Revue de la littérature : Les maladies infectieuses au cours des grands
Published in Current Infectious disease Reports 2018 20: 44 (IF = 3.828)
Epidémiologie des infections respiratoires et gastro-intestinales chez les pèlerins
Nous avons conduit une étude prospective afin d’évaluer l’épidémiologie des IRs et IGIs chez les pèlerins du Hajj de Marseille, de 2012 à 2018
The average age of pilgrims ranged from 57.3 to 61.7 years, with 81.2% to 93.4% experiencing respiratory symptoms during their stay Molecular biology studies using polymerase chain reaction (PCR) revealed a significant acquisition of respiratory viruses, particularly rhinovirus (27.7%), common coronaviruses (8.3%), and influenza virus (3.7%) Most pilgrims contracted these viruses shortly after arriving in Mecca, with rapid viral clearance observed Despite concerns about a potential measles outbreak, no cases were reported by the Saudi Ministry of Health, likely due to the older age structure of the pilgrims, many of whom are expected to be immunized through natural infection or prior vaccination The most commonly acquired respiratory bacteria included Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, and Klebsiella pneumoniae A specific dynamics of pathogen carriage was noted, with significant increases in rhinovirus and S aureus observed on the 5th and 6th days of the pilgrimage, followed by a gradual decline, while post-Hajj samples showed higher carriage rates than pre-Hajj samples In contrast, H influenzae carriage initially decreased on the 5th, 6th, 12th, and 13th days, then increased in post-Hajj samples, surpassing pre-Hajj levels Additionally, positive associations were found between rhinovirus and S aureus carriage.
Similarly, H influenzae and Moraxella catarrhalis showed significant variations in genotypes acquired during the Hajj compared to those present beforehand A notable biodiversity and absence of clonality of H influenzae were observed among French pilgrims The prevalence of H influenzae before the Hajj varied significantly over the years: 50.0% in 2014, 0.9% in 2015, 2.8% in 2016, 52.8% in 2017, and 35.5% in 2018 Post-Hajj prevalence remained consistently high, ranging from 41.0% to 67.8% These findings raise important questions regarding the potential benefits of vaccination.
Significant associations were observed between the carriage of certain pathogens, the presence of chronic conditions, demographic characteristics of pilgrims, the use of preventive measures, and respiratory symptoms Specifically, having at least one respiratory symptom was two to five times more common among carriers of rhinovirus or those with co-infections of H influenzae and S pneumoniae Coughing was twice as prevalent in pilgrims with chronic respiratory diseases and those carrying H influenzae in combination with K pneumoniae Pilgrims who coughed were also more likely to use disposable tissues Additionally, flu-like syndrome was more frequent among women, pilgrims with chronic respiratory illnesses, and those carrying S aureus or a combination of viruses and bacteria Influenza vaccination was linked to a reduced prevalence of flu-like syndrome However, no significant association was found between symptoms and vaccination against invasive pneumococcal diseases, although this vaccine significantly reduced the carriage of S pneumoniae.
During the pilgrimage, 18.6% of pilgrims experienced at least one gastrointestinal symptom, with diarrhea being the most common at 13.8% Overall, 36.4% of pilgrims acquired at least one enteric pathogen, with pathogenic Escherichia coli (EPEC) at 17.6% and Enteroaggregative E coli (EAEC) at 14.4% being the most frequently acquired pathogens Additionally, infections with Enterohemorrhagic E coli (EHEC), Shigella, and Salmonella were observed, albeit at lower prevalence rates While the acquisition of adenovirus and rotavirus was rare, norovirus was detected in 2.4% of cases Notably, 6.4% of pilgrims acquired more than one enteric pathogen.
9) Aucun échantillon (avant ou après le Hajj) n'était positif pour l'astrovirus, Entamoeba histolytica, Cryptosporidium spp., Campylobacter jejuni (article 9) ou Vibrio spp (article 10)
Female sex was significantly linked to the occurrence of gastrointestinal symptoms The acquisition of E coli O157:H7 (EHEC) was associated with a fourfold increased risk of gastrointestinal symptoms and diarrhea More frequent handwashing was also related to the presence of gastrointestinal symptoms and diarrhea.
Acquisition de virus respiratoires et présence de symptômes respiratoires chez
Acquisition of respiratory viruses and presence of respiratory symptoms in French pilgrims during the 2016 Hajj: A prospective cohort study
Hoang VT, Sow D, Dogue F, Edouard S, Drali T, Yezli S, Alotaibi B, Raoult D, Parola P,
Published in Travel Medicine and Infectious Disease 2019 Jul-Aug;30:32-38 (IF = 4.589)
Contents lists available at ScienceDirect
Travel Medicine and Infectious Disease journal homepage: www.elsevier.com/locate/tmaid
Acquisition of respiratory viruses and presence of respiratory symptoms in
French pilgrims during the 2016 Hajj: A prospective cohort study
Van-Thuan Hoang a,b,1 , Doudou Sow a,c,1 , Fabiola Dogue a , Sophie Edouard d , Tassadit Drali a ,
Saber Yezli e , Badriah Alotaibi e , Didier Raoult d , Philippe Parola a , Vincent Pommier de Santi a,f ,
Philippe Gautret is affiliated with multiple institutions, including Aix Marseille University, IRD, AP-HM, and IHU-Méditerranée Infection in Marseille, France He also collaborates with Thai Binh University of Medicine and Pharmacie in Vietnam, the Service de Parasitologie-Mycologie at Université Cheikh Anta Diop in Dakar, Senegal, and the Global Centre for Mass Gatherings Medicine under the Ministry of Health in Riyadh, Saudi Arabia Additionally, he is connected to the French Military Center for Epidemiology and Public Health in Marseille, France.
Viral respiratory tract infections are common among Hajj pilgrims, raising questions about the role of viruses in the symptoms experienced by sick individuals It remains unclear whether these viruses are the direct cause of illness or if they merely colonize both symptomatic and asymptomatic pilgrims.
In 2016, a prospective cohort study was carried out among French pilgrims participating in Hajj The study involved medical follow-ups and systematic nasal swabbing both before and after the pilgrimage Additional samples were collected from ill pilgrims at the onset of symptoms, with viruses identified using the BioFire FilmArray® Respiratory multiplex qualitative PCR panel.
A study involving 109 pilgrims found that 83.5% experienced respiratory symptoms during Hajj, with 39.5% still symptomatic upon their return Testing revealed that 5.5% of pre-Hajj samples, 95.2% of samples at symptom onset, and 46.5% of post-Hajj samples were positive for respiratory viruses (p < 0.0001) The acquisition rates for rhinovirus/enterovirus, coronavirus 229E, and influenza A virus were 38.6%, 19.8%, and 2.0%, respectively Despite clearance rates of 70.6% for rhinovirus/enterovirus, 71.4% for coronavirus 229E, and 100% for influenza A upon return, the overall virus carriage was 75.0% in pilgrims with influenza-like illness and 44.0% in those without symptoms, indicating a significant association (OR = 4.05, 95% CI [1.02–16.02]).
Viruses are likely involved in the development of respiratory tract infections during the Hajj pilgrimage Utilizing point-of-care rapid multiplex PCR assays can significantly enhance diagnosis when administered at the onset of respiratory symptoms or shortly thereafter.
The Hajj pilgrimage is linked to the increased transmission of infectious diseases, with historical epidemics of cholera and bacterial meningitis highlighting the risk of international spread among pilgrims from over 180 countries Recently, respiratory infections have garnered attention due to the prevalence of symptoms reported by pilgrims seeking medical care in Saudi Arabia Studies indicate that many pilgrims experience respiratory issues during their visit, and PCR tests have shown the acquisition of respiratory viruses among participants While SARS-CoV and MERS-CoV have not impacted pilgrims, other viruses like rhinovirus and influenza have been frequently detected in both symptomatic and asymptomatic individuals returning from Hajj The lack of comprehensive clinical data in many studies complicates the understanding of these health risks.
Received 20 December 2018; Received in revised form 2 March 2019; Accepted 5 March 2019
∗ Corresponding author VITROME, Institut Hospitalo-Universitaire Méditerranée Infection, 19-21 Boulevard Jean Moulin 13385 Marseille Cedex 05, France.
E-mail address: philippe.gautret@ap-hm.fr (P Gautret).
1477-8939/ © 2019 Elsevier Ltd All rights reserved.
T sensitivity of PCR tools, the contribution of viruses to observed symp- toms remains unknown.
This study aimed to assess the nasal carriage of respiratory viruses among French Hajj pilgrims from Marseille before and after their pilgrimage Additionally, it sought to explore the potential correlation between viral carriage and respiratory symptoms through meticulous clinical monitoring.
Fig 1 details the procedure of this study The study was conducted among French Hajj pilgrims traveling together to Mecca, from August
27th to September 20th, 2016, with one specialized travel agency in
In a study conducted in Marseille, voluntary participants over the age of 18 signed consent forms and completed a standardized pre-travel questionnaire covering demographics, chronic diseases, and vaccination status A medical doctor accompanied the group to document health issues, with respiratory tract infections (RTIs) identified by symptoms such as cough, rhinitis, or sore throat Influenza-like illness (ILI) was defined as the combination of cough, sore throat, and fever Participants were categorized as asymptomatic if they did not exhibit any respiratory symptoms throughout their stay in Saudi Arabia.
During travel in Arabia, travelers may experience different types of respiratory tract infections (RTIs) These include resolved RTIs, where individuals had symptoms like cough, sore throat, rhinitis, or voice failure but recovered by the time they returned to France Additionally, some travelers may experience ongoing RTIs, characterized by persistent respiratory symptoms at the time of their departure from Saudi Arabia.
The protocol was approved by our Institutional Review Board (July
23, 2013; reference No 2013-A00961-44) It was performed in ac- cordance with the good clinical practices recommended by the Declaration of Helsinki and its amendments All participants gave a written informed consent.
The study involved systematic nasal swab collections from participants 10 days prior to their departure from France and 1 day before leaving the Kingdom of Saudi Arabia on September 19, 2016 Previous research demonstrated that nasal swabs are more effective than pharyngeal swabs in detecting respiratory viruses among Hajj pilgrims, utilizing real-time reverse transcriptase-polymerase chain reaction methods Additionally, nasal swabs were conducted on symptomatic pilgrims who sought medical consultation at the onset of their symptoms.
No pre-Hajj samples were taken from asymptomatic pilgrims Samples were collected with commercial rigid cotton-tipped swabs (Medical Wire & Equipment, Wiltshire, UK), which were inserted into the anterior nasal cavity and subsequently placed in viral transport media.
Fig 1 Flow diagram of study participants.
(Sigma Virocult ® ) This standardized procedure was previously ex- plained to the pilgrims by the investigators The swabs were stored at
Samples were collected and stored at 20 °C before being transported to the Marseille laboratory They were then frozen at −80 °C within 48 hours of collection for both pre- and post-Hajj analysis Pre-Hajj specimens were maintained at 20 °C until their return.
The analyses were conducted in Marseille after returning from Saudi Arabia, as results were not available during the stay A validated multiplex qualitative PCR method was utilized, specifically the BioFire respiratory panel (BFRP), which targets various viruses including rhinovirus/enterovirus, adenovirus, and multiple strains of human coronavirus (229E, HKU1, NL63).
The study focuses on various respiratory pathogens, including OC43, human metapneumovirus, influenza viruses A and B, parainfluenza viruses (1-4), and respiratory syncytial virus It also targets three specific bacteria: Bordetella pertussis, Chlamydia pneumoniae, and Mycoplasma pneumoniae Pathogen acquisition was determined by the absence of a pathogen in samples collected before Hajj and its presence in samples taken during or after the Hajj pilgrimage.
The Pearson's Chi-square test and Fisher's exact test were utilized to analyze categorical variables in the study To assess the potential acquisition of respiratory viruses in Saudi Arabia, we conducted a thorough evaluation using these statistical methods.
Dynamique et interactions du portage des agents pathogènes respiratoires
The dynamics and interactions of respiratory pathogen carriage among French pilgrims during the 2018 Hajj
Hoang VT, Dao TL, Ly TDA, Belhouchat K, Chaht KL, Gaudart J, Mrenda BM, Drali T,
Yezli S, Alotaibi B, Fournier PE, Raoult D, Parola P, Pommier de Santi V, Gautret P Published in Emerging Microbes & Infections 2019;8(1):1701-1710 (IF = 5.776)
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The dynamics and interactions of respiratory pathogen carriage among French pilgrims during the 2018 Hajj
Van-Thuan Hoang , Thi-Loi Dao , Tran Duc Anh Ly , Khadidja Belhouchat ,
Kamel Larbi Chaht , Jean Gaudart , Bakridine Mmadi Mrenda , Tassadit
Drali , Saber Yezli , Badriah Alotaibi , Pierre-Edouard Fournier , Didier
Raoult , Philippe Parola , Vincent Pommier de Santi & Philippe Gautret
To cite this article: Van-Thuan Hoang , Thi-Loi Dao , Tran Duc Anh Ly , Khadidja Belhouchat ,
Kamel Larbi Chaht , Jean Gaudart , Bakridine Mmadi Mrenda , Tassadit Drali , Saber Yezli ,
Badriah Alotaibi , Pierre-Edouard Fournier , Didier Raoult , Philippe Parola , Vincent Pommier de
Santi & Philippe Gautret (2019) The dynamics and interactions of respiratory pathogen carriage among French pilgrims during the 2018 Hajj, Emerging Microbes & Infections, 8:1, 1701-1710, DOI: 10.1080/22221751.2019.1693247
To link to this article: https://doi.org/10.1080/22221751.2019.1693247 © 2019 The Author(s) Published by Informa
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The dynamics and interactions of respiratory pathogen carriage among French pilgrims during the 2018 Hajj
Van-Thuan Hoang a,b,c , Thi-Loi Dao a,b,c , Tran Duc Anh Ly a,b , Khadidja Belhouchat a,b , Kamel Larbi Chaht a,b , Jean Gaudart d,e , Bakridine Mmadi Mrenda h , Tassadit Drali a,b , Saber Yezli f , Badriah Alotaibi f ,
Pierre-Edouard Fournier, Didier Raoult, Philippe Parola, Vincent Pommier de Santi, and Philippe Gautret are affiliated with various institutions in France, including Aix Marseille University, IHU-Méditerranée Infection, and La Timone Hospital, as well as Thai Binh University of Medicine and Pharmacy in Vietnam and the Global Centre for Mass Gatherings Medicine in Saudi Arabia Their collaborative research focuses on infectious diseases and epidemiology, contributing valuable insights to public health.
This study aimed to investigate the dynamics of respiratory pathogen acquisition and associated risk factors for lower respiratory tract infection symptoms (LRTI) among French pilgrims during the 2018 Hajj A total of 121 participants underwent four systematic nasopharyngeal swabs before and during their stay in Saudi Arabia, with respiratory pathogens assessed through PCR testing Notably, 93.4% of the pilgrims reported experiencing respiratory symptoms throughout the study, highlighting the prevalence of infections such as rhinovirus and coronaviruses in this population.
Upon arrival in Saudi Arabia, Staphylococcus aureus was prevalent, with a gradual decline in rates observed by days 5 and 6 Conversely, the carriage rates of Streptococcus pneumoniae and Klebsiella pneumoniae showed a steady increase throughout the duration of the stay Additionally, Haemophilus influenzae and Moraxella catarrhalis began to rise in prevalence starting around day 12.
Our study found a significant interplay between various respiratory pathogens during the Hajj, highlighting that the dual carriage of H influenzae and M catarrhalis is strongly linked to S pneumoniae (OR = 6.22) Additionally, we observed a positive mutual association between S aureus and rhinovirus, as well as a negative correlation between M catarrhalis and K pneumoniae Chronic respiratory diseases were found to correlate with lower respiratory tract infection (LRTI) symptoms, particularly in cases of K pneumoniae, M catarrhalis-S aureus, and H influenzae-rhinovirus co-infections Overall, these findings suggest that respiratory tract infections during the Hajj are influenced by complex interactions among multiple viruses and bacteria.
ARTICLE HISTORY Received 5 October 2019; Revised 7 November 2019; Accepted 8 November 2019
KEYWORDS Hajj; pilgrims; respiratory tract infections; pathogen interaction
Each year, an increasing number of people travel to the
The Kingdom of Saudi Arabia (KSA) hosts the Hajj and Umrah pilgrimages, attracting approximately 10 million pilgrims annually from over 180 countries In 2017, more than two million international pilgrims participated in Hajj, with around 2,000 coming from Marseille, France This significant influx of visitors presents substantial public health challenges, particularly concerning the transmission of infectious diseases, especially respiratory infections.
Respiratory tract infections (RTIs) are prevalent among pilgrims due to crowded conditions, as highlighted in a recent study on morbidity and mortality among Indian Hajj pilgrims This research found that infectious diseases accounted for 53% of outpatient diagnoses, with RTIs and gastroenteritis being the most frequently reported illnesses.
During the Hajj, a significant percentage of French pilgrims, specifically 69.8% and 86.8%, experienced respiratory tract infection (RTI) symptoms A recent literature review highlighted the complex etiology of RTIs at this event, with multiple studies indicating a notable acquisition of respiratory pathogens among both symptomatic and asymptomatic pilgrims A systematic review conducted by Al-Tawfiq et al identified human rhinovirus (HRV) and influenza viruses as the most prevalent viral respiratory pathogens among ill Hajj pilgrims, while human non-MERS coronaviruses (HCoV) were also frequently associated with RTIs during the pilgrimage.
[7] On the other hand, Streptococcus pneumoniae , Hae- mophilus influenzae and Staphylococcus aureus were shown to be the most commonly acquired respiratory bacteria at the Hajj [5].
Respiratory tract infections (RTIs) arise from the complex interactions of various upper respiratory tract viruses These interactions can be both antagonistic and synergistic, influencing the severity and progression of the infections Understanding these dynamics is crucial for effective prevention and treatment strategies.
This Open Access article is available under the Creative Commons Attribution License, allowing unrestricted use, distribution, and reproduction in any medium, as long as the original work is properly cited.
CONTACT Philippe Gautret philippe.gautret@club-internet.fr VITROME, Institut Hospitalo-Universitaire Méditerranée Infection, 19-21 Boulevard Jean Moulin 13385 Marseille Cedex 05, France
Pathogens, often examined in isolation, frequently coexist or compete with various microbial species in their natural environments Infection diagnoses typically rely on the assumption of a single causative agent; however, this perspective overlooks the complex interactions among different infectious microorganisms that inhabit the same ecological niche, leading to the prevalence of mixed infections.
Understanding the polymicrobial interactions in the nasopharynx of Hajj pilgrims is crucial due to the frequent co-carriage of multiple pathogens, regardless of the presence of respiratory symptoms.
Colonization is the first step in the disease process, with nasopharyngeal colonization serving as a reservoir for respiratory pathogens that can facilitate transmission among pilgrims during the Hajj The use of antibiotics or vaccines targeting specific pathogens may disrupt polymicrobial interactions in the nasopharynx, leading to unexpected outcomes To date, the dynamics and interactions of major respiratory pathogens acquired during the Hajj have not been thoroughly investigated, and risk factors for lower respiratory tract infection symptoms during the pilgrimage remain unexplored.
In our 2018 study of French pilgrims participating in the Hajj, we aimed to examine the dynamics of respiratory pathogen acquisition and their potential interactions We also explored risk factors associated with possible lower respiratory tract infection (LRTI) symptoms.
Participants and study design (Figure 1)
Pilgrims travelling to Mecca, Saudi Arabia during the
In 2018, pilgrims from Marseille, France, participated in Hajj organized by a specialized travel agency, with two bilingual medical doctors overseeing their health Prior to departure, participants completed a standardized questionnaire detailing their demographics, medical history, and immunization status, including influenza and pneumococcal vaccinations A follow-up questionnaire was administered two days before their return to France, gathering data on clinical symptoms, antibiotic use, and adherence to health precautions like mask-wearing and hand hygiene To monitor respiratory pathogens, pilgrims underwent four nasopharyngeal swabs at various intervals: pre-travel, five to six days after arrival, twelve to thirteen days post-arrival, and just before leaving Saudi Arabia The Hajj rituals occurred from August 19 to 24, with influenza-like illness (ILI) defined by the presence of cough, sore throat, and subjective fever, while lower respiratory tract infection (LRTI) was characterized by specific respiratory symptoms Additionally, body mass index (BMI) classifications were utilized to assess participants' weight status, ranging from underweight to obese.
Nasopharyngeal swabs were collected from each pilgrim and placed in Sigma-Virocult® medium, then stored at -80°C for later analysis The sampling procedure was standardized and performed by accompanying doctors, involving a depth of 3 cm in the nostril with five rotations, followed by five streaks on the posterior wall of the pharynx.
Identi fi cation of respiratory pathogens