Abstract
BackgroundEach year, thousands of pilgrims travel to the Janai Purnima festival in Gosainkunda, Nepal (4380 m), ascending rapidly and often without the aid of pharmaceutical prophylaxis.MethodsDuring the 2012 Janai Purnima festival, 538 subjects were recruited in Dhunche (1950 m) before ascending to Gosainkunda. Through interviews, subjects provided demographic information, ratings of AMS symptoms (Lake Louise Scores; LLS), ascent profiles, and strategies for prophylaxis.ResultsIn the 491 subjects (91% follow-up rate) who were assessed upon arrival at Gosainkunda, the incidence of AMS was 34.0%. AMS was more common in females than in males (RR = 1.57; 95% CI = 1.23, 2.00), and the AMS incidence was greater in subjects >35 years compared to subjects ≤35 years (RR = 1.63; 95% CI = 1.36, 1.95). There was a greater incidence of AMS in subjects who chose to use garlic as a prophylactic compared to those who did not (RR = 1.69; 95% CI = 1.26, 2.28). Although the LLS of brothers had a moderate correlation (intraclass correlation = 0.40, p = 0.023), sibling AMS status was a weak predictor of AMS.ConclusionsThe incidence of AMS upon reaching 4380 m was 34% in a large population of Nepalese pilgrims. Sex, age, and ascent rate were significant factors in the development of AMS, and traditional Nepalese remedies were ineffective in the prevention of AMS.
Highlights
Failure to acclimatise upon ascent to altitudes above 2500 m manifests as acute mountain sickness (AMS), an illness characterized by headache, nausea, dizziness, fatigue, and poor sleep quality [1]
A Nepalese medical student or intern conducted an interview with each subject to collect demographic data, family information, and a baseline Lake Louise Score (LLS)
501 (93%) presented for follow-up at Gosainkunda (37 subjects (7%) were lost to follow-up; Table 1). Ten of these subjects were not assessed upon arrival to Gosainkunda, and they were excluded from further analyses
Summary
Failure to acclimatise upon ascent to altitudes above 2500 m manifests as acute mountain sickness (AMS), an illness characterized by headache, nausea, dizziness, fatigue, and poor sleep quality [1]. AMS may even progress to high-altitude cerebral edema, a rare but lifethreatening condition [3]. AMS affects millions of highaltitude sojourners [4], impacting their health, travel, and economic productivity. Ascent profile and individual characteristics determine one’s likelihood of developing AMS. For a given ascent regimen, individuals differ greatly in terms of their susceptibilities to AMS, with some developing AMS and others acclimatising well to hypoxia. The basis of these individual differences in susceptibility to AMS is not well understood Thousands of pilgrims travel to the Janai Purnima festival in Gosainkunda, Nepal (4380 m), ascending rapidly and often without the aid of pharmaceutical prophylaxis
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