Hajj is one of the largest annual mass gathering events on the world. Around 3 million Muslims from over 140 countries perform the hajj each year in a small specific area (Makkah). Overcrowding and frequent close contacts with other pilgrims greatly increase the risk of spread of respiratory diseases. As a result acute respiratory infections (ARI) have been the most common cause of illnesses among pilgrims.
Methodology
A prospective cohort study was conducted to assess the incidence of Acute Respiratory Infection among hajjis from Riyadh city performing hajj in the year 1434H and to identify the associated risk factors. A structured questionnaire was designed to collect data from the participating hajjis. First part covered question about identification data, current ARI status, vaccination status and chronic disease status of pilgrims and was to be filled by hajjis before leaving for hajj. Second part covered question about development of ARI during or after hajj, hajjis experience about use of face mask and exposure to crowdedness etc. to be filled after hajj by telephonic interview with hajjis.
Results
Out of 1073 persons recruited in the study, 1036 performed the hajj. 53.4% of hajjis were male and 72.8% were Saudi nationals. The mean age of hajjis was 32.6 years [(SD) 10.8 years]. 57.3% of hajjis had received university education and above. Among the total 84.2% of hajjis received Meningitis Vaccine and only 21.9% of them received Influenza Vaccine. Out of 1036 hajjis, 531 (51.3%) suffered from an ARI attack during the hajj and within 2 weeks of the end of hajj. Whereas ARI attack was defined as one of the constitutional symptoms (fever, headache, body ache) along with at least one of the local symptoms (running nose, sneezing, throat pain, cough with /without sputum, nasal blockage and difficulty in breathing) that developed after reaching to Makkah. The date of onset of illness ranged from 8 Dhul al-Hijja to 25 Dhul al-Hijja. (58.6%) of cases suffered from throat pain and (55.8%) of them suffered from running nose while (23.2%) of them had fever.
The incidence of ARI was higher in females (53.5%) and Saudi nationals (52.7%). Also, younger hajjis (< 25 years) increased the risk of ARI 1.41 times than other age groups. The risk of ARI among hajjis with different educational status, the highest risk for high-school education (53.5%) and the lowest risk was for university education (49.8%).
The hajjis who used a facemask most of time during hajj, fewer (45.9%) compared with hajjis who sometimes used it (51.3%), or never (52.9%). After stratified data by gender, female hajjis increased the risk of ARI who used a facemask sometimes during hajj (59.0%) than the male hajjis who used it sometimes during the hajj (46.8%) and that increased was statistically significant.
For women who only used Niqab without facemask 1.20 times increased the risk of ARI. The risk was decreased with the increases of duration spent in the hajj area.
During transportation between hajj area by bus or train the risk of ARI decrease 0.95 time for hajjis who used a facemask sometimes than hajjis who used a facemask most of the time but the decrease was not statistically significant.
Conclusion
Almost 51% of hajjis from Riyadh developed ARI during and after the hajj, female, younger age's group, low duration of stay in the hajj area. Using a facemask during hajj was found as useful protective measure to reduce the risk of ARI only among male hajjis.
Recommendation: According to this result personal protective measures should be encouraged during the hajj such as hygiene, vaccination, chemoprophylaxis to reduce the incidence of ARI. Further studies should be conducted to assess the effectiveness of facemask use-age to reduce the incidence of ARI especially among female.