Respiratory pathogens among ill pilgrims and the potential benefit of using point-of-care rapid molecular diagnostic tools during the Hajj.

We investigated respiratory pathogens among ill Hajj pilgrims from Marseille. We also discuss the potential role of point-of-care (POC) rapid molecular diagnostic tools for this purpose. Clinical data were collected using a standardised questionnaire. Influenza A and B viruses, human rhinovirus and human coronaviruses, Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae and Klebsiella pneumoniae were investigated using real-time PCR in respiratory samples obtained during travel, at the onset of symptoms. 207 participants were included. A cough, expectoration, rhinitis and a sore throat were the most frequent respiratory symptoms, followed by loss of voice and dyspnoea. 38.7% and 25.1% of pilgrims reported a fever and influenza-like symptoms, respectively. 59.4% pilgrims received antibiotics. Rhinovirus (40.6%) was the most frequent pathogen, followed by S. aureus (35.8%) and H. influenzae (30.4%). Virus and bacteria co-infections were identified in 28.5% of participants. 25.1% pilgrims who were positive for respiratory bacteria did not receive antibiotic treatment. In the context of the Hajj pilgrimage, it is important to detect infections that can be easily managed with appropriate treatment, and those that can affect prognosis, requiring hospitalisation. POC rapid molecular diagnostic tools could be used for patient management at small Hajj medical missions and to rationalise antibiotic consumption among Hajj pilgrims.

COVID-19 social distancing in the Kingdom of Saudi Arabia: Bold measures in the face of political, economic, social and religious challenges.

Social distancing at its various levels has been a key measure to mitigate the transmission of COVID-19. The implementation of strict measures for social distancing is challenging, including in the Kingdom of Saudi Arabia (KSA) due to its level of urbanization, its social and religious norms and its annual hosting of high visibility international religious mass gatherings. KSA started introducing decisive social distancing measures early before the first case of COVID-19 was confirmed in the Kingdom. These ranged from suspension or cancelations of religious, entertainment and sporting mass gatherings and events such as the Umrah, temporary closure of educational establishments and mosques and postponing all non-essential gatherings, to imposing a curfew. These measures were taken in spite of their socio-economic, political and religious challenges in the interest of public and global health. The effect of these actions on the epidemic curve of the Kingdom and on the global fight against COVID-19 remains to be seen. However, given the current COVID-19 situation, further bold and probably unpopular measures are likely to be introduced in the future.

Potential Cross-Reactive Immunity to COVID-19 Infection in Individuals With Laboratory-Confirmed MERS-CoV Infection: A National Retrospective Cohort Study From Saudi Arabia.

BACKGROUND: A growing number of experiments have suggested potential cross-reactive immunity between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and previous human coronaviruses. We conducted the present retrospective cohort study to investigate the relationship between previous Middle East respiratory syndrome-coronavirus (MERS-CoV) infection and the risk of SARS-CoV-2 infection as well as the relationship between previous MERS-CoV and COVID-19-related hospitalization and mortality. METHODS: Starting in March 2020, we prospectively followed two groups of individuals who tested negative for COVID-19 infection. The first group had a previously confirmed MERS-CoV infection, which was compared to a control group of MERS-negative individuals. The studied cohort was then followed until November 2020 to track evidence of contracting COVID-19 infection. FINDINGS: A total of 82 (24%) MERS-positive and 260 (31%) MERS-negative individuals had COVID-19 infection. Patients in the MERS-positive group had a lower risk of COVID-19 infection than those in the MERS-negative group (Risk ratio [RR] 0.696, 95% confidence interval [CI] 0.522-0.929; p =0.014). The risk of COVID-19-related hospitalization in the MERS-positive group was significantly higher (RR 4.036, 95% CI 1.705-9.555; p =0.002). The case fatality rate (CFR) from COVID-19 was 4.9% in the MERS-positive group and 1.2% in the MERS-negative group (p =0.038). The MERS-positive group had a higher risk of death than the MERS-negative group (RR 6.222, 95% CI 1.342-28.839; p =0.019). However, the risk of mortality was similar between the two groups when death was adjusted for age (p =0.068) and age and sex (p =0.057). After controlling for all the independent variables, only healthcare worker occupation and >1 comorbidity were independent predictors of SARS-CoV-2 infection. INTERPRETATION: Individuals with previous MERS-CoV infection can exhibit a cross-reactive immune response to SARS-CoV-2 infection. Our study demonstrated that patients with MERS-CoV infection had higher risks of COVID-19-related hospitalization and death than MERS-negative individuals.

Novel Respiratory Viruses in the Context of Mass-Gathering Events: A Systematic Review to Inform Event Planning from a Health Perspective.

BACKGROUND: Mass-gathering events (MGEs) occur regularly throughout the world. As people congregate at MGEs, there is an increased risk of transmission of communicable diseases. Novel respiratory viruses, such as Severe Acute Respiratory Syndrome Coronavirus-1 (SARS-CoV-1), Influenza A Virus Subtype H1N1 Strain 2009 (H1N1pdm09), Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), or Coronavirus Disease 2019 (COVID-19), may require specific infection prevention and control strategies to minimize the risk of transmission when planning MGEs. This literature review aimed to identify and analyze papers relating to novel respiratory viruses with pandemic potential and to inform MGE planning. METHOD: This paper used a systematic literature review method. Various health care databases were searched using keywords relating to MGEs and novel respiratory viruses. Information was extracted from identified papers into various tables for analysis. The analysis identified infection prevention and control strategies used at MGEs to inform planning before, during, and following events. RESULTS: In total, 27 papers met the criteria for inclusion. No papers were identified regarding SARS-CoV-1, while the remainder reported on H1N1pdm09 (n = 9), MERS-CoV (n = 15), and SARS-CoV-2 (n = 3). Various before, during, and after event mitigation strategies were identified that can be implemented for future events. CONCLUSIONS: This literature review provided an overview of the novel respiratory virus epidemiology at MGEs alongside related public health mitigation strategies that have been implemented at these events. This paper also discusses the health security of event participants and host communities in the context of cancelling, postponing, and modifying events due to a novel respiratory virus. In particular, ways to recommence events incorporating various mitigation strategies are outlined.

Knowledge, Attitude, and Perceived Risks Towards COVID-19 Pandemic and the Impact of Risk Communication Messages on Healthcare Workers in Saudi Arabia.

PURPOSE: To investigate knowledge, attitude, and perceived risks towards COVID-19 pandemic among healthcare workers (HCWs) in Saudi Arabia. Besides, the impact of risk communication strategy on the attitude and practice of HCWs was investigated. PATIENTS AND METHODS: We conducted a cross-sectional study that targeted HCWs from various Saudi health facilities. We utilized a self-administrated, online-based questionnaire designed to assess basic knowledge of COVID-19, attitude and disease perception, and the impact of risk communication messages among HCWs. RESULTS: A total of 1691 responses were received in the study. The HCWs exhibited good levels of knowledge (total maximum score is 1) of COVID-19 concerning the modes of transportation of COVID-19 (0.82±0.16), sample collection method for COVID-19 diagnosis (0.98±0.08), transmission of infection from asymptomatic individuals (0.99±0.11), and that antibiotics are not effective against the new COVID-19 (0.83±0.38). Nearly one-third of the participants considered a high/very high possibility of acquiring COVID-19 infection. HCWs had good attitude scores concerning their willingness to deal with new COVID-19 patients (0.87±0.33) and their beliefs in being educated on COVID-19 (0.99±0.11). Almost all participants strongly agree/agree that it is important to take action to prevent the spread of COVID-19 within healthcare facilities and received health information messages. Notably, 93.4% of the participants stated that the received messages changed their attitude towards COVID-19 and its preventive measures. Good knowledge scores were significantly associated with age > 49 years old, higher educational level, and physician occupation. Similarly, good attitude scores were higher among males, HCWs aged 40-49 years old, non-Saudi nationals, and physician and nurse occupations. CONCLUSION: HCWs have fair knowledge and attitude towards the COVID-19 pandemic. The risk communication is an effective strategy to improve the attitude and practice of HCWs towards COVID-19 in Saudi Arabia.

Interferon-induced transmembrane protein-3 genetic variant rs12252 is associated with COVID-19 mortality.

Interferon-induced membrane proteins (IFITM) 3 gene variants are known risk factor for severe viral diseases. We examined whether IFITM3 variant may underlie the heterogeneous clinical outcomes of SARS-CoV-2 infection-induced COVID-19 in large Arab population. We genotyped 880 Saudi patients; 93.8% were PCR-confirmed SARS-CoV-2 infection, encompassing most COVID-19 phenotypes. Mortality at 90 days was 9.1%. IFITM3-SNP, rs12252-G allele was associated with hospital admission (OR = 1.65 [95% CI; 1.01-2.70], P = 0.04]) and mortality (OR = 2.2 [95% CI; 1.16-4.20], P = 0.01). Patients less than 60 years old had a lower survival probability if they harbor this allele (log-rank test P = 0.002). Plasma levels of IFNγ were significantly lower in a subset of patients with AG/GG genotypes than patients with AA genotype (P = 0.00016). Early identification of these individuals at higher risk of death may inform precision public health response.

Risk Communication Effectiveness During COVID-19 Pandemic Among General Population in Saudi Arabia.

PURPOSE: The novel coronavirus (COVID-19), declared a pandemic by WHO in March 2020, is an unprecedented occurrence in our recent history. Effective risk communication by health authorities, through relaying reliable and authoritative information, is imperative in combating the spread of the outbreak. We aimed to measure the effectiveness of risk communication campaign and overall awareness during COVID-19 pandemic among the general population in Saudi Arabia. PATIENTS AND METHODS: A cross-sectional survey of 5472 individuals in Saudi Arabia was conducted to assess several factors regarding the risk communication messages during the COVID-19 pandemic, including the knowledge and response of the general population toward COVID-19 and MoH efforts. The questionnaire was divided into five main sections: general knowledge of COVID-19, channels and social media platforms used perceived risk and stress or panic toward COVID-19, satisfaction and community perception, most trusted source of information, and type of information received. RESULTS: A total of 5472 individuals participated in the study residing in Saudi Arabia. Overall knowledge of COVID-19 was determined to be above average (0.58 + 0.159). Of the general population, 57.1% perceived that the risk of getting sick with COVID-19 is low, while nearly half of the respondents (45.7%) have a high level of stress and panic toward COVID-19. The majority of responders to the questionnaire reinforced that MoH was their most trusted source of information for the COVID-19 pandemic (91.7%). CONCLUSION: This study showed that the risk communication campaign by healthcare authorities during the COVID-19 pandemic has improved the awareness among the general population in Saudi Arabia, where the overwhelming majority placed high trust in the MoH as its main reference for COVID-19 information.

Implementing the Health Early Warning System based on syndromic and event-based surveillance at the 2019 Hajj.

BACKGROUND: During the 2019 Hajj, the Ministry of Health in Saudi Arabia implemented for the first time a health early warning system for rapid detection and response to health threats. AIMS: This study aimed to describe the early warning findings at the Hajj to highlight the pattern of health risks and the potential benefits of the disease surveillance system. METHODS: Using syndromic surveillance and event-based surveillance data, the health early warning system generated automated alarms for public health events, triggered alerts for rapid epidemiological investigations and facilitated the monitoring of health events. RESULTS: During the deployment period (4 July-31 August 2019), a total of 121 automated alarms were generated, of which 2 events (heat-related illnesses and injuries/trauma) were confirmed by the response teams. CONCLUSION: The surveillance system potentially improved the timeliness and situational awareness for health events, including non-infectious threats. In the context of the current COVID-19 pandemic, a health early warning system could enhance case detection and facilitate monitoring of the disease geographical spread and the effectiveness of control measures.