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Gastrointestinal symptoms and the acquisition of enteric pathogens in Hajj pilgrims: a 3-year prospective cohort study

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Abstract

The acquisition of enteric pathogens and risk factors for Hajj-associated diarrhea in Hajj pilgrims is poorly documented. Pilgrims from Marseille participating in the Hajj in 2016–2018 underwent successive systematic rectal swabbing before and after their travel. Carriage of the main enteric pathogens was assessed by real-time PCR. Baseline demographics, adherence to individual preventive measures, gastrointestinal symptoms, and treatments were recorded. A total of 376 pilgrims were included. The median age was 62.0 years. During the Hajj, 18.6% presented at least one gastrointestinal symptom, 13.8% had diarrhea, and 36.4% had acquired at least one enteric pathogen. Enteropathogenic Escherichia coli (EPEC) and Enteroaggregative E. coli (EAEC) were the pathogens most frequently acquired by pilgrims (17.6% and 14.4%, respectively). Being female was associated with increased frequency of gastrointestinal symptoms during the pilgrimage (aOR = 2.38, p = 0.004). Enterohemorrhagic Escherichia coli (EHEC) acquisition was associated with a four-fold higher risk of reporting at least one gastrointestinal symptom and diarrhea (aOR = 3.68 and p = 0.01 and aOR = 3.96 and p = 0.01, respectively). Pilgrims who suffered from diarrhea were more likely to wash their hands more often (aOR = 2.07, p = 0.03) and to be either overweight (aOR = 2.71, p = 0.03) or obese (aOR = 2.51, p = 0.05). Enteric bacteria such as E. coli that are frequently associated with traveler’s diarrhea due to the consumption of contaminated food and drink were frequently found in pilgrims. Respecting strict measures regarding food and water quality during the Hajj and adherence to preventive measures such as good personal hygiene and environmental management will help reduce the burden of gastrointestinal infections at the event.

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Funding

This study was supported by the Institut Hospitalo-Universitaire (IHU) Méditerranée Infection; the French National Research Agency under the “Investissements d’avenir” programme, reference ANR-10-IAHU-03; the Région Provence-Alpes-Côte d’Azur, and European ERDF PRIMI funding.

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Authors and Affiliations

  1. Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France

    Van-Thuan Hoang, Thi-Loi Dao, Tran Duc Anh Ly, Doudou Sow, Khadidja Belhouchat, Kamel Larbi Chaht, Tassadit Drali, Philippe Parola, Vincent Pommier de Santi & Philippe Gautret

  2. Institut Hospitalo-Universitaire Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France

    Van-Thuan Hoang, Thi-Loi Dao, Tran Duc Anh Ly, Doudou Sow, Khadidja Belhouchat, Kamel Larbi Chaht, Laetitia Ninove, Tassadit Drali, Didier Raoult, Philippe Parola, Vincent Pommier de Santi & Philippe Gautret

  3. Thai Binh University of Medicine and Pharmacy, Thái Bình, Vietnam

    Van-Thuan Hoang & Thi-Loi Dao

  4. Service de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop, Dakar, Senegal

    Doudou Sow

  5. Unité des Virus Émergents (UVE: Aix Marseille Univ, IRD 190, Inserm 1207, IHU Méditerranée Infection), Marseille, France

    Laetitia Ninove

  6. The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia

    Saber Yezli & Badriah Alotaibi

  7. Aix Marseille Univ, IRD, MEPHI, Marseille, France

    Didier Raoult

  8. French Military Center for Epidemiology and Public Health, Marseille, France

    Vincent Pommier de Santi

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  1. Van-Thuan Hoang
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  2. Thi-Loi Dao
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Correspondence to Philippe Gautret.

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The authors declare that they have no conflict of interest.

Ethics approval

The protocol was approved by the Aix-Marseille University institutional review board (July 23, 2013; reference no. 2013-A00961-44). The study was performed according to the good clinical practices recommended by the Declaration of Helsinki and its amendments. All participants provided their written informed consent.

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Hoang, VT., Dao, TL., Ly, T.D.A. et al. Gastrointestinal symptoms and the acquisition of enteric pathogens in Hajj pilgrims: a 3-year prospective cohort study. Eur J Clin Microbiol Infect Dis 40, 315–323 (2021). https://doi.org/10.1007/s10096-020-04018-z

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