ABSTRACT
This study examines the feasibility of using a smartphone application [app] to conduct surveys among travellers during the Hajj pilgrimage, where the use of apps has not been evaluated for infectious disease surveillance. A longitudinal study was conducted among pilgrims at the Hajj 2014 using an iPhone app with separate questionnaires for three study phases covering before, during, and after Hajj. Forty-eight pilgrims from 13 countries downloaded the app. Respondents were aged between 21 and 61 [median 36] years and 58.5% [24/41] were male. Of these, 85% [41/48] completed the first phase, 52% [25/41] completed both the second and third phases, and 25 of these reported meningococcal vaccination, with 36% [9/25] receiving other vaccines. All [25] reported hand hygiene use and 64% [16/25] wore a facemask at some point during the pilgrimage. Four [6%] reported close contact with camels. Respiratory symptoms commenced from the 4th day of Hajj, with sore throat [20%] and cough [12%] being the most common. Three participants [12%] reported respiratory symptoms after returning home. Conducting a prospective survey using a smartphone app to collect data on travel-associated infections and traveler compliance to prevention is feasible at mass gatherings and can provide useful data associated with health-related behaviour
ABSTRACT
Background Cost-effective interventions are needed to control the transmission of viral respiratory tract infections [RTIs] in mass gatherings. Facemasks are a promising preventive measure, however, previous studies on the efficacy of facemasks have been inconclusive. This study proposes a large-scale facemask trial during the Hajj pilgrimage in Saudi Arabiaandpresents this protocol to illustrate its feasibility and to promote both collaboration with other research groups and additional relevant studies. Methods/design A cluster-r and omised controlled trial is being conducted to test the efficacy of st and ard facemasks in preventing symptomatic and proven viral RTIs among pilgrims during the Hajj season in Mina, Mecca, Saudi Arabia. The trial will compare the 'supervised use of facemasks' versus 'st and ard measures' among pilgrims over several Hajj seasons. Cluster-r and omisation will be done by accommodation tents with a 1:1 ratio. For the intervention tents, free facemasks will be provided to be worn consistently for 7 days. Data on flu-like symptoms and mask use will be recorded in diaries. Nasal samples will be collected from symptomatic recruits and tested for nucleic acid of respiratory viruses. Data obtained from questionnaires, diaries and laboratory tests will be analysed to examine whether mask use significantly reduces the frequency of laboratory-confirmed respiratory viral infection and syndromic RTI as primary outcomes. Conclusions This trial will provide valuable evidence on the efficacy of st and ard facemask use in preventing viral respiratory tract infections at mass gatherings. This study is registered at the Australian New Zeal and Clinical Trials Registry [ANZCTR], ACTRN: ACTRN12613001018707 [http://www.anzctr.org.au]
ABSTRACT
The potential for spread of infectious diseases associated with mass gatherings is well recognised. Hajj, the unique annual mass gathering of over 2 million Muslims from all over the world, presents enormous challenges to the authorities in Saudi Arabia. They have a comprehensive programme updated annually, to ensure that all aspects of Hajj rituals are conducted safely and without major incident. The inevitable overcrowding in a confined area of such large numbers increases the risk of respiratory infections. Of these Hajj cough' is the most frequently reported complaint and is caused by a variety of viruses and bacteria. The outbreaks of meningococcal W135 strains in 2000 and 2001 with the associated high mortality showed the potential for international spread at mass gatherings. Collaboration between health policy makers and community leaders in the UK resulted in a rapid and impressive reduction of these infections. On-going disease surveillance and data analysis is necessary to better understand health risks and strengthen evidence base for health policy and prevention. The battle against spread of travel-related infections is a shared responsibility. Countries sending pilgrims should co-ordinate preventive measures by healthcare professionals and community groups. A multi-pronged approach involving awareness programme for pilgrims and their health advisers, supported by rapid diagnosis, timely treatment, prevention by vaccine, community measures, infection prevention and control practices are necessary. The benefits from such measures go beyond the Hajj to protect health and reduce inequalities. Establishing an international centre for public health relating to the Hajj will enable co-ordinating international health action and appropriate intervention
Subject(s)
Humans , Religion and Medicine , Infection Control , Public Health , Population Surveillance , AwarenessABSTRACT
Children with sickle cell disease [SCD] are at high risk of severe infection with Streptococcus pneumoniae [SP]. From 2002, all children aged <5 years in the UK with SCD were recommended 7-valent pneumococcal conjugate vaccine [PCV-7] in infancy and 23-valent pneumococcal polysaccharide vaccine boosting, in addition to regular penicillin prophylaxis. Our objective was to determine the nasopharyngeal [NP] carriage rate of SP in children aged <5 years with SCD before and after vaccination with PCV-7 [by vaccine, cross-protection and non-vaccine serotypes]. NP swabs were obtained from 63 children attending the Royal London Hospital or Newham General Hospital paediatric haematology clinic between April 2001 and April 2002. Later, NP swabs were obtained from 43 children attending the clinic between June and December 2004 after a PCV-7 vaccination programme. All SP isolated by culture were serotyped and susceptibility to penicillin measured. In the first study group, 13 samples grew SP with 1 sample containing 2 different serotypes, giving a carriage rate of 21%. Four [31%] were intermediately susceptible to penicillin. In the second group overall NP carriage rate had decreased to 9% [n = 4], and the proportion directly or indirectly covered by the PCV-7 vaccine fell from 13/14 to 2/4 [P= 0.11]. One [25%] of these isolates was intermediately susceptible to penicillin. The introduction of PCV-7 appears to be associated with a shift in distribution of serotypes carried by children with SCD. This may have implications for vaccine effectiveness