Highlights
- •Hajj tent environment may contribute to the spread of airborne infections during Hajj.
- •Important in determining the risks and contribution of the Hajj tent environment to pilgrim health.
- •Cross transmission that could progress to infection.
- •Performing microbial surveillance during Hajj.
- •Prevent outbreaks and provide cautionary information related to possible future epidemics.
Background
Respiratory tract infections are common among pilgrims attending annual Hajj in Mecca,
Saudi Arabia. Pilgrims typically spend most of the Hajj period inside ventilated tents,
where microorganisms may be transmitted through bioaerosols and droplets.
Objective
To perform microorganism surveillance inside Hajj tents and assess the similarities
between microorganisms isolated from tent bioaerosol samples and nasopharyngeal swabs
(NP) of tent occupants.
Methods
Respiratory microorganisms in bioaerosols collected from Hajj tents over a 4-day period
were compared with NP of tent occupants using real-time multiplex polymerase chain
reaction analysis.
Results
A total of 152 samples were collected: 120 tent bioaerosol samples collected on days
9, 10, 11, and 12 of Dhu al-Hijjah, and 32 NP collected on day 12 of Dhu al-Hijjah
(corresponding to 23/08/2018). Eighty-three (69.2%) bioaerosol samples tested positive
for at least 1 microorganism, with the number of pathogens increasing over the 4 days
of sampling. Twenty-seven (84.38%) NP swabs from tent occupants also tested positive.
Microorganisms identified in pilgrim nasal carriage and tent bioaerosol samples were
similar, and included K. pneumonia, S. aureus, S. pneumonia, human adenovirus, Moraxella, influenza A, and H. influenza.
Conclusions
The data suggest that the Hajj tent environment may contribute to the spread of airborne
infections during Hajj. This can have important ramifications for novel pathogens
with pandemic potential.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Infection ControlAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Respiratory tract infections during the annual Hajj: potential risks and mitigationstrategies.Curr Opin Pulm Med. 2013; 9: 192-197
- Global public health implications of a mass gathering in Mecca, Saudi Arabia during the midst of an influenza pandemic.J Travel Med. 2010; 7: 75-81
- Health risk at the Hajj.Lancet. 2006; 367: 1008
- Respiratory infection during Hajj.Ann Thorac Med. 2009; 4: 50-53
- (n.d.). Factors involved in the aerosol transmission of infection and control of ventilation in healthcare premises.J Hosp Infect. 2006; 64: 100-114
- Mass gatherings and the spread of respiratory infections. Lessons from the Hajj.Ann Am Thorac Soc. 2016; 13: 759-765
- WHO Guidelines for Indoor Air Quality: Dampness and Mould.Copenhagen, Denmark: World Health Organization, 2009 (Accessed November 24, 2013)
World Health Organization. Interim travel advice on MERS-Cov for pilgrimage to the kingdom of Saudi Arabia- 25 July 2013; Accessed September 9, 2014. http://www.who.int/ith/update/20130725/en/
- Transmission of COVID-19 virus by droplets and aerosols: a critical review on the unresolved dichotomy.Environ Res. 2020; 188109819
- Global access to COVID-19 vaccines: a scoping review of factors that may influence equitable access for low and middle-income countries.BMJ Open. 2021; 11e049505
- The Hajj! Communicable and non-communicable health hazards and current guidance for pilgrims.Euro Surveill. 2010; 15: 19671
- Circulation of respiratory viruses among pilgrims during the 2012 Hajj pilgrimage.Clin Infect Dis. 2013; 57: 992-1000
- Hajj-associated viral respiratory infections: a systematic review.Travel Med Infect Dis. 2016; 14: 92-109
- Albar MBacteria and viruses that cause respiratory tract infections during the pilgrimage (Hajj) season in Makkha, Saudi Arabia.Trop. Med Int Health. 1998; 3: 205
- Viral respiratory infections at the Hajj: comparison between UK and Saudi pilgrims.Clin Microbiol Infect. 2008; 14: 569-574
- Influenza and respiratory syncytial virus infections in British Hajj pilgrims.Emerg Health Threats J. 2008; 1: e2
- Tuberculosis is the commonest cause of Pneumonia requiring hospitalization during Hajj.J Infect. 1998; 36: 303-306
- WHO Guidelines for Indoor Air Quality: Dampness and Mould.Copenhagen, Denmark: World Health Organization, 2009 (Accessed November 24, 2021)
- Indoor airborne bacterial communities are influenced by ventilation, occupancy, and outdoor air source.Indoor Air. 2014; 24: 41-48
- Tuberculosis transmission: modelled impact of air-tightness in dwellings in the UK 60–67.in: Indoor Air Conference Proceeding, Hong Kong2014
- Environmental sampling for respiratory pathogens in Jeddah airport during the 2013 Hajj season.Am J Infect Control. 2014; 42: 1266-1269
- Air microbial contamination at the holly mosque, Makkah, Saudi Arabia.Curr World Environ. 2013; 8: 179-187
- MALDI-TOF mass spectrometry and identification of new bacteria species in air samples from Makkah, Saudi Arabia.BMC Res Notes. 2014; 7: 892
- Environmental investigation of respiratory pathogens during the Hajj 2016 and 2018.Travel Med Infect Dis. 2020; 33101500
- Bioaerosol biomonitoring: sampling optimization for molecular microbial ecology.Mol Ecol Res. 2019; 19: 672-690
- Operative and technical modifications to the Coriolis® µ air sampler that improve sample recovery and biosafety during microbiological air sampling. perative and technical modifications to the Coriolis® µ air sampler that improve sample recovery and biosafety during microbiological air sampling.Annals of work exposures and health. 2020; 64: 852-865
- Transmission of respiratory tract infections at mass gathering events.Curr Opin Pulmonary Med. 2020; 26: 197-202
- Multiplication of microorganisms in an evaporative air cooler and possible indoor air contamination.Environ Int. 1990; 16: 203-211
- Tent air flow simulations and computational fluid dynamics analysis of an air cleaner design for Hajj tents: respiratory and critical care medicine.Am J Crit Care Med. 2015; 191: A4667
- Influenza a common viral infection among Hajj pilgrims: time for routine surveillance and vaccination.J Travel Med. 2004; 11: 82-86
- Serotypes of influenza during Hajj season, 1424H (2004).Saudi Epidemiol Bull. 2005; 12: 1-2
- Could influenza transmission be reduced by restricting mass gatherings? Towards an evidence-based policy framework.J Epidemiol Glob Health. 2011; 1: 33-60
- High risk of Mycobacterium tuberculosis infection during the Hajj pilgrimage.Trop Med Int Health. 2005; 10: 336-339
- Al-Tawfiq JAHajj: infectious disease surveillance and control.Lancet. 2014; 383: 2073-2082
Article info
Publication history
Published online: June 01, 2022
Footnotes
Conflicts of interest: None to report.
Identification
Copyright
© 2022 Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.
