The Rise of Antimicrobial Resistance in Mass Gatherings

Abstract

Mass gatherings (MGs) are a common human group behavior. Antimicrobial resistance (AMR) is a major public health issue. The Arab world hosts the annual Hajj pilgrimage, a MG with diverse attendees, and the region is also a layover hub for global travels. Although AMR surveillance is still insufficient, the available data on Hajj reveal that the AMR rate is generally high and is increasing each year. Enteric infections are common in Hajj and provide grounds for AMR acquisition and transmission, including emerging resistance to β-lactams. Respiratory infections are a major concern in Hajj, where incidences of outbreaks such as meningococcal disease being documented during the pilgrimage. With the recorded high usage of antimicrobials during Hajj, including mandatory prophylaxis for high-risk travelers and the availability of over-the-counter antimicrobials, the risk of AMR development is likely to increase.

Evaluation of the rate, pattern and appropriateness of antibiotic prescription in a cohort of pilgrims suffering from upper respiratory tract infection during the 2018 Hajj season

“…This is of considerable importance, as the inappropriate use of antibiotics may accelerate the rate of AMR emergence during the event [ 6, 25 ]. The most commonly prescribed antibiotic in Hajj is amoxicillin, often combined with clavulanic acid [ 26 ], to which most of the AMR organisms documented during the pilgrimage are resistant to [ 27 ]. A corresponding lack of AMR profiling for Hajj-associated URTI organisms means that there is limited knowledge on the effectiveness of such prescription practices.…”

Transmission of Antimicrobial Resistant Bacteria at the Hajj: A Scoping Review

“…Notably, infectious disease events related to the Hajj have included a cholera epidemic in 1821 that resulted in an estimated 20,000 deaths [ 14 ] and meningitis outbreaks in 1987 and 2000, which led to mandating meningococcal vaccination for all pilgrims [ 15 , 16 , 17 ]. These events highlight the risk of transmission of infectious diseases at the event [ 18 , 19 ]. The threat of AMR bacteria transmission and global spread associated with the Hajj has been noted as a global health concern [ 20 ].…”