title: Tuberculosis and mass gatherings-opportunities for defining burden, transmission risk, and the optimal surveillance, prevention, and control measures at the annual Hajj pilgrimage.
abstract: Tuberculosis (TB) is now the most common infectious cause of death worldwide. In 2014, an estimated 9.6 million people developed active TB. There were an estimated three million people with active TB including 360000 with multidrug-resistant TB (MDR-TB) who were not diagnosed, and such people continue to fuel TB transmission in the community. Accurate data on the actual burden of TB and the transmission risk associated with mass gatherings are scarce and unreliable due to the small numbers studied and methodological issues. Every year, an estimated 10 million pilgrims from 184 countries travel to the Kingdom of Saudi Arabia (KSA) to perform the Hajj and Umrah pilgrimages. A large majority of pilgrims come from high TB burden and MDR-TB endemic areas and thus many may have undiagnosed active TB, sub-clinical TB, and latent TB infection. The Hajj pilgrimage provides unique opportunities for the KSA and the 184 countries from which pilgrims originate, to conduct high quality priority research studies on TB under the remit of the Global Centre for Mass Gatherings Medicine. Research opportunities are discussed, including those related to the definition of the TB burden, transmission risk, and the optimal surveillance, prevention, and control measures at the annual Hajj pilgrimage. The associated data are required to develop international recommendations and guidelines for TB management and control at mass gathering events.
authors.affiliation: Division of Infection and Immunity, University College London, and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK; Global Centre for Mass Gatherings, Ministry of Health, Riyadh, Saudi Arabia; Global Health Department, Public Health England, London, UK; University of Zambia-University College London Medical School Research and Training Project University Teaching Hospital, Lusaka, Zambia; Special Infectious Agents Unit, King Fahd Medical Research Centre, and Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, King Abdul Aziz University, Jeddah, Saudi Arabia.
authors.forename: Alimuddin
authors.initials: A
authors.lastname: Zumla
authors.affiliation: Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Global Centre for Mass Gatherings, Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Abdulaziz Bin
authors.initials: AB
authors.lastname: Saeed
authors.affiliation: Global Centre for Mass Gatherings, Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Badriah
authors.initials: B
authors.lastname: Alotaibi
authors.affiliation: Global Centre for Mass Gatherings, Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Saber
authors.initials: S
authors.lastname: Yezli
authors.affiliation: Global Health Department, Public Health England, London, UK.
authors.forename: Osman
authors.initials: O
authors.lastname: Dar
authors.affiliation: Global Centre for Mass Gatherings, Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Kingsley
authors.initials: K
authors.lastname: Bieh
authors.affiliation: Division of Infection and Immunity, University College London, and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK; University of Zambia-University College London Medical School Research and Training Project University Teaching Hospital, Lusaka, Zambia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bates
authors.affiliation: Global Centre for Mass Gatherings, Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Tamara
authors.initials: T
authors.lastname: Tayeb
authors.affiliation: University of Zambia-University College London Medical School Research and Training Project University Teaching Hospital, Lusaka, Zambia.
authors.forename: Peter
authors.initials: P
authors.lastname: Mwaba
authors.affiliation: Global Centre for Mass Gatherings, Ministry of Health, Riyadh, Saudi Arabia; Muslim Council of Great Britain, London, UK.
authors.forename: Shuja
authors.initials: S
authors.lastname: Shafi
authors.affiliation: Global Centre for Mass Gatherings, Ministry of Health, Riyadh, Saudi Arabia; Global Health Department, Public Health England, London, UK.
authors.forename: Brian
authors.initials: B
authors.lastname: McCloskey
authors.affiliation: Global Centre for Mass Gatherings, Ministry of Health, Riyadh, Saudi Arabia; The Royal Hospital, Muscat, Oman; Aarhus University, Aarhus, Denmark.
authors.forename: Eskild
authors.initials: E
authors.lastname: Petersen
authors.affiliation: Global Centre for Mass Gatherings, Ministry of Health, Riyadh, Saudi Arabia; Special Infectious Agents Unit, King Fahd Medical Research Centre, and Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, King Abdul Aziz University, Jeddah, Saudi Arabia. Electronic address: eazhar@kau.edu.sa.
authors.forename: Esam I
authors.initials: EI
authors.lastname: Azhar
mesh_terms: D003441:Crowding; D062665:Epidemiological Monitoring; D005260:Female; D006693:Holidays; D006801:Humans; D007514:Islam; D008297:Male; D012307:Risk Factors; D012529:Saudi Arabia / Q000453:epidemiology; D014195:Travel; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D018088:Tuberculosis, Multidrug-Resistant
keywords: Hajj; Mass gatherings; Transmission; Tuberculosis