Acute respiratory tract infection symptoms and the uptake of dual influenza and pneumococcal vaccines among Hajj pilgrims

Background: Hajj pilgrims are encouraged to take influenza and pneumococcal vaccines prior to their travelto safeguard against acute respiratory tract infections (ARTIs). It is unclear whether dual immunisationwith influenza and pneumococcal vaccines have had any impact on ARTI symptoms. To this end, we haveexamined the data of the last several years to assess whether combined influenza and pneumococcalvaccination has affected the rate of ARTI symptoms among Hajj pilgrims.Materials and methods: Hajj pilgrims from United Kingdom, Australia, Saudi Arabia and Qatar who attendedthe congregation between 2005 and 2015 were included in this study. Data from surveillance studiesor clinical trials involving Hajj pilgrims were used. In this analysis we have made use of the raw data toconstruct a trend line graph with the prevalence of combined cough and fever (as a proxy for ARTI) againstthe uptake of combined influenza and pneumococcal vaccines, and to estimate the relative risk (RR) ofARTI with 95% confidence interval (95% CI).Results: Data of a pooled sample of 9350 pilgrims, aged 0.5–90 years with a male to female ratio of 1.1, wereanalysed. Although vaccination uptake did not rise significantly over the years, there was also no observed meaningfulbenefit of combined vaccination (RR = 1.1; 95% CI 0.8–1.4), the rates of ARTI symptoms demonstrateda decline over the last several years. The findings of this analysis highlight that the prevalence of ‘cough and fever’among Hajj pilgrims is on decline but the uptake of combined influenza and pneumococcal vaccines remainsunchanged over years, and the decline can not be attributed to dual influenza and pneumococcal vaccination.Conclusions: Acute respiratory tract infections among Hajj pilgrims are decreasing, it is unclear if thereduction is due to vaccine uptake, but the data and analysis have some limitations

Effect of the COVID-19 Vaccine on the Menstrual Cycle among Females in Saudi Arabia

BACKGROUND: The number of reports of menstrual changes after COVID-19 vaccination in the Saudi population is still unknown. Therefore, this study aimed to assess the effect of the COVID-19 vaccine(Pfizer, AstraZeneca, and Moderna) on the menstrual cycle among females in Saudi Arabia. METHODS: This descriptive cross-sectional study was conducted in Saudi Arabia at Umm Al-Qura University (UQU) from August 2021 to February 2022. Data was collected through a previously validated online questionnaire. RESULTS: A total of 2338 participants who received the first dose of the COVID-19 vaccine participated in this study; 1606 (68.7%) of them received the second dose in addition to the first. The mean age of the study participants was 35.4±9.5 years. No significant associations were found between the type of COVID-19 vaccine and the impact on the menstrual cycle, either for the first or second dose (P-values > 0.05). A significant association was found only between the first dose vaccination day and the impact on the menstrual cycle in the second question of “After receiving the COVID-19 vaccine, your next period was” (P-value ≤ 0.05). Significant associations were found between the second dose vaccination day and the impact on the menstrual cycle in the first and second questions of “After receiving the COVID-19 vaccine, your next period was”, and “After receiving the first dose, your next period was," respectively (P-values ≤ 0.05). CONCLUSION: The study found a potential association between the COVID-19 vaccine and menstrual cycle irregularities, which could impact females' quality of life

Evaluating the effectiveness of influenza vaccine among Hajj pilgrims

Hajj pilgrimage is one of the largest annual mass gathering events in the world. Respiratory tract infections, particularly due to viruses such as influenza, are considered as the commonest medical presentations at Hajj. To prevent the occurrence and transmission of respiratory viral infections, including influenza, during Hajj, several preventive measures such as influenza vaccination have been recommended for Hajj pilgrims. However, the available data on influenza vaccine effectiveness (VE) among Hajj pilgrims are derived from sporadic and small studies and the outcome is inconclusive. Therefore, this PhD thesis aimed to assess influenza vaccination rate among Hajj pilgrims and its role in preventing respiratory infections including influenza during Hajj. At the beginning, we evaluated the uptake of influenza vaccine among domestic pilgrims and explored pilgrims’ attitude towards influenza vaccination in recent Hajj seasons. With the observed increase in the vaccine uptake, it was unclear whether such an increase is associated with a decline in the burden of influenza at Hajj or not. Therefore, a retrospective analysis of raw and published data has been performed to examine the association between the vaccine uptake and the prevalence of influenza-like illness and laboratory-proven influenza during Hajj. After that, a retrospective analysis of data from individual Hajj studies across several years was undertaken by using ‘test-negative’ design to estimate the VE of trivalent influenza vaccine at Hajj. To explore possible explanations for the finding of VE in Hajj pilgrims, data on antigenic characteristics of the viruses were collated for both hemispheres and compared to the vaccine strains. Moreover, we collaborated with molecular biologists to perform phylogenetic analysis and characterization of influenza viruses at Hajj

Infectious causes of sudden infant death syndrome

Investigators have long suspected the role of infection in sudden infant death syndrome (SIDS). Evidence of infectious associations with SIDS is accentuated through the presence of markers of infection and inflammation on autopsy of SIDS infants and isolates of some bacteria and viruses. Several observational studies have looked into the relation between seasonality and incidence of SIDS, which often showed a winter peak. These all may suggest an infectious aetiology of SIDS. In this review we have summarised the current literature on infectious aetiologies of SIDS by looking at viral, bacterial, genetic and environmental factors which are believed to be associated with SIDS

Pandemic Viruses at Hajj: Influenza and COVID-19

Hajj is the largest annual mass gathering event on the planet and usually attracts two to three million people from all over the world and is one of the most significant events in the life of a practicing Muslim. Viruses that may cause pandemic outbursts, such as influenza and COVID-19, are important public health threats at Hajj. Influenza, both seasonal and pandemic, has been reported at Hajj at variable frequencies. Preventive measures including vaccination and hand hygiene are known to be beneficial. The vaccination uptake is still suboptimal but improving, and time is ripe to consider using quadrivalent influenza vaccine that provides protection against both lineages of influenza B. In response to COVID-19, Hajj pilgrimage was essentially cancelled in 2020, downscaling to just a few thousand local pilgrims who were required to comply with strict preventive measures including maintaining optimum physical distance from fellow pilgrims, and no case of Hajj-associated COVID-19 has been reported. To combat COVID-19 in the coming years, all evidence-based preventive measures, including hand hygiene and use of personal protective equipment, should be considered for Hajj pilgrims in addition to limiting the number of attendees. The recently approved and rolled out COVID-19 vaccines would be important preventive measures for prospective Hajj pilgrims

Mismatching between circulating strains and vaccine strains of influenza: effect on Hajj pilgrims from both hemispheres

The trivalent seasonal influenza vaccine is expected to provide optimum protection if the vaccine strains match the circulating strains. The effect of worldwide mismatch between the vaccine strains and extant strains on travelers attending Hajj pilgrimage is not known. Annually 2-3 million Muslims coming from north and south hemispheres congregate at Hajj in Mecca, Saudi Arabia, where intense congestion amplifies the risk of respiratory infection up to eight fold. In order to estimate, to what extent mismatching increases the risk of vaccine failure in Hajj pilgrims, we have examined the global data on influenza epidemiology since 2003, in light of the available data from Hajj. These data demonstrate that globally mismatching between circulating and vaccine strains has occurred frequently over the last 12\ua0years, and the mismatch seems to have affected the Hajj pilgrims, however, influenza virus characteristics were studied only in a limited number of Hajj seasons. When the vaccines are different, dual vaccination of travelers by vaccines for southern and northern hemispheres should be considered for Hajj pilgrims whenever logistically feasible. Consideration should also be given to the use of vaccines with broader coverage, i.e., quadrivalent, or higher immunogenicity. Continuous surveillance of influenza at Hajj is important

Acute respiratory tract infection symptoms and the uptake of dual influenza and pneumococcal vaccines among Hajj pilgrims

Background: Hajj pilgrims are encouraged to take influenza and pneumococcal vaccines prior to their travel to safeguard against acute respiratory tract infections (ARTIs). It is unclear whether dual immunisation with influenza and pneumococcal vaccines have had any impact on ARTI symptoms. To this end, we have examined the data of the last several years to assess whether combined influenza and pneumococcal vaccination has affected the rate of ART/symptoms among Hall pilgrims.Materials and methods: Hall pilgrims from United Kingdom, Australia, Saudi Arabia and Qatar who attended the congregation between 2005 and 2015 were included in this study. Data from surveillance studies or clinical trials involving Hall pilgrims were used. In this analysis we have made use of the raw data to construct a trend line graph with the prevalence of combined cough and fever (as a proxy for ARTI) against the uptake of combined influenza and pneumococcal vaccines, and to estimate the relative risk (RR) of ARTI with 95% confidence interval (95% CI).Results: Data of a pooled sample of 9350 pilgrims, aged 0.5-90 years with a male to female ratio of 1.1, were analysed. Although vaccination uptake did not rise significantly over the years, there was also no observed meaningful benefit of combined vaccination (RR = 1.1; 95% CI 0.8-1.4), the rates of ARTI symptoms demonstrated a decline over the last sever-alyeats. The findings of this analysis highlight that the prevalence of 'cough and fever' among Hajj pilgrims is on decline but the uptake of combined influenza and pneumococcal vaccines remains unchanged over years, and the decline can not be attributed to dual influenza and pneumococcal vaccination.Conclusions: Acute respiratory tract infections among Hajj pilgrims are decreasing, it is unclear if the reduction is due to vaccine uptake, but the data and analysis have some limitations

Uptake and effectiveness of facemask against respiratory infections at mass gatherings: a systematic review

Objectives: The risk of acquisition and transmission of respiratory infections is high among attendees of mass gatherings (MGs). Currently used interventions have limitations yet the role of facemask in preventing those infections at MG has not been systematically reviewed. We have conducted a systematic review to synthesise evidence about the uptake and effectiveness of facemask against respiratory infections in MGs. Methods: A comprehensive literature search was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines using major electronic databases such as, Medline, EMBASE, SCOPUS and CINAHL. Results: Of 25 studies included, the pooled sample size was 12710 participants from 55 countries aged 11 to 89 years, 37% were female. The overall uptake of facemask ranged from 0.02% to 92.8% with an average of about 50%. Only 13 studies examined the effectiveness of facemask, and their pooled estimate revealed significant protectiveness against respiratory infections (relative risk [RR] = 0.89, 95% CI: 0.84-0.94, p < 0.01), but the study end points varied widely. Conclusion: A modest proportion of attendees of MGs use facemask, the practice is more widespread among health care workers. Facemask use seems to be beneficial against certain respiratory infections at MGs but its effectiveness against specific infection remains unproven

Epidemiological Differences in Hajj-Acquired Airborne Infections in Pilgrims Arriving from Low and Middle-Income versus High-Income Countries: A Systematised Review

This systematised review aims to compare the epidemiological patterns of Hajj-acquired airborne infections among pilgrims from low and middle-income countries (LMIC) versus those from high-income countries (HIC). A PubMed search was carried out for all published articles before February 2023, using a combination of MeSH terms and text words. The Newcastle–Ottawa Scale (NOS) was used to assess data quality. From a total of 453 titles identified, 58 studies were included in the review (LMIC = 32, and HIC = 26). In the pooled sample, there were 27,799 pilgrims aged 2 days to 105 years (male: female = 1.3:1) from LMIC and 70,865 pilgrims aged 2 months to 95 years (male: female = 1:1) from HIC. Pilgrims from both HIC and LMIC had viral and bacterial infections, but pilgrims from HIC tended to have higher attack rates of viral infections than their LMIC counterparts. However, the attack rates of bacterial infections were variable: for instance, pilgrims from LMIC seemed to have higher rates of meningococcal infections (0.015–82% in LMIC vs. 0.002–40% in HIC) based on the study population, but not Mycobacterium tuberculosis (0.7–20.3% in LMIC vs. 38% in HIC). Targeted measures are needed to prevent the spread of airborne infections at Hajj

Hand Hygiene Knowledge, Perception, and Practices among Domestic Visitors to the Prophet's Mosque in Al Madinah City Amid the COVID-19 Pandemic: A Cross-Sectional Study.

This study aimed to assess hand hygiene knowledge, perception, and practices of visitors to the Prophet's Mosque in Al Madinah City, Saudi Arabia. Using a self-administered electronic questionnaire, a cross-sectional survey was conducted among domestic r