Uptake and effectiveness of facemask against respiratory infections at mass gatherings: a systematic review.

OBJECTIVES: The risk of acquisition and transmission of respiratory infections is high among attendees of mass gatherings (MGs). Currently used interventions have limitations yet the role of facemask in preventing those infections at MG has not been systematically reviewed. We have conducted a systematic review to synthesise evidence about the uptake and effectiveness of facemask against respiratory infections in MGs. METHODS: A comprehensive literature search was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines using major electronic databases such as, Medline, EMBASE, SCOPUS and CINAHL. RESULTS: Of 25 studies included, the pooled sample size was 12710 participants from 55 countries aged 11 to 89 years, 37% were female. The overall uptake of facemask ranged from 0.02% to 92.8% with an average of about 50%. Only 13 studies examined the effectiveness of facemask, and their pooled estimate revealed significant protectiveness against respiratory infections (relative risk [RR]=0.89, 95% CI: 0.84-0.94, p<0.01), but the study end points varied widely. CONCLUSION: A modest proportion of attendees of MGs use facemask, the practice is more widespread among health care workers. Facemask use seems to be beneficial against certain respiratory infections at MGs but its effectiveness against specific infection remains unproven.

Foot Injuries Among Hajj Pilgrims with and Without Diabetes Mellitus: Implications for Infection Management.

Pilgrims attending Hajj in Makkah are at high risk of suffering from trauma and foot injury as they are required to make circuits barefooted on scorching marbles around the Holy Mosque, and march between two hillocks for hours. No study has systematically described the pattern of foot wounds among them. This observational study aimed to determine the spectrum of foot injuries among diabetic and non-diabetic Hajj pilgrims and the preventive measures adopted by them. Pilgrims who attended the Hajj 2013 and sought medical care for foot wounds at mobile podiatric clinics in Mina during the peak days of Hajj were invited to participate in the study and fill out a questionnaire while they were serviced. Podiatric carers noted down the significant signs of foot injuries. Out of 197 pilgrims from 21 different countries who participated in this study, 60 (31%) were diabetic. The two most common injuries observed were blisters (34%) and erythema (25%). Both diabetic and non-diabetic Hajj pilgrims were at high risk of developing infectious wounds, however a significantly higher proportion of diabetic pilgrims had callosities. Use of appropriately fitting protective footwear, and regularity in diets and drugs are highly recommended for pilgrims' optimum foot care. Tailored educational advice on foot hygiene before and during travel could be beneficial for Hajj pilgrims.

Pneumococcal Vaccine Uptake Among Australian Hajj Pilgrims in 2011-13.

The uptake of the pneumococcal vaccine is suboptimal in Australia and remains unknown among Australian Hajj pilgrims, many of whom are eligible because of age or underlying disease and at particular risk because of travel and activities at Hajj. Pneumococcal vaccination uptake was examined over three consecutive years (2011 to 2013) through anonymous self-administered cross sectional surveys among Australian pilgrims who assembled in Mina valley, Mecca, Saudi Arabia. Respectively, 158, 513 and 219 pilgrims were recruited in 2011, 2012 and 2013; their mean ages were 43.8 (SD±13), 43 (SD±13.5) and 42.6 (SD±12.3) years; males accounted for 67 (42.4%), 325 (63.4%) and 172 (78.5%). Pneumococcal vaccine uptake rates were 28.5% (45/158), 28.7% (147/513) and 14.2% (31/219); among the pilgrims with 'at risk' conditions the pneumococcal vaccine uptake rates were 15 (30.6%), 43 (45.3%) and 9 (29%) respectively. According to our surveys, the pneumococcal vaccine uptake among Australian pilgrims is low. Further research is needed to explore the reasons through a validated study.