Tuberculosis and mass gatherings—opportunities for defining burden, transmission risk, and the optimal surveillance, prevention, and control measures at the annual Hajj pilgrimage

Abstract

Tuberculosis (TB) is now the most common infectious cause of death worldwide. In 2014, an estimated 9.6 million people developed active TB. There were an estimated three million people with active TB including 360000 with multidrug-resistant TB (MDR-TB) who were not diagnosed, and such people continue to fuel TB transmission in the community. Accurate data on the actual burden of TB and the transmission risk associated with mass gatherings are scarce and unreliable due to the small numbers studied and methodological issues. Every year, an estimated 10 million pilgrims from 184 countries travel to the Kingdom of Saudi Arabia (KSA) to perform the Hajj and Umrah pilgrimages. A large majority of pilgrims come from high TB burden and MDR-TB endemic areas and thus many may have undiagnosed active TB, sub-clinical TB, and latent TB infection. The Hajj pilgrimage provides unique opportunities for the KSA and the 184 countries from which pilgrims originate, to conduct high quality priority research studies on TB under the remit of the Global Centre for Mass Gatherings Medicine. Research opportunities are discussed, including those related to the definition of the TB burden, transmission risk, and the optimal surveillance, prevention, and control measures at the annual Hajj pilgrimage. The associated data are required to develop international recommendations and guidelines for TB management and control at mass gathering events.

Mass gatherings medicine: public health issues arising from mass gathering religious and sporting events

“…Further studies are required to define the scale of the tuberculosis during the Hajj and to develop proactive screening, treatment, and prevention guidelines. 92 Several studies also done on enteric pathogens during the Hajj show the emergence of antibioticresistant bacteria (appendix). 33,34,93 To prevent emergence of and spread of antibioticresistant bacteria, antibiotic pre scription and consumption by pilgrims at mass gathering events should be rationalised and regulated.…”

Undiagnosed Active Pulmonary Tuberculosis among Pilgrims during the 2015 Hajj Mass Gathering: A Prospective Cross-sectional Study

“…1 Mortality from TB in 2015 reached 1.8 million, making it one of the top ten causes of death worldwide. 1,2 International travel, mass gathering events, and migration facilitate the spread of TB. In this context, the Kingdom of Saudi Arabia (KSA) is particularly relevant because of its hosting of the Hajj, where annually around 2 million pilgrims from over 180 countries visit KSA.…”

“…Scanty data are available on the prevalence of active TB during Hajj, and there have been no specific studies to define the burden of TB during the pilgrimage. 2 Evidence of TB in pilgrims comes from clinical studies of causes of hospital admissions during Hajj which reported the isolation of Mycobacterium tuberculosis from 5% to 28% of patients with pneumonia during the event. 2,5 Given the short duration of the Hajj pilgrimage, these active TB cases are likely to be either imported or reactivated.…”

“…2 Evidence of TB in pilgrims comes from clinical studies of causes of hospital admissions during Hajj which reported the isolation of Mycobacterium tuberculosis from 5% to 28% of patients with pneumonia during the event. 2,5 Given the short duration of the Hajj pilgrimage, these active TB cases are likely to be either imported or reactivated. 3 We conducted a cross-sectional study to evaluate the burden of undiagnosed active pulmonary TB in pilgrims arriving in the KSA for the 2015 Hajj.…”

What is the experience from previous mass gathering events? Lessons for Zika virus and the Olympics 2016

“…Some infections like tuberculosis have a long incubation period of several years, and exposure at a mass gathering will not be apparent and may easily be overlooked. 12 The transmission of multidrug-resistant bacteria, for instance Gram-negative bacteria hosted in the intestine, is another concern that has not been well studied. Asymptomatic individuals are colonized with local bacteria and may be carriers for months.…”