P. Gautret

Lack of nasal carriage of novel corona virus (HCoV‐EMC) in French Hajj pilgrims returning from the Hajj 2012, despite a high rate of respiratory symptoms

Abstract A cohort of 154 French Hajj pilgrims participating in the 2012 Hajj were systematically sampled with nasal swabs prior to returning to France, and screened for the novel HCoV-EMC coronavirus by two real-time RT-PCR assays. Despite a high rate of respiratory symptoms (83.4%), including 41.0% influenza-like illness, no case of HCoV-EMC infection was detected. Despite the fact that zoonotic transmission was suspected in the first few cases, a recent family cluster in the Kingdom of Saudi Arabia suggests that the virus might show at least limited spread from person to person, which justifies continuing epidemiological surveillance.

Hajj pilgrims' knowledge about Middle East respiratory syndrome coronavirus, August to September 2013.

In preparation for Hajj 2013, 360 French pilgrims were interviewed regarding their knowledge about Middle East respiratory syndrome (MERS). Respondents were aged 20–85 years, male-female ratio was 1.05:1;64.7% were aware of the MERS situation in Saudi Arabia; 35.3% knew about the Saudi Ministry of Health recommendations for at-risk pilgrims to postpone participation in the 2013 Hajj. None of 179 at-risk individuals(49.9%) decided to cancel their Hajj participation even after advice during consultation.

Hajj-associated viral respiratory infections: A systematic review

Summary Respiratory tract infections (RTI) are the most common infections transmitted between Hajj pilgrims. The aim of this systematic review was to determine the prevalence of virus carriage potentially responsible for RTI among pilgrims before and after participating in the Hajj. A systematic search for relevant literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. 31 studies were identified. Severe Acute Respiratory Syndrome coronavirus and Middle East Respiratory Syndrome coronavirus (MERS) were never isolated in Hajj pilgrims. The viruses most commonly isolated from symptomatic patients during the Hajj by PCR were rhinovirus (5.9–48.8% prevalence), followed by influenza virus (4.5–13.9%) and non-MERS coronaviruses (2.7–13.2%) with most infections due to coronavirus 229E; other viruses were less frequently isolated. Several viruses including influenza A, rhinovirus, and non-MERS coronaviruses had low carriage rates among arriving pilgrims and a statistically significant increase in their carriage rate was observed, following participation in the Hajj. Further research is needed to assess the role of viruses in the pathogenesis of respiratory symptoms and their potential role in the severity of the symptoms.

The spread of vaccine-preventable diseases by international travellers: a public-health concern.

Vaccine-preventable diseases (VPDs) are costly at both the individual and societal levels. The most common VPDs recorded in travellers are enteric (typhoid or paratyphoid B) fever, acute viral hepatitis, influenza, varicella, measles, pertussis and bacterial meningitis. Travellers suffering from VPDs are frequently hospitalized, illustrating the point that VPDs are serious and expensive. Many travellers are not properly immunized before travel. In addition to individual consequences, VPDs can have public-health consequences if they are introduced or re-introduced by infected travellers returning to areas with susceptible populations. The international spread of poliomyelitis, Neisseria meningitidis serogroup W135 meningococcal infections, measles and influenza provides strong evidence of the role of international travel in the globalization of VPDs. The surveillance of the emergence, re-emergence or spread of VPDs is essential to adapt pre-travel advice and the responses to the VPD.

A comprehensive review of the Kumbh Mela: identifying risks for spread of infectious diseases

Abstract The Kumbh Mela in India is the largest mass gathering in the world which witnessed close to 100 million visitors in 2013. An event of this magnitude presents challenges. Increased population density, reduced hygienic conditions and exposure to environmental pollutants pave the way for easy transmission of pathogens. Due to the possibility of epidemics, the primary focus should be on identifying the potential risk factors and implementing appropriate preventive measures. The context of religion and psychology of the pilgrims is also closely associated with the evolution of the risk factors and so forms an important part of the discussion. We provide a brief background to the Kumbh Mela with a description of the existing and potential risk factors that require our attention.

Emerging respiratory tract infections

www.thelancet.com/infection Published online September 2, 2014 http://dx.doi.org/10.1016/S1473-3099(14)70899-0 1 Emerging and re-emerging respiratory tract infectious diseases and the growing problem of antimicrobial resistance continue to challenge diagnostic, treatment, prevention, and control strategies. Respiratory tract infections with epidemic and pandemic potential have plagued people since the dawn of human history. Comprehensive assessments of the global burden of disease show that respiratory tract infections are some of the commonest causes of morbidity and mortality worldwide, imposing a huge burden on health services. The past century has seen several epidemics of new viral respiratory tract infections, most of which emerged from interactions between people and animals. Several newly discovered viruses with epidemic potential have threatened global health security. These include severe acute respiratory syndrome-coronavirus (SARS-CoV), avian infl uenza viruses H5N1, H7N9, and H10N8, variant infl uenza A H3N2 virus, swine-origin infl uenza A H1N1, human adenovirus-14, and the Middle East respiratory syndrome-coronavirus (MERS-CoV). The pathogenesis and mode of transmission of MERSCoV and infl uenza A H7N9 are still poorly understood, which hampers implementation of intervention and preventive measures. Furthermore, the emergence and spread of antimicrobial-resistant bacterial, viral, and fungal pathogens, for which treatment options are diminishing, are of major global concern. These intricate and complex relations between microbes, human and animal hosts, and environmental factors infl uence risk, exposure, pathogenicity, infectiousness, and transmissibility. Furthermore, microorganisms do not respect international boundaries, and ease of global travel and airborne spread make them a persistent threat to global health security. This emerging respiratory tract infections Series in The Lancet Infectious Diseases includes fi ve articles on infectious diseases with epidemic and pandemic potential. The fi rst article reviews surveillance systems in place for early detection of emerging and re-emerging respiratory viruses. The second 10 reviews the pandemic potential of these emerging viruses. The focus of pandemic preparedness should include upstream prevention through better collaboration between human and animal health sciences to improve identifi cation of potential pathogens before they become serious human threats and to prevent their emergence where possible. The third article gives an overview of the epidemiology of new viruses, their geographical distribution, and mode of transmission from zoonotic or environmental sources and between human beings. Rapid and accurate identifi cation of pathogens is crucial to achieve optimum treatment, public health surveillance, and control outcomes. Other important challenges to the improvement of management outcomes of respiratory tract infections are development of tests for prediction and monitoring of treatment response; rapid identifi cation of drug resistant pathogens; more widespread surveillance of infections, locally and internationally; and those viruses with pandemic potential that require a global response. The fourth article reviews the present portfolio of diagnostic tests and technological advances that are enabling progress to be made in development of near point-of-care rapid diagnostic tests for viral and bacterial respiratory tract infections, including drug-resistant tuberculosis. The emergence and spread of antimicrobial-resistant infections for which diminishing treatment options are available is of major global concern. The fi fth article focuses on development and use of new antimicrobial agents and immune-based and host-directed therapies for a range of conventional and emerging viral respiratory tract infections. Although advances in molecular biology allow for genomic studies to rapidly identify new pathogens and predict their evolution and spread in human populations, improved understanding of dynamics of these microbes in animals could prevent outbreaks in people. Because of space constraints, we do not cover the following important aspects of respiratory tract infections in this series: pathogenesis, infectivity, pathogenicity, immunity, kinetics, and transmissibility of new viruses; preventive strategies including vaccines (existing and those under development), infection control measures and the relation between environmental ventilation, imbalanced ward airfl ow, design of hospital wards, and spread of viral respiratory infections in the hospital and the community; the growing problem of antibiotic resistant bacterial respiratory tract infections in the community, in hospitals, and in immunocompromised patients; and surveillance data and bioinformatics to model and predict the pandemic potential of viral respiratory tract infections. Emerging respiratory tract infections

The spectrum of respiratory pathogens among returning Hajj pilgrims: myths and reality

Summary Enhanced surveillance systems have been implemented recently in many countries in order to rapidly detect and investigate any possible cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection among travellers returning from the Middle East, including notably Hajj pilgrims. According to the available surveillance data, only a few sporadic travel-associated MERS-CoV cases have been reported outside the Arabian Peninsula so far, mainly in Europe, North Africa, and Asia. These have resulted in no cases, or limited numbers of secondary cases except in Korea. The vast majority of viral respiratory infections in pilgrims returning home have been due to seasonal influenza viruses, rhinoviruses, and other known coronaviruses distinct from the MERS coronavirus. Influenza vaccination should be a priority for all Hajj pilgrims, as recommended by experts.

Molecular dynamics of Staphylococcus aureus nasal carriage in Hajj pilgrims

During the 2012 Hajj season, the risk of acquisition of Staphylococcus aureus nasal carriage in a cohort of French pilgrims was 22.8%, and was statistically associated with the acquisition of viral respiratory pathogens (p 0.03). The carriage of S. aureus belonging to the emerging clonal complex 398 significantly increased following the pilgrimage (p < 0.05).

Mobile populations across the Mediterranean Sea and beyond: travel medicine, mass gathering medicine and homeless health

Abstract The Méditerranée Infection institute is internationally recognized for its expertise in infectious diseases and tropical medicine, and is one of the most active research centres for infectious diseases in Europe. Surveillance and research addressing infectious diseases in globally mobile populations is one of the strong components of the research conducted at the institute. A significant amount of clinical, microbiologic and epidemiologic works have been conducted in international travellers, pilgrims participating in large international religious gatherings, economic migrants and homeless migrant people over the last decades by our group. Our strong anchoring in several countries around the Mediterranean Sea and beyond, as well as the pivotal role of Marseille in the EuroTravNet and GeoSentinel international networks that monitor travel-associated diseases, reinforce our leading position in the fields of travel and tropical medicine, mass gathering medicine and homeless health.

Epidemiology of respiratory pathogen carriage in the homeless population within two shelters in Marseille, France, 2015–2017: cross sectional 1-day surveys

Abstract Objectives To assess risk factors for respiratory tract infection symptoms and signs in sheltered homeless people in Marseille during the winter season, including pathogen carriage. Methods Data on 479 male participants within two shelters who completed questionnaires and a total of 950 nasal and pharyngeal samples were collected during the winters of 2015–2017. Respiratory pathogen carriage including seven viruses and four bacteria was assessed by quantitative PCR. Results The homeless population was characterized by a majority of individuals of North African origin (300/479, 62.6%) with a relatively high prevalence of chronic homelessness (175/465, 37.6%). We found a high prevalence of respiratory symptoms and signs (168/476, 35.3%), a very high prevalence of bacterial carriage (313/477, 65.6%), especially Haemophilus influenzae (280/477, 58.7%), and a lower prevalence of virus carriage (51/473, 10.8%) with human rhinovirus being the most frequent (25/473, 5.3%). Differences were observed between the microbial communities of the nose and throat. Duration of homelessness (odds ratio (OR) 1.77, p 0.017), chronic respiratory diseases (OR 5.27, p <0.0001) and visiting countries of origin for migrants (OR 1.68, p 0.035) were identified as independent risk factors for respiratory symptoms and signs. A strong association between virus (OR 2.40, p 0.012) or Streptococcus pneumoniae (OR 2.32, p 0.014) carriage and respiratory symptoms and signs was also found. Conclusions These findings allowed identification of the individuals at higher risk for contracting respiratory tract infections to better target preventive measures aimed at limiting the transmission of these diseases in this setting.