#Hajj, #Umrah, and the neglected #tropical #diseases (PLoS Negl Trop Dis., introduction)

[Source: PLoS Neglected Tropical Diseases, full page: (LINK). Abstract, edited.]


Hajj, Umrah, and the neglected tropical diseases

Mashal M. Almutairi , Waleed Saleh Alsalem, Mazen Hassanain, Peter J. Hotez

Published: August 16, 2018 / DOI: https://doi.org/10.1371/journal.pntd.0006539

Citation: Almutairi MM, Alsalem WS, Hassanain M, Hotez PJ (2018) Hajj, Umrah, and the neglected tropical diseases. PLoS Negl Trop Dis 12(8): e0006539. https://doi.org/10.1371/journal.pntd.0006539

Editor: Samuel V. Scarpino, Northeastern University, UNITED STATES

Published: August 16, 2018

Copyright: © 2018 Almutairi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: The authors received no specific funding for this work.

Competing interests: PJH is investigator and patent holder on several vaccines in development, including vaccines for diseases discussed in the article.



Together, the Hajj and Umrah rank among the leading global venues that host annual mass human migrations. The Hajj is an annual pilgrimage to the Islamic holy city of Makkah in Saudi Arabia (Fig 1). It is considered a religious obligation for all adult Muslims worldwide who have the physical and financial ability and draws an estimated 2–3 million people annually [1]. Umrah is an Islamic pilgrimage to Makkah, which occurs at times other than the period of the Hajj—the period of Ramadan (fasting month) is considered the peak period [2]. In 2018, the Hajj is scheduled to take place in August, while Ramadan will occur between May and June [2].

Through the Hajj and Umrah, it is estimated that visitors to Saudi Arabia arrive from almost every country, based on a ratio of “one pilgrim per 1,000 Muslims from that country” [2]. Currently, the largest countries in terms of Muslim populations are Asian nations located in tropical disease–endemic areas, led by Indonesia, Pakistan, India, and Bangladesh, followed by Nigeria and Egypt in Africa, where neglected tropical diseases (NTDs) are also widespread (Table 1) [3]. Together, these nations account for almost 700,000 Hajj pilgrims, and according to the Global Burden of Disease Study, they account for some of the largest numbers of people living with NTDs [4].

The largest numbers of Hajj immigrants are from South and Southeast Asian tropical countries where globally the largest numbers of cases of dengue, lymphatic filariasis (LF), soil-transmitted helminth infections, leprosy, and kala-azar are also endemic [4]. Similarly, Nigeria is the most highly endemic country in Africa for the major NTDs, especially schistosomiasis, soil-transmitted helminth infections, LF, onchocerciasis, and rabies. Each of these diseases has the potential of being either introduced or reintroduced in the Middle East and North Africa (MENA) region due to Hajj and Umrah activities.

Previously reported major Hajj-associated infectious diseases included respiratory tract infections like seasonal influenza, meningococcal disease, lower respiratory infections due to pneumococcus, and tuberculosis; water-borne and blood-borne infections including hepatitis A, B, and C were discussed elsewhere [5, 6]. In this report, we focus on the major NTDs that have either been introduced into the Middle East through Hajj and Umrah pilgrimages from tropical disease–endemic countries of Asia and Africa or where importation from Saudi Arabia to other parts of the world are possible. In some cases, these diseases have now become endemic in Saudi Arabia and elsewhere in the MENA region. Our report emphasizes the recent scientific literature published within the last five years.


Keywords: Mass Gathering Events; The Hajj; Middle East Region; Saudi Arabia; Infectious Diseases; Emerging Diseases.


The #challenges of #cholera at the 2017 #Hajj #pilgrimage (Lancet Infect Dis., summary)

[Source: The Lancet Infectious Diseases, full page: (LINK). Summary, edited.]

The challenges of cholera at the 2017 Hajj pilgrimage

Alimuddin Zumla, Brian McCloskey, Tina Endericks, Esam I Azhar, Eskild PetersenEmail the author Eskild Petersen

Published: 10 August 2017 / DOI: http://dx.doi.org/10.1016/S1473-3099(17)30454-1



In September, 2017, up to 2 million pilgrims from all continents will arrive in Saudi Arabia for the annual Hajj pilgrimage.1 Living and worshipping together in crowded conditions will expose the pilgrims and the local Saudi Arabian community to a range of imported and local infections.1 Over the past 5 years the Hajj has focused attention on new and re-emerging infectious diseases with epidemic potential such as the Middle East respiratory syndrome coronavirus (MERS-CoV), Zika virus, and pan-antibiotic-resistant bacteria—global health security threats that are ongoing and under active surveillance.

Keywords: The Hajj; Saudi Arabia; MERS-CoV; Cholera.


#Zika Virus #Screening among #Spanish #Team Members After 2016 #Rio de Janeiro, #Brazil, Olympic #Games (@CDC_EIDjournal, abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 23, Number 8—August 2017 / Research Letter

Zika Virus Screening among Spanish Team Members After 2016 Rio de Janeiro, Brazil, Olympic Games

Natalia Rodriguez-Valero, Alberto M. Borobia, Mar Lago, Maria Paz Sánchez-Seco, Fernando de Ory, Ana Vázquez, Jose Luis Pérez-Arellano, Cristina Carranza Rodríguez, Miguel J. Martínez, Alicia Capón, Elias Cañas, Joaquin Salas-Coronas, Arkaitz Azcune Galparsoro, and Jose Muñoz

Author affiliations: IS Global-Hospital Clínic de Barcelona, Barcelona, Spain (N. Rodriguez-Valero, J. Muñoz); Hospital La Paz-Carlos III, Madrid, Spain (A.M. Borobia, M. Lago); Instituto de Salud Carlos III, Madrid, Madrid, Spain (M.P. Sánchez-Seco, F. de Ory, A. Vázquez); Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain (J.L. Pérez-Arellano, C. Carranza Rodríguez); Hospital Clinic de Barcelona, Barcelona, Spain (M.J. Martínez, A. Capón); Hospitales Universitarios Virgen del Rocío, Sevilla, Spain (E. Cañas); Hospital de Poniente, El Ejido, Spain (J. Salas-Coronas); Hospital Universitario de Donostia, Donostia, Spain (A. Azcune Galparsoro)



We evaluated the risk for the Spanish Olympic Team acquiring Zika virus in Rio de Janeiro, Brazil, during 2016. We recruited 117 team members, and all tested negative for Zika virus. Lack of cases in this cohort supports the minimum risk estimates made before the Games.

Keywords: Zika Virus; Brazil; Spain; Mass Gathering Events.


Increased #risk of #dementia in the aftermath of the 2011 Great East #Japan #Earthquake and #Tsunami (Proc Natl Acad Sci USA, abstract)

[Source: Proceedings of the National Academy of Sciences of the United States of America, full page: (LINK). Abstract, edited.]

Increased risk of dementia in the aftermath of the 2011 Great East Japan Earthquake and Tsunami

Hiroyuki Hikichi a,1, Jun Aida b, Katsunori Kondo c,d, Toru Tsuboya b, Yusuke Matsuyama b, S. V. Subramanian a, and Ichiro Kawachi a

Author Affiliations: a Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA 02115; b Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Miyagi 980-8575, Japan; c Center for Preventive Medical Sciences, Chiba University, Chiba-shi, Chiba 260-8670, Japan; d Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan

Edited by Susan T. Fiske, Princeton University, Princeton, NJ, and approved September 16, 2016 (received for review May 15, 2016)



Recovery after major disaster poses potential risks of dementia for the elderly population. However, no previous studies have examined exposure to natural disaster and changes in risk factors as predictors of deterioration in cognitive function. We prospectively examined whether housing damage and loss of relatives or friends were associated with cognitive decline in the aftermath of the 2011 Great East Japan Earthquake and Tsunami. In this study, which included 3,566 survivors who are 65 y old or older, the severity of housing damage was significantly associated with cognitive decline after controlling changes of covariates and risk factors during the follow-up period. The cognitive decline should be listed as a health risk of older survivors in the aftermath of natural disasters.



No previous study has been able to examine the association by taking account of risk factors for dementia before and after the disaster. We prospectively examined whether experiences of a disaster were associated with cognitive decline in the aftermath of the 2011 Great East Japan Earthquake and Tsunami. The baseline for our natural experiment was established in a survey of older community-dwelling adults who lived 80 km west of the epicenter 7 mo before the earthquake and tsunami. Approximately 2.5 y after the disaster, the follow-up survey gathered information about personal experiences of disaster as well as incidence of dementia from 3,594 survivors (82.1% follow-up rate). Our primary outcome was dementia diagnosis ascertained by in-home assessment during the follow-up period. Among our analytic sample (n = 3,566), 38.0% reported losing relatives or friends in the disaster, and 58.9% reported property damage. Fixed-effects regression indicated that major housing damage and home destroyed were associated with cognitive decline: regression coefficient for levels of dementia symptoms = 0.12, 95% confidence interval (CI): 0.01 to 0.23 and coefficient = 0.29, 95% CI: 0.17 to 0.40, respectively. The effect size of destroyed home is comparable to the impact of incident stroke (coefficient = 0.24, 95% CI: 0.11 to 0.36). The association between housing damage and cognitive decline remained statistically significant in the instrumental variable analysis. Housing damage appears to be an important risk factor for cognitive decline among older survivors in natural disasters.



1 To whom correspondence should be addressed. Email: hikichi@hsph.harvard.edu.

Author contributions: H.H. and I.K. designed research; H.H., J.A., K.K., T.T., Y.M., S.V.S., and I.K. performed research; H.H. analyzed data; and H.H., J.A., K.K., T.T., Y.M., S.V.S., and I.K. wrote the paper.

The authors declare no conflict of interest.

This article is a PNAS Direct Submission.

This article contains supporting information online at http://www.pnas.org/lookup/suppl/doi:10.1073/pnas.1607793113/-/DCSupplemental.

Keywords: Japan; Dementia; Mass Casualty Events; Earthquakes; Tsunami.


Acquisition of #mcr1 #plasmid-mediated #colistin #resistance in #Escherichia coli and #Klebsiella pneumoniae during #Hajj 2013 and 2014 (AAC, abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Acquisition of mcr-1 plasmid-mediated colistin resistance in Escherichia coli and Klebsiella pneumoniae during Hajj 2013 and 2014.

Thongpan Leangapichart a, Philippe Gautret a, Philippe Brouqui a, Ziad Mimish b, Didier Raoult a and Jean-Marc Rolain a*

Author Affiliations: a Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE) CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille-Université, Marseille, France. b Ministry of Health, Riyadh, Saudi Arabia; Alfaisal University, College of Medicine, Riyadh, Saudi Arabia.



A plasmid-mediated transferable colistin resistance gene, mcr-1, was recently described in China (1) and was rapidly reported in several other countries (2).…

*Corresponding author Phone: (33) 4 91 32 43 75. Fax: (33) 4 91 38 77 72 Email: jean-marc.rolain@univ-amu.fr

Copyright © 2016, American Society for Microbiology. All Rights Reserved.

Keywords: Research; Abstracts; Antibiotics; Drugs Resistance; Colistin; MCR1; Klebsiella Pneumoniae; Escherichia Coli; Mass Gathering Events.


#Yellowfever #outbreaks, #vaccine #shortages and the #Hajj and #Olympics: call for #global #vigilance (Lancet, abstract)

[Source: The Lancet, full page: (LINK). Extract.]


Yellow fever outbreaks, vaccine shortages and the Hajj and Olympics: call for global vigilance

Habida Elachola, John Ditekemena, Jiatong Zhuo, Ernesto Gozzer, Paola Marchesini, Mujeeb Rahman, Samba Sow, Rana F Kattan, Ziad A Memish

Article has an altmetric score of 10 / DOI: http://dx.doi.org/10.1016/S0140-6736(16)31546-X

© 2016 Elsevier Ltd. All rights reserved.



The identification in China of 11 non-immunised travellers from west Africa with yellow fever elevated global attention on this vaccine preventable disease that puts about 1 billion people in 46 countries at risk.1, 2, 3 Yellow fever is an acute mosquito transmitted viral haemorrhagic disease with a case fatality rate of 15–50% and no cure. On May 19, 2016, WHO declared yellow fever outbreaks a “serious public health concern”.2


Keywords: Research; Public Health; Yellow Fever; Mass Gethering Events.


Mass #Gatherings and #Respiratory Disease #Outbreaks in #USA – Should We Be Worried? Results from a Systematic Literature Review and Analysis of the National Outbreak Reporting System (PLoS One, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

PLoS One. 2016 Aug 18;11(8):e0160378. doi: 10.1371/journal.pone.0160378.

Mass Gatherings and Respiratory Disease Outbreaks in the United States – Should We Be Worried? Results from a Systematic Literature Review and Analysis of the National Outbreak Reporting System.

Rainey JJ1, Phelps T1, Shi J1.

Author information: 1Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.




Because mass gatherings create environments conducive for infectious disease transmission, public health officials may recommend postponing or canceling large gatherings during a moderate or severe pandemic. Despite these recommendations, limited empirical information exists on the frequency and characteristics of mass gathering-related respiratory disease outbreaks occurring in the United States.


We conducted a systematic literature review to identify articles about mass gathering-related respiratory disease outbreaks occurring in the United States from 2005 to 2014. A standard form was used to abstract information from relevant articles identified from six medical, behavioral and social science literature databases. We also analyzed data from the National Outbreaks Reporting System (NORS), maintained by the Centers for Disease Control and Prevention since 2009, to estimate the frequency of mass gathering-related respiratory disease outbreaks reported to the system.


We identified 21 published articles describing 72 mass gathering-related respiratory disease outbreaks. Of these 72, 40 (56%) were associated with agriculture fairs and Influenza A H3N2v following probable swine exposure, and 25 (35%) with youth summer camps and pandemic Influenza A H1N1. Outbreaks of measles (n = 1) and mumps (n = 2) were linked to the international importation of disease. Between 2009 and 2013, 1,114 outbreaks were reported to NORS, including 96 respiratory disease outbreaks due to Legionella. None of these legionellosis outbreaks was linked to a mass gathering according to available data.


Mass gathering-related respiratory disease outbreaks may be uncommon in the United States, but have been reported from fairs (zoonotic transmission) as well as at camps where participants have close social contact in communal housing. International importation can also be a contributing factor. NORS collects information on certain respiratory diseases and could serve as a platform to monitor mass gathering-related respiratory outbreaks in the future.

PMID: 27536770 DOI: 10.1371/journal.pone.0160378

[PubMed – as supplied by publisher]

Keywords: Research; Abstracts; USA; Mass Gathering Events; Infectious Diseases; Emerging Diseases.