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

Hashim A Mahdi; Mohammed Alluhidan; Abdulrahman B Almohammed; Mohammad Alfelali; Ramon Z Shaban; Robert Booy; Harunor Rashid

doi:10.3390/tropicalmed8080418

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

Trop Med Infect Dis. 2023 Aug 17;8(8):418. doi: 10.3390/tropicalmed8080418.

Authors

Hashim A Mahdi^{1

2

3}, Mohammed Alluhidan⁴, Abdulrahman B Almohammed⁵, Mohammad Alfelali⁶, Ramon Z Shaban^{7

8

9

10}, Robert Booy^{1

2

10}, Harunor Rashid^{1

2

10}

Affiliations

¹ National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia.
² The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia.
³ Department of Public Health, College of Health Sciences, Saudi Electronic University, Jeddah 23442, Saudi Arabia.
⁴ General Directorate for National Health Economics and Policy, Saudi Health Council, Riyadh 13315, Saudi Arabia.
⁵ College of Medicine, Imam Muhammad Ibn Saud Islamic University, Riyadh 11564, Saudi Arabia.
⁶ Family and Community Medicine Department, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 25732, Saudi Arabia.
⁷ New South Wales Biocontainment Centre, New South Wales Ministry of Health, Westmead, NSW 2151, Australia.
⁸ Faculty of Medicine and Health Susan Wakil School of Nursing, The University of Sydney, Sydney, NSW 2006, Australia.
⁹ Public Health Unit, Centre for Population Health, Western Sydney Local Health District, North Parramatta, NSW 2151, Australia.
¹⁰ Sydney Infectious Diseases Institute, The University of Sydney, Westmead, NSW 2145, Australia.

Abstract

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.

Keywords: Hajj; airborne infections; high-income countries; low and middle-income countries; pilgrims.

Publication types

Review

Grants and funding

This research received no external funding.