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Prevalence of Influenza Among Hajj Pilgrims: A Systematic Review and Meta-Analysis

Published online by Cambridge University Press:  24 March 2021

Hamid Safarpour Open the ORCID record for Hamid Safarpour [Opens in a new window] ,
Meysam Safi-Keykaleh ,
Iman Farahi-Ashtiani ,
Jafar Bazyar Open the ORCID record for Jafar Bazyar [Opens in a new window] ,
Salman Daliri  and
Ali Sahebi
Hamid Safarpour
Affiliation:
Department of Nursing, School of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Meysam Safi-Keykaleh
Affiliation:
Nahavand School of Allied Medical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
Iman Farahi-Ashtiani
Affiliation:
Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Jafar Bazyar
Affiliation:
Prehospital Emergency Center, Ilam University of Medical Sciences, Ilam, Iran
Salman Daliri
Affiliation:
Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
Ali Sahebi*
Affiliation:
Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran Non-Communicable Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
*
Corresponding author: Ali Sahebi, Email: [email protected].
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Abstract

Objectives:

Respiratory transmission, especially in mass gatherings, is considered one of the main ways of influenza transmission. The Hajj ceremony, as one of the largest gatherings worldwide, can increase the distribution of influenza infection. Thus, the present study aimed to evaluate the incidence of influenza among Hajj pilgrims.

Methods:

In this present systematic review and meta-analysis, all English studies published by 2019 were extracted from several databases such as the Web of Science, PubMed, Scopus, Cochrane Library, Science Direct, and Google Scholar. Finally, the data were extracted using a pre-prepared checklist and then analyzed by fixed and random effects model tests in the meta-analysis, Cochran, meta-regression, and Begg’s test.

Results:

Eighteen studies with a sample size of 62 431 were entered into the meta-analysis process. The overall prevalence of influenza, in addition to the prevalence of types A, B, and C influenza, was estimated at 5.9 (95% CI: 4.3-8.0), 3.6 (95% CI: 2.6-4.9), 2.9 (95% CI: 2.8-3.1), and 0.9% (95% CI: 0.5-1.5), respectively.

Conclusions:

In general, influenza remains widespread regardless of vaccinating pilgrims and following health protocols. Therefore, it is recommended that comprehensive management and educational approaches be used to reduce the prevalence of influenza and its adverse consequences among the pilgrims.

Keywords

fluhajjdisastermass gatheringpilgrimsprevalence
Type
Systematic Review
Information
Disaster Medicine and Public Health Preparedness , Volume 16 , Issue 3 , June 2022 , pp. 1221 - 1228
Copyright
© Society for Disaster Medicine and Public Health, Inc. 2021

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References

Caini, S, Kusznierz, G, Garate, VV, et al. The epidemiological signature of influenza B virus and its B/Victoria and B/Yamagata lineages in the 21st century. PLoS One. 2019;14(9):e0222381.CrossRefGoogle Scholar
Centers for Disease Control and Prevention (CDC). National Center for Immunization and Respiratory Diseases (NCIRD). Types of influenza viruses. 2018. https://www.cdc.gov/flu/about/viruses/types.htm. Accessed Jan 7, 2020.Google Scholar
Dikmen, AU, Aksakal, FNB, Aycan, Z, Aycan, S. Prevalence of influenza vaccination among health care workers and adverse effects after vaccination: a cross-sectional study. J Surg Med. 2019;3(7):520–524.Google Scholar
World Health Organization. Influenza (seasonal). April 2009. Accessed Jan 8, 2020.Google Scholar
Rambaut, A, Pybus, OG, Nelson, MI, et al. The genomic and epidemiological dynamics of human influenza A virus. Nature. 2008;453(7195):615.Google ScholarPubMed
Vasoo, S, Stevens, J, Singh, K. Rapid antigen tests for diagnosis of pandemic (swine) influenza A/H1N1. Clin Infect Dis. 2009;49(7):1090–1093.CrossRefGoogle ScholarPubMed
Christman, MC, Kedwaii, A, Xu, J, et al. Pandemic (H1N1) 2009 virus revisited: an evolutionary retrospective. Infect Genet Evol. 2011;11(5):803–811.CrossRefGoogle ScholarPubMed
Crawford, P, Dubovi, EJ, Castleman, WL, et al. Transmission of equine influenza virus to dogs. Science. 2005;310(5747):482–485.CrossRefGoogle ScholarPubMed
Ashshi, A, Azhar, E, Johargy, A, et al. Demographic distribution and transmission potential of influenza A and 2009 pandemic influenza A H1N1 in pilgrims. J Infect Dev Countr. 2014;8(09):1169–1175.CrossRefGoogle ScholarPubMed
Haghshenas, M, Jafarian, E, Babamahmoodi, F, et al. Prevalence of influenza A/H3N2 virus in northern Iran from 2011 to 2013. Caspian J Intern Med. 2015;6(2):116.Google ScholarPubMed
Karampourian, A, Ghomian, Z, Khorasani-Zavareh, D. Exploring challenges of health system preparedness for communicable diseases in Arbaeen mass gathering: a qualitative study. F1000Research. 2018;7:1448.CrossRefGoogle ScholarPubMed
Karampourian, A, Khorasani-Zavareh, D, Ghomian, Z. Communicable diseases pattern in religious mass gatherings: a systematic review. J Clin Diagn Res. 2019;13(2):LE01–LE06.Google Scholar
Alzeer, AH. Respiratory tract infection during Hajj. Ann Thorac Med. 2009;4(2):50.CrossRefGoogle ScholarPubMed
Al-Abdallat, MM, Rha, B, Alqasrawi, S, et al. Acute respiratory infections among returning Hajj pilgrims – Jordan, 2014. J Clin Virol. 2017;89:34–37.CrossRefGoogle ScholarPubMed
Alqahtani, AS, Wiley, KE, Tashani, M, et al. Exploring barriers to and facilitators of preventive measures against infectious diseases among Australian Hajj pilgrims: cross-sectional studies before and after Hajj. Int J Infect Dis. 2016;47:53–59.CrossRefGoogle ScholarPubMed
Refaey, S, Amin, MM, Roguski, K, et al. Cross-sectional survey and surveillance for influenza viruses and MERS-CoV among Egyptian pilgrims returning from Hajj during 2012-2015. Influenza Other Respir Viruses. 2017;11(1):57–60.CrossRefGoogle ScholarPubMed
Al-Asmary, S, Al-Shehri, A-S, Abou-Zeid, A, et al. Acute respiratory tract infections among Hajj medical mission personnel, Saudi Arabia. Int J Infect Dis. 2007;11(3):268–272.CrossRefGoogle ScholarPubMed
Al-Tawfiq, JA, Zumla, A, Memish, ZA. Respiratory tract infections during the annual Hajj: potential risks and mitigation strategies. Curr Opin Pulmon Med. 2013;19(3):192–197.Google ScholarPubMed
Memish, ZA, Assiri, A, Turkestani, A, et al. Mass gathering and globalization of respiratory pathogens during the 2013 Hajj. Clin Microbiol Infect. 2015;21(6):571. e571-571. e578.CrossRefGoogle ScholarPubMed
Memish, ZA, Zumla, A, Alhakeem, RF, et al. Hajj: infectious disease surveillance and control. Lancet. 2014;383(9934):2073–2082.CrossRefGoogle ScholarPubMed
Forde, AM. The Hajj. Influenza Other Respir Viruses. 2012;6(6):e72–e73.Google ScholarPubMed
Hashem, AM, Al-Subhi, TL, Badroon, NA, et al. MERS-CoV, influenza and other respiratory viruses among symptomatic pilgrims during 2014 Hajj season. J Med Virol. 2019;91(6):911–917.CrossRefGoogle Scholar
Alqahtani, A, Rashid, H, Heywood, A. Vaccinations against respiratory tract infections at Hajj. Clin Microbiol Infect. 2015;21(2):115–127.CrossRefGoogle ScholarPubMed
Ortiz, JR, Perut, M, Dumolard, L, et al. A global review of national influenza immunization policies: analysis of the 2014 WHO/UNICEF Joint Reporting Form on immunization. Vaccine. 2016;34(45):5400–5405.CrossRefGoogle ScholarPubMed
Al-Tawfiq, JA, Memish, ZA. Prevention of pneumococcal infections during mass gathering. Hum Vaccin Immunother. 2016;12(2):326–330.CrossRefGoogle ScholarPubMed
Gautret, P, Benkouiten, S, Al-Tawfiq, JA, Memish, ZA. Hajj-associated viral respiratory infections: a systematic review. Travel Med Infect Dis. 2016;14(2):92–109.CrossRefGoogle ScholarPubMed
Haworth, E, Barasheed, O, Memish, ZA, et al. Prevention of influenza at Hajj: applications for mass gatherings. J Royal Soc Med. 2013;106(6):215–223.Google ScholarPubMed
Moher, D, Shamseer, L, Clarke, M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1.CrossRefGoogle ScholarPubMed
Von Elm, E, Altman, DG, Egger, M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495–1499.CrossRefGoogle ScholarPubMed
Daliri, S, Safarpour, H, Bazyar, J, et al. The relationship between some neonatal and maternal factors during pregnancy with the prevalence of congenital malformations in Iran: a systematic review and meta-analysis. J Matern-Fetal Neonatal Med. 2019;32(21):3666–3674.CrossRefGoogle ScholarPubMed
Bazyar, J, Pourvakhshoori, N, Safarpour, H, et al. Hospital disaster preparedness in Iran: a systematic review and meta-analysis. Iran J Public Health. 2020;49(5):837–850.Google ScholarPubMed
Crippa, A, Khudyakov, P, Wang, M, et al. A new measure of between-studies heterogeneity in meta-analysis. Stat Med. 2016;35(21):3661–3675.Google ScholarPubMed
Lin, L. Comparison of four heterogeneity measures for meta-analysis. J Eval Clin Pract. 2020;26(1):376–384.CrossRefGoogle ScholarPubMed
Huedo-Medina, TB, Sánchez-Meca, J, Marín-Martínez, F, Botella, J. Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods. 2006;11(2):193.CrossRefGoogle ScholarPubMed
Egger, M, Smith, GD, Schneider, M, Minder, C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–634.CrossRefGoogle ScholarPubMed
Copas, J, Shi, JQ. Meta-analysis, funnel plots and sensitivity analysis. Biostatistics. 2000;1(3):247–262.CrossRefGoogle ScholarPubMed
Al-Tawfiq, JA, Gautret, P, Benkouiten, S, Memish, ZA. Mass gatherings and the spread of respiratory infections. Lessons from the Hajj. Ann Am Thorac Soc. 2016;13(6):759–765.Google ScholarPubMed
Annan, A, Owusu, M, Marfo, KS, et al. High prevalence of common respiratory viruses and no evidence of Middle East respiratory syndrome coronavirus in Hajj pilgrims returning to Ghana, 2013. Trop Med Int Health. 2015;20(6):807–812.Google ScholarPubMed
Balkhy, HH, Memish, ZA, Bafaqeer, S, Almuneef, MA. Influenza a common viral infection among Hajj pilgrims: time for routine surveillance and vaccination. J Travel Med. 2004;11(2):82–86.CrossRefGoogle ScholarPubMed
Koul, PA, Mir, H, Saha, S, et al. Influenza not MERS CoV among returning Hajj and Umrah pilgrims with respiratory illness, Kashmir, North India, 2014–15. Travel Med Infect Dis. 2017;15:45–47.CrossRefGoogle Scholar
Yavarian, J, Jandaghi, NZS, Naseri, M, et al. Influenza virus but not MERS coronavirus circulation in Iran, 2013–2016: Comparison between pilgrims and general population. Travel Med Infect Dis. 2018;21:51–55.CrossRefGoogle Scholar
Al-Tawfiq, JA, Benkouiten, S, Memish, ZA. A systematic review of emerging respiratory viruses at the Hajj and possible coinfection with Streptococcus pneumoniae. Travel Med Infect Dis. 2018;23:6–13.CrossRefGoogle ScholarPubMed
Razavi, SM, Torabi, SM, Salamati, P. Treatment and prevention of acute respiratory infections among Iranian Hajj pilgrims: a 5-year follow up study and review of the literature. Med J Islam Repub Iran. 2014;28:31.Google ScholarPubMed
Aledort, JE, Lurie, N, Wasserman, J, Bozzette, SA. Non-pharmaceutical public health interventions for pandemic influenza: an evaluation of the evidence base. BMC Public Health. 2007;7(1):208.CrossRefGoogle ScholarPubMed
Oshitani, H. Potential benefits and limitations of various strategies to mitigate the impact of an influenza pandemic. J Infect Chemother. 2006;12(4):167–171.CrossRefGoogle ScholarPubMed
Osterholm, MT, Kelley, NS, Sommer, A, Belongia, EA. Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12(1):36–44.CrossRefGoogle ScholarPubMed
Alborzi, A, Aelami, MH, Ziyaeyan, M, et al. Viral etiology of acute respiratory infections among Iranian Hajj pilgrims, 2006. J Travel Med. 2009;16(4):239–242.CrossRefGoogle ScholarPubMed
Alotaibi, BM, Yezli, S, Bin Saeed, A-AA, et al. Strengthening health security at the Hajj mass gatherings: characteristics of the infectious diseases surveillance systems operational during the 2015 Hajj. J Travel Med. 2017;24(3):taw087.CrossRefGoogle ScholarPubMed
Benkouiten, S, Al-Tawfiq, JA, Memish, ZA, et al. Clinical respiratory infections and pneumonia during the Hajj pilgrimage: a systematic review. Travel Med Infect Dis. 2019;28:15–26.Google ScholarPubMed
AlSaleh, E, Al Mazroua, M, Choudhary, AJ, et al. Serotypes of influenza during Hajj season, 1424 H (2004). Saudi Epidemiol Bull. 2005;12(1):1–12.Google Scholar
Kholeidi, D, Baksh, MF, Al Mazam, AA, Ashry, G. Seropositivity in clinical influenza cases among pilgrims during Hajj, 1421 Ha. Saudi Epidemiol Bull. 2001;8(4):27–28.Google Scholar
Memish, ZA, Assiri, AM, Hussain, R, et al. Detection of respiratory viruses among pilgrims in Saudi Arabia during the time of a declared influenza A (H1N1) pandemic. J Travel Med. 2011;19(1):15–21.CrossRefGoogle ScholarPubMed
Ziyaeyan, M, Alborzi, A, Jamalidoust, M, et al. Pandemic 2009 influenza A (H1N1) infection among 2009 Hajj pilgrims from Southern Iran: a real-time RT-PCR-based study. Influenza Other Respir Viruses. 2012;6(6):e80–e84.CrossRefGoogle ScholarPubMed
Atabani, SF, Wilson, S, Overton-Lewis, C, et al. Active screening and surveillance in the United Kingdom for Middle East respiratory syndrome coronavirus in returning travellers and pilgrims from the Middle East: a prospective descriptive study for the period 2013–2015. Int J Infect Dis. 2016;47:10–14.CrossRefGoogle ScholarPubMed
Aberle, JH, Popow-Kraupp, T, Kreidl, P, et al. Influenza A and B viruses but not MERS-CoV in Hajj pilgrims, Austria, 2014. Emerg Infect Dis. 2015;21(4):726.CrossRefGoogle Scholar
Moattari, A, Emami, A, Moghadami, M, Honarvar, B. Influenza viral infections among the Iranian Hajj pilgrims returning to Shiraz, Fars Province, Iran. Influenza Other Respir Viruses. 2012;6(6):e77–e79.CrossRefGoogle ScholarPubMed
Ma, X, Liu, F, Liu, L, et al. No MERS-CoV but positive influenza viruses in returning Hajj pilgrims, China, 2013–2015. BMC Infect Dis. 2017;17(1):715.CrossRefGoogle ScholarPubMed
Rashid, H, Shafi, S, Haworth, E, et al. Viral respiratory infections at the Hajj: comparison between UK and Saudi pilgrims. Clin Microbiol Infect. 2008;14(6):569–574.CrossRefGoogle ScholarPubMed
Imani, R, Karimi, A, Habibian, R. Acute respiratory viral infections among Tamattu’ Hajj pilgrims in Iran. Life Sci J. 2013;10(3):449–453.Google Scholar
Benkouiten, S, Charrel, R, Belhouchat, K, et al. Respiratory viruses and bacteria among pilgrims during the 2013 Hajj. Emerg Infect Dis. 2014;20(11):1821.CrossRefGoogle ScholarPubMed