Abstract
BackgroundArbaeenia is the largest religious mass gathering organized annually in Karbala city, Iraq, and is attended by 8-14 million people. Outbreaks of communicable diseases are a significant risk due to overcrowding and potential food and water contamination. Syndromic surveillance is often used for rapid detection and response to disease outbreaks.ObjectiveThis study was conducted to identify the main communicable diseases syndromes among pilgrims during the Arbaeenia mass gathering in Wassit governorate, Iraq, in 2014.MethodsThis cross-sectional study was conducted in the 40 mobile clinics established within Wassit governorates along the road to Karbala during the Arbaeenia mass gathering. Six communicable disease syndromes were selected: acute watery diarrhea, bloody diarrhea, fever and cough, vomiting with or without diarrhea, fever and bleeding tendency, and fever and rash. A simple questionnaire was used to directly gather basic demographics and the syndromic diagnosis from the attendees.ResultsA total of 87,865 patients attended the clinics during the 10-day period, with an average of 219 patients/clinic/day. Approximately 5% (3999) of the attendees had communicable diseases syndromes: of these, 1693 (42%) had fever and cough, 1144 (29%) had acute diarrhea, 1062 (27%) presented with vomiting with/without diarrhea, and 100 (2%) had bloody diarrhea. The distribution of the syndromes did not vary by age or gender. Stool specimen cultures for Vibrio cholerae performed for 120 patients with acute diarrhea were all negative.ConclusionsSyndromic surveillance was useful in determining the main communicable diseases encountered during the mass gathering. Expansion of this surveillance to other governorates and the use of mobile technology can help in timely detection and response to communicable disease outbreaks.
Highlights
Mass gatherings are defined as preplanned public events that are held for a limited time period and attended by more than25,000 people
This cross-sectional study was conducted in the 40 mobile clinics established within Wassit governorates along the road to Karbala during the Arbaeenia mass gathering
Stool specimen cultures for Vibrio cholerae performed for 120 patients with acute diarrhea were all negative
Summary
Mass gatherings are defined as preplanned public events that are held for a limited time period and attended by more than25,000 people. Participants in mass gatherings are at risk of infection, with the potential to transmit diseases to their local communities after returning from the event. Mass gatherings may exacerbate noncommunicable disease conditions, which may lead to emergencies and hospital admissions [3]. Infectious disease outbreaks are common during mass gatherings [4,5,6]. National surveillance systems are often incapable of monitoring the public health threats from mass gatherings [11]. Mass gatherings pose challenges to health care systems worldwide [12], they provide an opportunity to strengthen both emergency and routine surveillance and response systems, which can benefit countries long after the event [13]. Arbaeenia is the largest religious mass gathering organized annually in Karbala city, Iraq, and is attended by 8-14 million people. Syndromic surveillance is often used for rapid detection and response to disease outbreaks
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