Syndromic surveillance of respiratory-tract infections and hand hygiene practice among pilgrims attended Hajj in 2021: a cohort study

• Published in: BMC infectious diseases Vol. 22; no. 1; pp. 1 - 578
• Main Authors: Mahdi, Hashim A, Rashid, Harunor, Qashqari, Fadi S, Hariri, Sumyya H, Marglani, Osama A, Barasheed, Osamah, Albutti, Aqel, Alwashmi, Ameen S, Shaban, Ramon Z, Booy, Robert, Alfelali, Mohammad
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 27.06.2022; BioMed Central; BMC
• Subjects: Care and treatment; Cohort analysis; Confidence intervals; Coronaviruses; Cough; COVID-19; COVID-19 vaccines; Diagnosis; Disease transmission; Fever; Hajj; Hand hygiene; Hand washing; Health aspects; Health risks; Hygiene; Immunization; Infection control; Infections; Infectious diseases; Influenza; Influenza-like illnesses; Methods; Pandemics; Personal hygiene; Pharyngitis; Pilgrimages; Pilgrims; Public health; Questionnaires; Respiratory tract; Respiratory tract diseases; Respiratory tract infection; Respiratory tract infections; Risk; Risk factors; Social aspects; Software; Viral diseases; Saudi Arabia; United States > US
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-022-07559-0

The risk of transmission of viral respiratory tract infections (RTIs) is high in mass gatherings including Hajj. This cohort study estimated the incidence of symptomatic RTIs and hand hygiene compliance with its impact among Hajj pilgrims during the COVID-19 pandemic. During the week of Hajj rituals in 2021, domestic pilgrims were recruited by phone and asked to complete a baseline questionnaire. Pilgrims were followed up after seven days using a questionnaire about the development of symptoms, and practices of hand hygiene. Syndromic definitions were used to clinically diagnose 'possible' influenza-like illnesses (ILI) and COVID-19 infection. A total of 510 pilgrims aged between 18 and 69 (median of 50) years completed the questionnaire, 280 (54.9%) of whom were female, and all of them (except for one) were vaccinated against COVID-19 with at least one dose. The mean ([+ or -] SD) of pilgrims' hand hygiene knowledge score (on a scale of 0 to 6) was 4.15 ([+ or -] 1.22), and a higher level of knowledge was correlated with a higher frequency of handwashing using soap and water. Among those 445 pilgrims who completed the follow-up form, 21 (4.7%) developed one or more respiratory symptoms, of which sore throat and cough were the commonest (respectively 76.2% and 42.8%); 'possible ILI' and 'possible COVID-19' were present in 1.1% and 0.9% of pilgrims. Obesity was found to be a significant factor associated with the risk of developing RTIs (odds ratio = 4.45, 95% confidence interval 1.15-17.13). Hajj pilgrims are still at risk of respiratory infections. Further larger and controlled investigations are needed to assess the efficacy of hand hygiene during Hajj.