aureus occurred soon after arrival in Saudi Arabia and rates decreased gradually after days 5 and 6. In contrast, Streptococcus pneumoniae and Klebsiella pneumoniae carriage increased progressively until the end of the stay in Saudi Arabia. Haemophilus influenzae and Moraxella catarrhalis carriage increased starting around days 12 and 13, following an initial clearance. Influenza viruses were rarely isolated. We observed an independent positive mutual association between S. aureus and rhinovirus carriage and between H. influenzae and M. catarrhalis carriage. Dual carriage of H. influenzae and M. catarrhalis was strongly associated with S. pneumoniae carriage (OR = 6.22). Finally, our model showed that M. catarrhalis carriage was negatively associated with K. pneumoniae carriage. Chronic respiratory disease was associated with symptoms of LRTI. K. pneumoniae, M. catarrhalis-S. aureus and H. influenzae-rhinovirus dual carriage was associated with LRTI symptoms. Our data suggest that RTIs at the Hajj are a result of complex interactions between a number of respiratory viruses and bacteria.

Hajj and Umrah Mass Gatherings and COVID-19 Infection

“…The epidemiology of respiratory viruses in KSA is likely affected by the gathering of more than 10 million Muslims in the holy sites of Makkah and Medina during the Umrah and Hajj seasons [ 11 ]. In pilgrims, human rhinovirus (HRV), common human coronaviruses (HCoV), and influenza virus were the respiratory viruses most frequently acquired at the Hajj [ 2 , 5 , 6 , 12 – 16 ].…”

“…More recently (2014 to 2017), in a 4-year cohort of 485 French pilgrims, 26.9% participants acquired HRV after their pilgrimage [ 18 ]. The dynamic of HRV acquisition during the pilgrimage was recently described in French pilgrims [ 6 ]. The authors showed an early increase in HRV carriage during the first days of the pilgrimage with a prevalence 24 times higher than that of pre-travel samples.…”

“…The authors showed an early increase in HRV carriage during the first days of the pilgrimage with a prevalence 24 times higher than that of pre-travel samples. Then, HRV carriage decreased progressively in subsequent samples but was still eight times higher in post-Hajj samples compared to pre-Hajj [ 6 ].…”

“…Respiratory tract infections (RTIs) are the most frequent infections transmitted between pilgrims [ 1 •, 5 ]. Most of pilgrims develop RTIs early after their arrival in Makkah with prevalence up to 90% [ 6 ].…”

Pilot Survey of Knowledge, Attitudes and Perceptions of Hajj Deployed Health Care Workers on Antibiotics and Antibiotic Prescriptions for Upper Respiratory Tract Infections: Results from Two Hajj Seasons

“…URTI is the most common medical complication among Hajj pilgrims [12][13][14][15], and studies showed that the majority of URTIs are treated with antibacterial agents (henceforth referred to as antibiotics without specification) [16], even though up to 95% at onset of symptoms, during Hajj, are known to be viral [17]. A recent study revealed that around 93% of pilgrims develop respiratory symptoms, of which 78% of tested samples were positive for at least one pathogen [18]. The most commonly found bacterial causes for respiratory infections were Haemophilus influenzae and Staphylococcus aureus, and viral causes were human rhinoviruses [19][20][21].…”