Prevention of influenza at Hajj: applications for mass gatherings

被引:39
作者
Haworth, Elizabeth [1 ]
Barasheed, Osamah [2 ,3 ]
Memish, Ziad A. [4 ]
Rashid, Harunor [2 ,3 ]
Booy, Robert [2 ,3 ,5 ]
机构
[1] Univ Oxford, Dept Publ Hlth, Oxford OX3 7LF, England
[2] Childrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Westmead, NSW 2145, Australia
[3] Univ Sydney, Westmead, NSW 2145, Australia
[4] Alfaisal Univ, Coll Med, Minist Hlth, Riyadh 11533, Saudi Arabia
[5] Univ Sydney, Sydney Emerging Infect & Biosecur Inst, Westmead, NSW 2145, Australia
关键词
PANDEMIC H1N1 2009; RESPIRATORY-INFECTIONS; SAUDI-ARABIA; PILGRIMS; VACCINATION; STRATEGIES; TIME; UK;
D O I
10.1258/jrsm.2012.120170
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Outbreaks of infectious diseases that spread via respiratory route, e.g. influenza, are common amongst Hajj congregation in Mecca, Saudi Arabia. The Saudi Arabian authority successfully organized the Hajj 2009 amidst fear of pandemic influenza. While severe influenza A(H1N1) pdm09 was rare, the true burden of pandemic influenza at Hajj that year remains speculative. In this article we review the latest evidence on influenza control and discuss our experience of influenza and its prevention at Hajj and possible application to other mass gatherings. Depending on study design the attack rate of seasonal influenza at Hajj has ranged from 6% in polymerase chain reaction or culture confirmed studies to 38% in serological surveillance. No significant effect of influenza vaccine or the use of personal protective measures against influenza has been established from observational studies, although the uptake of the vaccine and adherence to face masks and hand hygiene has been low. In all, there is a relatively poor evidence base for control of influenza. Until better evidence is obtained, vaccination coupled with rapid antiviral treatment of symptomatic individuals remains the mainstay of prevention at Hajj and other mass gatherings. Hajj pilgrimage provides a unique opportunity to test the effectiveness of various preventive measures that require a large sample size, such as testing the efficacy of plain surgical masks against laboratory-confirmed influenza. After successful completion of a pilot trial conducted among Australian pilgrims at the 2011 Hajj, a large multinational cluster randomized controlled trial is being planned. This will require effective international collaboration.
引用
收藏
页码:215 / 223
页数:9
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