title: Impact of the Hajj on pneumococcal transmission.
abstract: Over two million Muslim pilgrims assemble annually in Mecca and Medina, Saudi Arabia, to complete the Hajj. The large number of people in a crowded environment increases the potential for pneumococcal carriage amplification. We evaluated pneumococcal carriage prevalence with four cross-sectional studies conducted at beginning-Hajj (Mecca) and end-Hajj (Mina) during 2011 and 2012. A questionnaire was administered and a nasopharyngeal swab was collected. The swab was tested for pneumococcus, serotype and antibiotic resistance. A total of 3203 subjects (1590 at beginning-Hajj and 1613 at end-Hajj) originating from 18 countries in Africa or Asia were enrolled. The overall pneumococcal carriage prevalence was 6.0%. There was an increase in carriage between beginning-Hajj and end-Hajj cohorts for: overall carriage (4.4% versus 7.5%, prevalence ratio (PR) 1.7, 95% CI 1.3-2.3), and carriage of 23-valent pneumococcal polysaccharide vaccine serotypes (2.3% versus 4.1%, PR 1.8, 95% CI 1.2-2.7), 13-valent pneumococcal conjugate vaccine (PCV) serotypes (1.1% versus 3.6%, PR 3.2, 95% CI 1.9-5.6), 10-valent PCV serotypes (0.6% versus 1.6%, PR 2.6, 95% CI 1.2-5.3), antibiotic non-susceptible isolates (2.5% versus 6.1%, PR 2.5, 95% CI 1.7-3.6) and multiple non-susceptible isolates (0.6% versus 2.2%, PR 3.8, 95% CI 1.8-7.9). Fifty-two different serotypes were identified, most commonly serotypes 3 (17%), 19F (5%) and 34 (5%). These results suggest that the Hajj may increase pneumococcal carriage-particularly conjugate vaccine serotypes and antibiotic non-susceptible strains, although the exact mechanism remains unknown. The Hajj may therefore provide a mechanism for the global distribution of pneumococci.
authors: Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh Saudi Arabia; College of Medicine, Al Faisal University, Riyadh, Kingdom of Saudi Arabia. Electronic address: zmemish@yahoo.com.
authors: Z A
authors: ZA
authors: Memish
authors: Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh Saudi Arabia.
authors: A
authors: A
authors: Assiri
authors: Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh Saudi Arabia.
authors: M
authors: M
authors: Almasri
authors: Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh Saudi Arabia.
authors: R F
authors: RF
authors: Alhakeem
authors: Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh Saudi Arabia.
authors: A
authors: A
authors: Turkestani
authors: Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh Saudi Arabia.
authors: A A
authors: AA
authors: Al Rabeeah
authors: Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh Saudi Arabia.
authors: N
authors: N
authors: Akkad
authors: Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh Saudi Arabia.
authors: S
authors: S
authors: Yezli
authors: Department of Global Health, Emory University, Atlanta, GA USA.
authors: K P
authors: KP
authors: Klugman
authors: International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: K L
authors: KL
authors: O'Brien
authors: German National Reference Center for Streptococci, University Hospital RWTH Aachen, Germany.
authors: M
authors: M
authors: van der Linden
authors: Agence de Medecine Preventive, Paris, France.
authors: B D
authors: BD
authors: Gessner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission; D003430:Cross-Sectional Studies; D003441:Crowding; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007514:Islam; D008297:Male; D008875:Middle Aged; D009305:Nasopharynx / Q000382:microbiology; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission; D012307:Risk Factors; D012529:Saudi Arabia / Q000453:epidemiology; D013296:Streptococcus pneumoniae / Q000145:classification / Q000187:drug effects; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic resistance; Hajj; Streptococcus pneumoniae; carriage; pneumococcus