Hajj vaccination strategies: Preparedness for risk mitigation.

Millions of pilgrims travel annually to Makkah and Madinah, Saudi Arabia, for the Hajj, posing unique challenges for public health management and disease control. The large influx of pilgrims from diverse backgrounds traveling to a confined geographic area, coupled with the close proximity and interactions among them, create significant pressure on the healthcare system and heighten the potential for the spread of communicable diseases. This review examines current trends in communicable diseases and their impact, drawing insights from expert perspectives on the required (i.e., meningococcal meningitis, polio, and yellow fever) and recommended vaccinations (influenza, COVID-19) for Hajj participants. The updated COVID-19 vaccine is mandatory for local pilgrims and is strongly recommended for international visitors, with ongoing discussions on adapting protocols to address emerging variants. The timing and strain coverage of influenza vaccination, along with quadrivalent meningococcal vaccination, are also emphasized as critical preventive measures. Diseases such as cholera and yellow fever are addressed underscoring the need for rigorous surveillance and targeted vaccination strategies to mitigate the risk of transmission during the Hajj. By providing up-to-date information on mandated and recommended vaccinations, this review aims to empower pilgrims and healthcare professionals to make informed decisions regarding public health and disease prevention during this significant event.

Moving population is a challenge for malaria elimination in India: A cross-sectional study to assess malaria parasite infections in walking pilgrims in western Rajasthan, India.

Objectives: India is vigorously pursuing malaria elimination by 2030 and one of the key challenges is how to prevent the malaria risk associated with long-distance migrations of populations from endemic to non-endemic areas. Millions of pilgrims walking to the holy Ramdevra temple stay in temporary shelters along the route in district of Jaisalmer, Rajasthan state in western India. The main pilgrimage period coincides with the post-monsoon period with elevated vector densities. We investigated this situation to assess the potential risk posed by migrant pilgrims along the four highways in the temple district in disseminating malaria infections associated with their annual movements. Methods: A cross-sectional study was conducted for screening malaria in walking pilgrims from neighboring states at selected sites and a follow-up study for screening residents in Rajasthan from 2021 to 2023. The study comprises state entry routes, Ramdevra shrine, and pilgrimage route villages situated in western Rajasthan. Epidemiologic and entomologic surveillance was conducted during the "fair" period (August-September) and in pilgrimage route villages in three different seasons of the year to assess malaria in humans and the vector's infectivity. Results: Of the 5251 individuals tested for malaria, a total of 76 (1.4%) tested positive for malaria, of whom 40.7% were infected with Plasmodium vivax (n = 31), 36.8% with P. falciparum (n = 28), and 22.3% with P. vivax and P. falciparum (n = 17). Anopheles density was highest during the fair season, peaking in August. An. stephensi exhibited a higher human blood index (0.65) than An. culicifacies (0.50). No mosquitoes were found positive for parasites. Conclusions: Up to 1.5% of pilgrims carried malaria parasites, posing a risk of spreading malaria to surrounding communities that otherwise would have low or no malaria burden. Moving populations pose the risk of local malaria transmission and reintroduction to the areas undergoing elimination. Sentinel point surveillance at the border of states will be helpful for states to share information on malaria and subsequently for the prevention of malaria transmission.

Prevalence of and risk factors for infectious disease syndromic symptoms among pilgrimage to Arba'een mass gathering religious in 2023.

Background: There is a growing participation of Shia Muslims, in the Arba'een pilgrimage every year. It is imperative to conduct a comprehensive study on the transmission of diseases among Arba'een pilgrims in order to identify and promptly respond to potential epidemics effectively. We aimed to assess the syndromic symptoms associated with infectious diseases and the prevalence of mask usage among patients visiting outpatient clinics during the Arba'een pilgrimage in Ira, in 2023. Methods: In this descriptive-analytical study, 300 outpatients who sought medical care at outpatient clinics during the Arba'een pilgrimage were randomly selected. The study data and infectious disease syndromic symptoms were assessed using trained healthcare professionals. A multiple logistic regression analysis was carried out to estimate the crude and Adjusted odds ratios (AORs) of symptoms and risk factors associated with respiratory syndrome and flu-like symptoms with 95 % confidence intervals. Results: The mean age of the participants was 39 years and 61 % of those were male. Out of 72 (24 %) of mask users, 41.6 % had changed masks in less than 8 h. The most common syndromic symptoms was Flu-like illness (53 %). In the final analysis, not wearing a mask AOR = 1.40 (1.1-9.8) and smoking AOR = 3.25 (1.1-9.5) both elevated the risk of the flu-like syndrome and severe respiratory disease symptoms. Conclusions: Pilgrims are especially vulnerable to the flu and other respiratory illnesses. Therefore, performing a differential diagnosis in these people, including flu and COVID-19, is essential to prevent an outbreak during the Arba'een pilgrimage.

Identity enactment as a social accomplishment: Shared identity and the provision of mutual support amongst pilgrims undertaking the Hajj.

Experimental and survey research shows that a common group membership can result in increased levels of social support. Here we complement such research with qualitative data concerning the forms and function of such support. Specifically, we explore the mutual support reported by pilgrims undertaking the Hajj. This requires participants enact a series of identity-related beliefs and values (including specific rituals) in conditions that are practically and psychologically challenging. Using data obtained through semi-structured interviews (N = 33), we investigate how participants' shared identity facilitated their behavioural enactment of these identity-defining beliefs and values. We focus on how their shared understanding of their beliefs and values as Hajj pilgrims allowed various forms of support (psychological, material, informational, and behavioural) which helped participants translate their identity-related ideals into behaviour. Our analysis implies that a shared identity provides a frame of reference with which group members can recognize each other's identity-related concerns and what they need in order to enact their identity. In turn, it implies that in situations where there are practical and psychological constraints on behaviour, action in terms of one's social identity can be conceptualized as a joint accomplishment in which the mutual support of group members is key.

The Camino de Santiago as a 'Spiritual Journey': A Contemporary Challenge to Religion?

According to many surveys, the pilgrimage along the Way of St James (Camino de. Santiago) can lead to spiritual benefits, but there is some disagreement about this because these benefits can be associated with the pilgrim's motivation. This article presents a conceptual framework for understanding the phenomenon of pilgrimages to Compostela and their impact on human spiritual well-being. Many diaries mention various positive psychological effects from these trips, but they are presented in religious/spiritual dialectical tension. The article presents the classical concept of spirituality as related to the ability to transcend, and then classifies what is spiritual in the writings of some Polish pilgrims. In this way, conceptual precision will be offered, which is important for understanding the positive impact of pilgrimages on well-being and empowerment.

Sacred journeys and pilgrimages: health risks associated with travels for religious purposes.

BACKGROUND: Pilgrimages and travel to religious Mass Gatherings (MGs) are part of all major religions. This narrative review aims to describe some characteristics, including health risks, of the more well known and frequently undertaken ones. METHODS: A literature search was conducted using keywords related to the characteristics (frequency of occurrence, duration, calendar period, reasons behind their undertaking and the common health risks) of Christian, Muslim, Hindu, Buddhist and Jewish religious MGs. RESULTS: About 600 million trips are undertaken to religious sites annually. The characteristics varies between religions and between pilgrimages. However, religious MGs share common health risks, but these are reported in a heterogenous manner. European Christian pilgrimages reported both communicable diseases, such as norovirus outbreaks linked to the Marian Shrine of Lourdes in France, and noncommunicable diseases (NCD). NCD predominated at the Catholic pilgrimage to the Basilica of Our Lady of Guadalupe in Mexico, which documented 11 million attendees in one week. The Zion Christian Church Easter gathering in South Africa, attended by about 10 million pilgrims, reported mostly motor vehicles accidents. Muslim pilgrimages, such as the Arbaeen (20 million pilgrims) and Hajj documented a high incidence of respiratory tract infections, up to 80% during Hajj. Heat injuries and stampedes have been associated with Hajj. The Hindu Kumbh Mela pilgrimage, which attracted 100 million pilgrims in 2013, documented respiratory conditions in 70% of consultations. A deadly stampede occurred at the 2021 Jewish Lag BaOmer MG. CONCLUSION: Communicable and NCD differ among the different religious MGs. Gaps exists in the surveillance, reporting, and data accessibility of health risks associated with religious MGs. A need exists for the uniform implementation of a system of real-time monitoring of diseases and morbidity patterns, utilising standardised modern information-sharing platforms. The health needs of pilgrims can then be prioritised by developing specific and appropriate guidelines.

Beyond borders: Exploring the mental, emotional, and spiritual significance of Hajj.

For Muslims all across the world, the desire to participate in the religious rites of the Hajj (pilgrimage to Mecca) which stands as one of the five pillars of Islam is a heartfelt longing. It stands for the pinnacle of devotion and spiritual gratification, luring followers to the most sacred city in Islam for a life-changing journey of faith, comradery, and submission to Allah. Muslims hold Mecca in the highest regard; it is a source of endless inspiration and devotion throughout their lives, as seen by their desire to undertake the Hajj and Umrah. The pilgrimage encompasses a series of synchronized rituals and acts of worship, each holding its unique spiritual meaning, and serve as a powerful testament to the universal nature of Islamic teachings. These rituals have a significant impact on Muslims' mental and spiritual well-being. Hajj elicits a spectrum of feelings; creates unity, humility, and thankfulness; and encourages self-reflection as well as personal development. It also instills a sense of spiritual fulfillment. Hajj transcends personal boundaries, strengthening a pilgrim's sense of connection to the larger Muslim community that rejuvenates their hearts and souls toward the teaching of Islam. Hence, it is imperative to explore in depth this transformative journey, illuminating the mental, emotional, and spiritual dimensions that bind Muslims across the globe.

Triggers, Risk Factors, and the Prevalence of Syncope Among Domestic Hajj Pilgrims, 2023: A Cross-Sectional Study.

BACKGROUND: Syncope and other transient loss of consciousness episodes in crowded and unfamiliar environments may lead to major health hazards. Despite numerous publications, data on syncope among Hajj pilgrims in Makkah is lacking. OBJECTIVES: To identify the triggers, risk factors, and prevalence of syncope and other transient loss of consciousness episodes among domestic pilgrims. METHODOLOGY: This cross-sectional study included a convenient sample of domestic pilgrims who performed Hajj in July 2023 using an online Google Forms questionnaire (Alphabet Inc., Mountain View, CA). RESULTS: Out of 388 participants, 69 (18.1%) reported a history of syncope during the Hajj pilgrimage. Among these, 57 (82.6%) reported complete loss of consciousness, and 56 (81.2%) noted warning symptoms preceding the episode. The syncopal attack occurred once in 49 respondents (71%). Several triggers for syncope were identified, with sudden standing from a sitting position being the most prevalent (100%). Additional co-triggers were crowding (n=43; 62.3%), stressful conditions (n=30; 43.2%), prolonged standing (n=21; 30.4%), and walking (n=11; 15.9%). Traumatic injuries were reported in 33 (47.8%) as a result of syncope. Standing for long periods of time on the day of Arafat (Arafat standing) emerged as the most common triggering situation (n=48; 69.6%). There were multiple medical factors contributing to syncopal episodes; the most common medical explanations were heat exhaustion (n=48; 69.6%), dehydration (n=24; 34.8%), over-exertion (n=48; 69.6%), low blood sugar (n=10; 14.5%), and low blood pressure (n=17; 24.6%). Significant predictors were the presence of cardiac disease (odd ratio (OR) 7.6, 95% confidence interval (CI) 2.71-21.45, p<0.001), anemia (OR 2.5, 95% CI 1.01-6.09, p=0.049), previous syncope (OR 2.5, 95% CI 1.02-6.27, p=0.049, and family history of syncope (OR 10.1, 95% CI 2.08-49.32, p=0.004). CONCLUSION: Syncope during the domestic Hajj pilgrimage is frequent, especially on the day of Arafat, and carries the risk of traumatic injury. People with previous episodes of syncope and comorbidities, especially cardiac patients and those who have a family history of syncope, are particularly prone to this risk. Healthcare should focus on at-risk patients, particularly on critical pilgrimage days, and increase pilgrims' awareness about triggers of syncope including sudden and prolonged standing, exertion, and heat exposure.

Journey in the Impure Land: Buddhist Pilgrimage and Perceptions of Life and Old Age in Vietnam.

Religiously inspired travel has burgeoned in Vietnam in recent years, amidst rapid economic development and a booming tourist industry. Buddhist pilgrimages particularly attract older women, who compose the majority of temple goers in Vietnam. Having lived through volatile historical periods of war, economic hardship, and political transformations, travelling on pilgrimage is the first opportunity for many older Vietnamese women to enjoy new places and experiences. Drawing on data collected during my field research among Buddhist women pilgrims in their sixties and seventies from Ho Chi Minh City, I show how pilgrimage is seen as a journey of a lifetime and how it reflects the perception of life and self-transformation along the life course. Drawing on Victor and Edith Turner's (1978 [2011]) discussion of pilgrimage as the antistructure of everyday social life, this paper explains why pilgrimage is markedly different from other life experiences of Vietnamese women, and how religious travel positions old age not as the culmination of self-development, but rather as an ongoing process of gaining wisdom.

An outbreak of COVID-19 after a pilgrimage to Medjugorje due to Delta sub-lineages.

INTRODUCTION: A COVID-19 outbreak occurred at the end of October 2021 among pilgrims returning from Medjugorje (Bosnia and Herzegovina). METHODOLOGY: Whole genome sequencing (WGS) of SARS-CoV-2, epidemiological data, and phylogenetic analysis were used to reconstruct outbreak dynamics. RESULTS: The results suggest that only in one case, associated with the SARS-CoV-2 sub-lineage AY.9.2, it is possible to trace back the place of contagion to Medjugorje, while the other cases were likely to be acquired in the country of origin. CONCLUSIONS: The combined use of phylogenetic data derived from WGS, and epidemiological data allowed us to study epidemic dynamics and to formulate a possible hypothesis on the place of exposure to SARS-CoV-2. The identification of different sub-lineages of the SARS-CoV-2 Delta variant also suggested that different chains of transmission contributed to the outbreak.

Health challenges and facilitators of arbaeen pilgrimage: a scoping review.

BACKGROUND: The Arbaeen Pilgrimage, a momentous religious journey drawing millions of participants annually, presents a profound spiritual experience. However, amidst its significance lie various health challenges that pilgrims encounter along the way. Addressing these challenges is vital to ensure the well-being of participants and the success of this extraordinary event. In light of this, the aim of this study is to examine the health challenges of the Arbaeen Pilgrimage, identify facilitators for solving these challenges, and propose effective solutions to enhance the overall pilgrimage experience for all involved. METHODS: The scoping review was performed by searching databases such as Web of Science, PubMed, Scopus, and Google Scholar search engine with a focus on the keywords "Arbaeen", "Arbaeen walk" and "Arbaeen pilgrimage". The search was not constrained by a specific time limitation in the databases. Data from studies were extracted using a data extraction form consisting of 9 fields. The selection of articles and data extraction were carried out by two researchers, adhering to predefined inclusion and exclusion criteria. Any disagreements were resolved through consultation with a third researcher. The study was reported following the PRISMA checklist. RESULTS: Out of 1619 retrieved articles, 9 were finally included in this study. All these studies were published since 2017 and conducted in Iraq and Iran. In total, 101 health challenges and facilitators were identified, comprising 61 challenges and 40 facilitators. The challenges with the highest frequency included "infectious disease outbreaks" (n = 7), "Poor management of Iraq's health system in waste collection and disposal" (n = 4), "Rising incidence of walking injuries among pilgrims (e.g., burns, fractures, lacerations, wounds, and blisters)" (n = 4), and "Insufficient knowledge about personal and public health"(n = 4). The most important facilitators to solving the challenges were: "Customized pilgrim training and addressing their issues, with a focus on vital practices" (n = 6), "Coordinating mass gathering stakeholders, including health ministries and organizations" (n = 4), and "Implementing an agile syndromic system for rapid surveillance and identification of contagious illnesses" (n = 4). CONCLUSION: The article discusses health challenges faced during the Arbaeen Pilgrimage and proposes facilitative measures for participants' well-being. It emphasizes the significance of addressing health risks in large gatherings and suggests incorporating measures for a safer and enjoyable pilgrimage experience. Overall, understanding and managing these health factors can lead to a successful execution of the Arbaeen Pilgrimage, benefiting the physical and spiritual well-being of all involved.

Pilgrimage in pediatric palliative care: The journey of caregivers.

Admission of terminally ill patients into pediatric palliative care remains a challenge in Mexico and Latin America, despite the multiple benefits of early transfer. In this context the trajectories in search of health care of patients and caregivers have not been documented. Therefore, the objective of this study was to describe and analyze the experiences of primary caregivers and family members of pediatric patients in the palliative care unit of a Children's Hospital in Mexico, between October 19, 2019, and January 19, 2022. We used the framework of health pilgrimage, which comprises the transformative search of healing for patients, focusing on health barriers and the necessary displacement in search of care. With information obtained through interviews, we reconstructed the pilgrimages in search of health care navigating the Mexican healthcare system. Furthermore, we describe the experience of the primary caregiver accompanying the sick child during their journey to palliative care. We recount the adverse factors associated with this pilgrimage, such as the emotional and socioeconomic impact on primary and secondary caregivers.

Between Sacredness and Public Health: Global Religious Sacred Places and the Fight Against COVID-19.

This paper aims to explore the diverse impacts of religious sacred places on specific spheres of contemporary international relations, particularly in the context of public health governance as well as the fight against COVID-19. The spread of disease or germs and viruses within the context of pilgrimage, the healing purposes associated with such practices, as well as historical conquests of sacred places have attracted the attention of ancient physicians and modern scientists. In the nineteenth century, many Abrahamic religions sought to strengthen their influence in the Holy Land, particularly in the sacred city of Jerusalem. As part of their efforts, they focused on constructing modern hospitals, which became a means of religious competition over the region. From the perspective of the specific relationship between the sacred places and the public health governance system in the modern age, sacred places continue to succeed in animal management (native animals and sacrifice animals), water source management (sacred water and holy rivers), and management of sanitary quarantine (the extension of homeland health security defense), which have present positive effects. Based on the literature review, case analysis and interdisciplinary research methods, several findings have emerged regarding the global fight against COVID-19 since early 2020. Mecca-Medina, Jerusalem-Bethlehem, Rome-Vatican, Santiago de Compostela, Qom, and other religious sacred cities have faced huge pandemic pressures. These cities have played unique roles in protecting the health of pilgrims and have implemented measures to reduce the number and scale of pilgrimages in response to the global mobility challenges posed by the pandemic.

Antimicrobial utilization in Hajj 2022: An evaluation of quality indicators.

BACKGROUND: The mass gathering in Hajj (Islamic pilgrimage) makes the spread of infectious diseases inevitable. Antibiotics are frequently prescribed during this season. We aimed to measure antimicrobial utilization during the 2022 Hajj and evaluate the practice using quality indicators. METHODS: Antimicrobial utilization by Hajj medical facilities (77 primary clinics and 7 hospitals) was measured using the anatomic therapeutic classification defined daily dose (DDD) and DDD/1,000-inhabitant/day (DID), where inhabitants were the Hajj 2022 pilgrims (n = 899,353). Quality indicators included percentages of consumption of different antibiotic classes of the total consumption of antibacterials for systemic use in DID. RESULTS: During Hajj, there was 87,173 outpatient visits and 740 hospitalizations (215 critically ill). Amoxicillin was the most prescribed antibiotic (DID=11.708) followed by azithromycin (DID=7.395). Penicillins fell in the second quartile (i.e., highly prescribed) with a quality indicator value (J01_CE%) of 48.149. The consumption of other antibacterials, including fluoroquinolones, fell in the first quartile (<25%). The overall ratio of broad- to narrow-spectrum antibiotic prescribing (J01_B/N) was 1.49. CONCLUSION: Although the prescribing of ß-lactams over fluoroquinolones indicates a good practice, clinicians should be reminded that most infections spreading in mass gatherings are viral; hence, do not require antibiotics. Implementation of antimicrobial stewardship is recommended to improve antimicrobial utilization.

Domestic religious pilgrimage in Ethiopia: Validating Ethiopian orthodox Tewahido church monasteries sacredness through the name of Jerusalem and its significance.

Ethiopian Orthodox Tewahido Christians have a long history of pilgrimage. The Ethiopian Orthodox pilgrims' journey to Jerusalem, in particular, was very well known and ancient. However, when Jerusalem was under the control of Muslim leaders, Ethiopian Orthodox Tewahido Christian pilgrims used domestic pilgrimage as an alternative to the pilgrimage to Jerusalem. The fall of Jerusalem at the hands of Muslim leaders and the recurrent problems of pilgrims while they travelled to the sacred places of Jerusalem were the turning points for the proliferation of holy places in Ethiopia. King Lalibela was a man of great inspiration regarding domestic pilgrimage (the journey to sacred places in Ethiopia). The domestic pilgrimage, initiated by King Lalibela to replace Jerusalem in Ethiopia, reached its climax in medieval Ethiopian history. This study explores how the Ethiopian Orthodox Tewahido Church (EOTC) validated and authenticated Ethiopian monasteries and other holy places' sacredness by the name of Jerusalem to develop and encourage domestic pilgrimage. It also shows the significance or implications of domestic pilgrimage in building good social values such as peaceful coexistence, kindness, compassion, and social harmony among diverse communities. By taking Debre-Libanos Monastery (DLM) and Gishen Debre Kerbe (GDK) as the litmus tests, this study shows that religious promises (Qalikidanoch) written in hagiographies and other writings of the EOTC are the main ways for validating and authenticating Ethiopian monasteries sacredness. The religious promises promote and sanctify monasteries and other pilgrims' destinations. It initiates pilgrims to enter the seven-day prayer (Subae) and celebrate the saints' feasts. The practices and various experiences in the monasteries make pilgrims humble and kind, as well as teach them to develop the values of social harmony and peaceful coexistence. Apart from tourism attractions, therefore, these monasteries have a great possibility of significance for realizing good social values such as national unity, kindness, tolerance, social harmony, and peaceful coexistence. Thus, domestic pilgrimage should be encouraged, as Ethiopia is in the throes of ethnic divisions and the destructive effects ethnicization.

[The nontrivial approach or how physicians-bolsheviks treated kings. The Soviet medicine in the Arabian peninsula in 1920-1930s].

In the late 1920s, the USSR intensified its international activities in the Arabian Peninsula. The rapprochement with Arab monarchies provided opportunity to study political, economic and ethno-cultural characteristics of region by organizing transit of pilgrims to Mecca through the Soviet territory and providing medical care in first-aid posts at diplomatic missions. The Soviet physicians, in atypical situation of Arab monarchies, played important role as intermediaries between royal courts and the Soviet government, serving as agents of "soft power". The article considers causes of Moscow geopolitical interest to this region in 1920s-1930s. The distinctions of interaction between Soviet physicians and ruling circles of Hijaz and Yemen were explored. The humanitarian, cultural and geopolitical significance of these activities were examined. The article considers and explains, through optics of geopolitical approach, situational rationality that was applied by medical men when approaching treatment of royal personages despite ideological mismatch of this work with Bolshevism dogmas. The article consistently demonstrates, noting non-triviality of both locus itself and approaches to organization of medical care, how professionalism of Soviet physicians gained confidence of monarchs of Hijaz and Yemen in complicated conditions of competition with highly qualified physicians from Western Europe. It is emphasized that in conditions of Arabia, ideological attitudes had secondary importance, while such qualities as personal charisma and medical professionalism, which created solid reputation foundation for Soviet physicians, came to foreground.

A Systematic Review on Outcomes of Patients with Heatstroke and Heat Exhaustion.

Introduction: Heatstroke (HS) is a severe form of heat-related illness (HRI) associated with high morbidity and mortality, representing a condition that includes long-term multiorgan dysfunction and susceptibility to further heat illness. Methods: In a systematic review searching Medline PubMed from the studies conducted between 2009 and 2020, 16 papers were identified. Results: A hallmark symptom of heat stroke is CNS dysfunction (a hallmark sign of HS) which manifests as mental status changes, including agitation, delirium, epilepsy, or coma at the time of the collapse. Acute kidney injury (AKI), gut ischemia, blood clots in the stomach and small intestine, cytoplasmic protein clumps in the spleen, and injury of skeletal muscle (rhabdomyolysis) are all characteristics of peripheral tissue damage. Severe heat stroke tends to be complicated by rhabdomyolysis, especially in patients with exertional heat stroke. Rhabdomyolysis may lead to systemic effects, including the local occurrence of compartment syndrome, hyperkalemic cardiac arrest, and/or lethal disseminated intravascular coagulopathy. Untreated heat stroke might exacerbate psychosis, lactic acidosis, consumptive coagulopathy, hematuria, pulmonary edema, renal failure, and other metabolic abnormalities. Core body temperature and level of consciousness are the most significant indicators to diagnose the severity of heat stroke and prevent unfavorable consequences. Heatstroke is a life-threatening illness if not promptly recognized and effectively treated. Discussion: This review highlighted that core body temperature and white blood cell count are significant contributing factors affecting heat stroke outcomes. Other factors contributing to the poor outcome include old age, low GCS, and prolonged hospital stay. The prevalence of both classic and exertional heatstroke can be reduced by certain simple preventive measures, such as avoiding strenuous activity in hot environments and reducing exposure to heat stress.