Enteric Infections Circulating during Hajj Seasons, 2011-2013

Abstract

Hajj, the annual Muslim pilgrimage to Mecca, Saudi Arabia, is a unique mass gathering event that raises public health concerns in the host country and globally. Although gastroenteritis and diarrhea are common among Hajj pilgrims, the microbial etiologies of these infections are unknown. We collected 544 fecal samples from pilgrims with medically attended diarrheal illness from 40 countries during the 2011-2013 Hajj seasons and screened the samples for 16 pathogens commonly associated with diarrheal infections. Bacteria were the main agents detected, in 82.9% of the 228 positive samples, followed by viral (6.1%) and parasitic (5.3%) agents. Salmonella spp., Shigella/enteroinvasive Escherichia coli, and enterotoxigenic E. coli were the main pathogens associated with severe symptoms. We identified genes associated with resistance to third-generation cephalosporins ≈40% of Salmonella- and E. coli-positive samples. Hajj-associated foodborne infections pose a major public health risk through the emergence and transmission of antimicrobial drug-resistant bacteria.

Keywords: Hajj; Saudi Arabia; antimicrobial resistance; bacteria; diarrhea; enteric infections; mass gathering; viruses.

Figure

Distribution of infectious agents among persons who acquired enteric infections during their travel for Hajj, 2011–2013, by age group. A) Identified versus unidentified samples; B) type of pathogen; C) bacterial agent. Bacterial agents were the most predominant pathogen detected among all age groups. NI, age not identified.