Control of Respiratory Tract Infections during Hajj Pilgrimage: A Narrative Review

Abstract

Introduction: Factors that contribute to the high prevalence of respiratory disease among Alhaj pilgrims include physical exhaustion, sleep deprivation, and heat stress, inevitable overcrowding, both in housing and ritual sites. The aim of this review was to determine the magnitude and determinants of respiratory infections and pneumonia during the Hajj pilgrimage.
Methods: An online search was conducted in PubMed, Scopus, and Cochrane to identify eligible articles. Published studies and reviews explored pre and post-Hajj health education interventions for the prevention of respiratory infections and literature covering various prevention guidelines such as the use of facemasks, vaccination, cough etiquette, and social distancing during Hajj were included. Non-experimental studies such as reviews, letters, case reports, and systematic reviews were excluded from the review. Each of the selected articles was reviewed in full by two reviewers.
Results: Before each Hajj, the Saudi Ministry of Health disseminates the health requirements for the issuance of travel visas, and provides advice about public health guidelines to prevent the spread of respiratory and gastrointestinal infections. Current evidence indicates that simple physical interventions would be useful for reducing the spread of respiratory viruses. Some studies have addressed the impact of face mask use during the Hajj on the prevalence of both respiratory symptoms and viral pathogens using PCR assays from pilgrim nasal samples, and no significant effect was observed. By contrast, no positive effect of frequent hand washing or using hand sanitizer was observed among pilgrims on the occurrence of respiratory symptoms during the Hajj or on the prevalence of respiratory viruses as investigated by PCR assays on nasal swabs during the Hajj.