Abstract
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.
Highlights
Each year, an increasing number of people travel to the Kingdom of Saudi Arabia (KSA) for the Hajj and Umrah pilgrimages, which attract around 10 million pilgrims annually from more than 180 countries
Despite the recommendation to take individual preventive measures to prevent respiratory tract infections (RTIs) [25,26], these infections remain common among Hajj pilgrims
Overcrowding during the event is thought to increase the risk of the transmission of infectious diseases, but interaction between respiratory pathogens is probably one factor contributing towards the development of RTIs
Summary
An increasing number of people travel to the Kingdom of Saudi Arabia (KSA) for the Hajj and Umrah pilgrimages, which attract around 10 million pilgrims annually from more than 180 countries. More than two million pilgrims from outside Saudi Arabia participated in the Hajj pilgrimages in 2017 [1]. In a recent study on morbidity and mortality among Indian Hajj pilgrims, infectious diseases represented 53% of outpatient diagnoses, with RTIs and gastroenteritis being the most common [3]. A recent literature review suggested that etiology of RTIs at the Hajj is complex; several studies showed a significant acquisition of respiratory pathogens by pilgrims following participation in the Hajj in both symptomatic and asymptomatic individuals [5]. In a systematic review of 31 studies, AlTawfiq et al showed that human rhinovirus (HRV) and influenza viruses were the most common viral respiratory pathogens isolated from ill Hajj pilgrims [6]. Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus were shown to be the most commonly acquired respiratory bacteria at the Hajj [5]
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