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.

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.

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.

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.

Adventure and Spiritual Restoration: Older Adult Motivations for Undertaking a Pilgrimage on El Camino de Santiago.

A pilgrimage is an intentional journey undertaken for reasons that can increase a sense of well-being. Although originally completed for religious purposes, motives in contemporary times may include anticipated religious, spiritual, and humanistic benefits as well as appreciation of culture and geography. This quantitative and qualitative survey research explored the motivations of a sample subset age 65 and over from a larger study who completed one of the Camino de Santiago de Compostela routes in Spain. Consistent with life course and developmental theory, some respondents walked at life decision points. The analyzed sample was 111 people, nearly 60% of whom were from Canada, Mexico, and the US. Nearly 42% were non-religious while 57% were Christian or a subset, Catholic. Five key themes emerged: challenge and adventure, spirituality and intrinsic motivation, cultural or historical interest, recognition of life experiences and gratitude, and relationships. In reflecting, participants wrote about sensing a call to walk and experiencing transformation. Limitations included snowball sampling, as it is difficult to systematically sample those who complete a pilgrimage. The Santiago pilgrimage counters a narrative of aging as diminishment through positioning identity, ego integrity, friendships and family, spirituality, and positive physical challenge at the center of aging.

[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.

Faith Community Engagement to Mitigate COVID-19 Transmission Associated with Mass Gathering, Uman, Ukraine, September 2021.

Annually, ≈30,000 Hasidic and Orthodox Jews travel to Uman, Ukraine, during the Jewish New Year to pray at the burial place of the founder of the Breslov Hasidic movement. Many pilgrims come from the northeastern United States. The global health implications of this event were seen in 2019 when measles outbreaks in the United States and Israel were linked to the pilgrimage. The 2020 pilgrimage was cancelled as part of the COVID-19 travel restrictions imposed by the government of Ukraine. To prepare for the 2021 event, the National Public Health Institute, the Public Health Center of Ukraine, organized mitigation measures for pilgrims arriving in Uman, and the CDC COVID-19 International Task Force assisted with mitigation measures for pilgrims coming from the United States. We describe efforts to support COVID-19 mitigation measures before, during, and after this mass gathering and lessons learned for future mass gatherings during pandemics.

Structural violence and the need for compassionate use of methadone in Mexico.

BACKGROUND: Epidemiological data from Mexico have documented an increase in heroin use in the last decade. However, there is no comprehensive care strategy for heroin users, especially those who have been accused of a crime. The objective of this study was to describe the heroin and methadone use of intravenous heroin users of both sexes who have been in jail, to offer evidence for the formulation of health policy. METHODS: This study used an ethnographic approach, with open-ended interviews carried out from 2014 to the present. Heroin users of both sexes attending a private methadone clinic in Mexico City were invited to participate. The sample was non-probabilistic. All interviews were audiotaped and transcribed, and narratives were analyzed using thematic analysis. RESULTS: Participants in this study were 33 users of heroin, two of them women, who had been in prison. They ranged in age from 33 to 62 years, had used heroin for a period of 13-30 years, and were from three states: Michoacan, Oaxaca, and Mexico City. Three principal categories of analysis were structured: 1. Pilgrimage for help (dynamics of the drama of suffering, pain, and time through health care spaces); 2) methadone use as self-care; and 3) accessibility to methadone treatment. The impossibility of access to methadone treatment is a condition which motivates users in their journey. The dynamics of methadone use are interpreted as a form of self-care and care to avoid substance use. Reducing the psychological, physical, and harmful effects of the substance allows them to perform daily activities. The inability to access treatment leads to a significant effect on users who experience structural violence. CONCLUSION: Compassionate methadone treatment and holistic attention should be considered as a way to meet patients' needs and mitigate their suffering, based on public health policy that allows for human rights-based care.

Queer Pilgrimage: Anne Lister, Gentleman Jack, and Locating Community.

Queer pilgrimage is a journey made by an individual or a group to a location, permanent or transitory, which bears relevance to the lives, cultures, and politics of queer people. It is undertaken for the pilgrim/s to feel an affinity with the space itself through emotional and/or physical proximity. Since Gentleman Jack first aired in 2019, acts of queer pilgrimage have increased substantially to key sites associated with Lister, including to Shibden Hall (her ancestral home), Halifax, York, and beyond. In this article I draw upon two forms of queer pilgrimage in relation to Anne Lister. The first is this substantial increase in tourism and attraction to sites associated with Lister. The second is the queer pilgrimage Lister herself undertook in 1822 to the Ladies of Llangollen at their home, Plas Newydd.In drawing out these two comparatively, I propose that historical and contemporary forms of queer pilgrimage have more in common than may initially be apparent, namely a commonality between the queer pilgrims of the 19th and 21st centuries around a desire for community.

The Impact of COVID-19 on Pilgrimages and Religious Tourism in Europe During the First Six Months of the Pandemic.

This study presents the results of the examination of the influence of the SARS-Cov-2 coronavirus pandemic on religious tourism and pilgrimages to selected Catholic pilgrimage sites in Europe during the first six months of the COVID-19 pandemic (March-September 2020). Field research conducted in shrines and on several pilgrimage routes involved interviews with shrine custodians and staff as well as pilgrims. Data regarding tourism and pilgrimage movement were also gathered. Research results have shown that the tourism and pilgrimage movement to the analysed shrines decreased by 90-95% during the first six months of the pandemic. The shrines in Santiago de Compostela and Lourdes were closed for a few weeks during the first wave of coronavirus spread. The influence of the pandemic on the age structure of pilgrims is noticeable, with a distinct decrease in the number of pilgrims aged 60 + . Also, the reasons for pilgrimages to shrines have changed. The overriding principle followed by shrine custodians and organisers of pilgrimages was to ensure the safety of pilgrims on their way to shrines and, most importantly, in the shrine areas. The largest Catholic shrines in Europe encouraged pilgrims to deepen their bonds with the shrine through participation in online services and prayers and to pursue spiritual and virtual pilgrimages. The study also shows a model of the development of pilgrimages and religious tourism during the COVID-19 pandemic.

The Lourdes Pilgrimage and the Impact on Pilgrim Quality of Life.

Lourdes, France, is a major site of pilgrimage, particularly for Roman Catholics with illness. The direct impact of pilgrimage on pilgrim quality of life (QOL) has not previously been measured. The present study aimed to measure the impact of pilgrimage to Lourdes on QOL in self-defined "sick pilgrims". The standardised EuroQol EQ-5D-5L questionnaire measured two aspects of QOL, namely a Visual Analogue Scale (VAS) score of self-rated health and an Index Value Score (IVS) of the five dimensions of QOL, in a group of pilgrims, before (Q1), immediately after (Q2) and two months after (Q3) return from pilgrimage to Lourdes. A total of 93 pilgrims responded at time Q1, 71 at Q2 and 64 at Q3. The VAS scores of self-rated health showed statistically significant improvement at Q2 (p = 0.04), although this was not sustained at Q3. The IVS Scores showed no significant differences at Q2 or Q3. However, at Q2, 67.6% of pilgrims reported their self-rated QOL as "much better" or "better", and this was maintained in 54.7% at Q3. Pilgrims identified "spiritual and religious aspects of pilgrimage", "a sense of togetherness" and "spiritual healing" as having the most significant impact on their QOL. The Lourdes pilgrimage had a statistically significant positive impact on the immediate post-pilgrimage VAS scores of QOL of "sick pilgrims", but this was not sustained two months following pilgrimage. The IVS scores were unchanged. Pilgrims identified beneficial holistic, spiritual and communal aspects of the pilgrimage experience.

Transcendent Experiences Among Pilgrims to Lourdes: A Qualitative Investigation.

Millions of pilgrims visit Lourdes each year, often seeking revitalisation rather than miraculous cures. We sought to understand the phenomenon of transcendent experiences. We spoke with 67 pilgrims including assisted pilgrims, young volunteers and medical staff. About two in five reported a transcendent experience: some felt they had communicated or had close contact with a divine presence, while others reported a powerful experience of something intangible and otherworldly. Transcendent experiences are an important feature of pilgrimage to Lourdes and the place offers the faithful a means of connecting with the divine, with nature and with the self.

Job satisfaction amongst surgical healthcare professionals during Hajj and Non-Hajj periods: An analytical multi-center cross-sectional study in the holy city of Makkah, Saudi Arabia.

OBJECTIVE: To assess the job satisfaction of surgical healthcare professionals working during Hajj, and to determine the potential predictors of overall job satisfaction in Hajj and non-Hajj periods. METHODS: A multicenter cross-sectional study was conducted at King Abdullah Medical City, King Faisal Hospital and Al-Noor Specialist Hospital, Makkah, Saudi Arabia, from August 27 to September 5, 2018, which represented the period of 10 days following the Hajj season in that year. All surgeons who were employed during Hajj were interviewed regarding their job satisfaction in-Hajj versus non-Hajj periods using the Warr-Cook-Wall job satisfaction scale. A stepwise multiple linear regression was carried out to analyse predictors of overall job satisfaction in both Hajj and non Hajj periods separately. SPSS 16 was used for data analysis. RESULTS: Of the 146 participants, 28(19.18%) were consultants, 61(41.78%) specialists and 57(39.04%) were residents. Overall job satisfaction scores in Hajj period was 5.53 ±1.19 compared to 5.40±1.33 in non-Hajj period (p>0.05). During Hajj period, the participants were significantly more satisfied in terms of "amount of variety in work" (p<0.05), while they were significantly dissatisfied with regard to "physical work in g cond ition", "hours of work" an d "attention paid to suggestions" (p<0.05). CONCLUSIONS: The variety of cases encountered by surgeons during Hajj contributed significantly to job satisfaction. However, lack of attention to physicians' suggestions, extended hours of work and physical working condition during Hajj were potential factors causing less Job satisfaction during Hajj duty.

Diabetes and Hajj pilgrims: A Narrative review of literature.

The performance of the Hajj pilgrimage is a pillar of Islam and is obligatory at least once in the lifetime of every Muslim in good health who can afford to undertake the journey. Hajj creates stressful conditions that require strenuous physical activities which present specific challenges for people with diabetes. A pre-travel consultation with a health professional is highly recommended for people with diabetes. People in poor health should consider the religious dispensation with their doctor to see if the risk of attending the event is too great. Using the available literature, this narrative review discusses and summarises how this event affects diabetes and its management. The review was planned to provide possible practical recommendations for healthcare professionals to deal with this challenge and help their patients perform hajj safely.

Medical Problems of Way of St. James Pilgrimage.

It appears that the El Camino pilgrimage route has become a long-distance trek and endurance test of the individual. The continuously increasing number of hikers demands more attention by travel medicine professionals. Analysis of the age groups of the pilgrims over recent years shows that the number of young pilgrims (< 30 years) is decreasing, but the number of middle-aged people (30-60 years) is slightly increasing, while the number of elderly people (> 60 years) is considerably increased. The leading cause of fatalities during the pilgrimage is ACS. The majority of the cardiac problems occur among the elderly people. The second most common cause of death is a traffic accident, and the third and fourth causes are a fatal exacerbation of the pilgrim's pre-existing disease and illnesses caused by the extreme temperature (hot and cold environment alike). The aforementioned data suggest that pre-travel advice should be an indispensable part of the preparation for the El Camino peregrination, especially for the patient with chronic disease and elderly people.

[Pre-travel advice for the Hungarian pilgrims of El Camino. Travel risks and instructions]. / Az El Camino zarándokút egészségügyi kockázatai. Tanulságok és tanácsok.

The Way of St. James (El Camino) is getting more and more popular. Analysis of the age groups of the pilgrims shows that the number of young pilgrims (30< years) is decreasing, but the number of middle-aged people (30-60 years) is slightly increasing, while the number of elderly people (>60 years) has considerably increased. The statistical data of the Pilgrims' office in Santiago de Compostela also display the continuous elevation in the number of the "pilgrims" who had completed the El Camino without any religious or spiritual reason. Therefore this pilgrim route became a long-distance trekking - in the point of view of travel medicine. The old age is a high risk for travellers moreover in this long distance trekking. Therefore pre-travel counselling would be vital for aged pilgrims. Unfortunately, a few articles have been published only on the medical problems of El Camino. Taking into consideration the possible health damages during the 800 km long "Camino", the author describes its health hazards. This study could be a useful guideline for pre-travel advice for El Camino pilgrims as only limited information can be gained from the Pilgrims' Reception Office (PRO) in Santiago de Compostela. Some information was collected from the relevant pages of the internet. Therefore the author could draw limited consequences from the statistical data. Yet, the analysis of the medical causes of the deceased pilgrims told more about the hazards of 'The Way'. Although the number of female and male pilgrims was equal in the statistical data, yet the mortality rate of the male pilgrims is much more higher than that of the female pilgrims (93-7%). The most frequent cause of death was acute coronary syndrome or its suspicion (40-34%). The second most frequent cause of death was road traffic accident (17,5-25%). The most vulnerable pilgrims are the cyclists in this respect. The exacerbation of any chronic disease was also different among the genders (3-25%) but homicide is a more frequent cause of death in the female group (2%-8%). The cause of death was exhaustion, stroke, hypothermia and drowning (because of the ritual bathing in the sea, after the route completed) as well. Orv Hetil. 2018; 159(38): 1535-1542.

The impact of importation of live ruminants on the epizootiology of foot and mouth disease in Saudi Arabia.

Approximately five million live ruminants are imported annually into Saudi Arabia. The majority of these animals are imported shortly before the pilgrimage season from Sudan and the Horn of Africa, where foot and mouth disease (FMD) is known to be enzootic. This study was designed to investigate the impact of the importation of these live ruminants on the epizootiology of FMD in Saudi Arabia. The authors carried out antibody testing on a total of 480 sheep and 233 cattle from the sacrificial livestock yards of the Saudi Project for Utilization of Hajj Meat, which performs ritual slaughter on behalf of pilgrims in the Holy City of Makkah. The results revealed that 136 (28.3%) of the 480 sheep tested were serologically positive for FMD, using an indirect enzymelinked immunosorbent assay (ELISA) (3ABC FMD ELISA). This included 17.7% of Sawakani sheep (imported from Sudan) and 40.9% of Barbari sheep (imported from the Horn of Africa). Among the cattle, 120 (51.5%) of 233 animals tested positive for FMD virus (FMDV) antibodies. The 120 seropositive cattle included all clinically suspected cattle and 62 (35.4%) symptom-free, in-contact cattle. The findings highlight the risks associated with the annual importation of live ruminants from FMD-enzootic areas. The risks include the possible introduction of new exotic FMDV serotypes, particularly when potential carriers or subclinically infected animals are considered. An understanding of the epidemiology of different strains and the ability to track their movement between geographical regions is essential for the development of efficient control strategies for the disease. Therefore, genotyping of FMDV strains isolated from imported and local animals is recommended.

Environ 5 millions de ruminants vivants sont importés chaque année par l'Arabie saoudite. La plupart de ces importations ont lieu peu avant la saison du pèlerinage (hajj) et proviennent du Soudan et de la Corne de l'Afrique, où la fièvre aphteuse est réputée endémique. Les auteurs ont élaboré une étude visant à déterminer l'impact de ces importations de ruminants vivants sur l'épizootiologie de la fièvre aphteuse en Arabie saoudite. Pour ce faire, ils ont testé 480 moutons et 233 bovins appartenant au cheptel d'animaux destinés à l'abattage du Projet saoudien d'utilisation de la viande sacrificielle, qui effectue l'abattage rituel pour le compte des pèlerins de la ville sainte de La Mecque. Le test sérologique utilisé était une épreuve immuno-enzymatique de détection d'anticorps dirigés contre la protéine 3ABC (3ABC FMD ELISA). Sur les 480 moutons testés, 136 (28,3 %) ont donné des résultats positifs. Les moutons trouvés positifs étaient pour 17,7 % d'entre eux, de race sawakani (importés du Soudan) et pour 40,9 % de race barabarine (importés de la Corne de l'Afrique). Concernant les bovins, 120 (51,5 %) des 233 bovins testés possédaient des anticorps dirigés contre la fièvre aphteuse. Parmi ces 120 bovins séropositifs figuraient tous les cas cliniquement suspects, mais aussi 62 bovins (35,4 %) qui ne présentaient aucun signe clinique et qui avaient été exposés naturellement à l'infection. Ces résultats mettent en exergue l'existence des risques associés aux importations annuelles de ruminants vivants en provenance de régions où la fièvre aphteuse est enzootique. Ce risque comprend celui d'une introduction de sérotypes exotiques nouveaux du fait de la présence de porteurs potentiels ou d'animaux infectés asymptomatiques. Pour mettre en place des stratégies de lutte efficaces contre la fièvre aphteuse, il est nécessaire de bien comprendre l'épidémiologie des différentes souches et d'être en mesure de les suivre à mesure qu'elles se propagent d'une région à l'autre. Il est donc recommandé de procéder à la caractérisation des génotypes des souches du virus de la fièvre aphteuse isolées chez les animaux importés et autochtones.

Cada año Arabia Saudí importa aproximadamente 5 millones de rumiantes vivos. En su gran mayoría esos animales son importados, poco antes de la temporada de peregrinajes, desde el Sudán y el Cuerno de África, regiones donde la fiebre aftosa, según se sabe, es enzoótica. Los autores refieren un estudio encaminado a analizar los efectos de la importación de esos rumiantes vivos sobre la epizootiología de la fiebre aftosa en Arabia Saudí. Utilizando un ensayo inmunoenzimático (ELISA) indirecto (detección de anticuerpos contra la poliproteína 3ABC del virus), se practicaron pruebas de detección de anticuerpos a un total de 480 ovejas y 233 vacunos procedentes de los establos de sacrificio del proyecto saudí para la utilización de carne «halal¼, donde se practican sacrificios rituales en nombre de los peregrinos que llegan a la ciudad santa de La Meca. Los resultados revelaron que 136 (un 28,3%) de las 480 ovejas eran seropositivas para la fiebre aftosa, de las cuales un 17,7% eran ovejas sawakani (importadas del Sudán) y un 40,9% ovejas barbarinas (importadas del Cuerno de África). Por lo que respecta a los vacunos, resultaron positivos a los anticuerpos contra el virus de la fiebre aftosa 120 (un 51,5%) de los 233 animales. Entre esos 120 seropositivos estaban todos los ejemplares clínicamente sospechosos y 62 (un 35,4%) asintomáticos, que eran contactos naturales. Los resultados ponen de manifiesto los riesgos ligados a la importación anual de rumiantes vivos desde zonas donde la fiebre aftosa es enzoótica. Entre ellos figura el riesgo de introducir nuevos serotipos exóticos del virus, sobre todo si se tiene en cuenta la existencia de posibles portadores o animales con infección asintomática. Para concebir e instituir estrategias eficaces de lucha contra la enfermedad es fundamental entender la epidemiología de las diferentes cepas y poder seguir sus movimientos entre regiones geográficas. Es recomendable, por lo tanto, determinar el genotipo de las cepas víricas que se aíslen en animales importados y locales.

High prevalence of common respiratory viruses and no evidence of Middle East respiratory syndrome coronavirus in Hajj pilgrims returning to Ghana, 2013.

OBJECTIVE: The Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in 2012 on the Arabian Peninsula and has caused severe respiratory disease with more than 800 laboratory-confirmed cases. The return of infected pilgrims to their home countries with a putative spread of MERS-CoV necessitates further surveillance. METHODS: A cross sectional study of 839 adult African Hajj pilgrims returning to Accra in Ghana, West Africa, was conducted in 2013 to assess the prevalence of respiratory symptoms as well as of MERS-CoV, human rhinovirus (HRV), respiratory syncytial virus (RSV) and influenza A virus (FLU A) infection. RESULTS: Six hundred and fifty-one (77.6%) pilgrims had respiratory symptoms. Tests were positive for at least one of the viruses other than MERS-CoV in 179 (21.3%) of all pilgrims, with 22.4% detection in symptomatic vs. 17.6% detection in asymptomatic pilgrims. No MERS-CoV was detected, although common respiratory viruses were prevalent, with positive findings for HRV in 141 individuals (16.8%), RSV in 43 individuals (5.1%) and FLU A in 11 individuals (1.3%). Results were positive for more than one virus in 16 (1.9%) individuals, including 14 (1.7%) RSV/HRV co-infections and 2 (0.2%) FLU A/HRV co-infections. A total 146 (22.4%) of the symptomatic returnees tested positive for at least one respiratory virus compared with 33 (17.6%) of the asymptomatic pilgrims who had at least one detectable virus in their sample. CONCLUSIONS: The prevalence of viral respiratory infections among Hajj pilgrims in both symptomatic and asymptomatic subjects was high. Although it is reassuring that MERS-CoV was not detected in the tested population, there is a need for active surveillance of Hajj pilgrims.

Monks on the move: Evaluating pilgrimage to Byzantine St. Stephen's monastery using strontium isotopes.

OBJECTIVES: Written and archaeological evidence indicates that migration, in the form of pilgrimage to Byzantine Palestine, was a major social phenomenon between the 5th and 7th centuries CE. Monasteries saw record growth at this time as pilgrims chose to stay in the region and take up religious life. A major influx of people to the region, with a corresponding growth in monastic vocations that led travelers to stay in the area, is not in question; however, the distant origins of pilgrims reflected in surviving texts may be an artifact of preservation, biased towards an elite minority. The Byzantine monastery of St. Stephen's provides an opportunity to study this question from a bioarchaeological perspective, given the excellent preservation of the human skeletal assemblage, a wealth of written works about the community as well as daily life in Byzantine Palestine, and a rich archaeological record for the site and region. MATERIALS AND METHODS: An analysis of radiogenic strontium isotope values from the third molars of 22 individuals recovered from the St. Stephen's crypt complex was conducted to test whether those interred at the monastery were of local origin. RESULTS: Of those examined ( x¯= 0.7084 ± 0.0007, 1σ), 8 out of 22 (36%) exhibited (87) Sr/(86) Sr ratios that fell outside of local ranges. DISCUSSION: These results confirmed the sizeable presence of nonlocals at St. Stephen's Monastery. While most of these migrants likely traveled to Jerusalem from different areas of the Levant as pilgrims, others may have hailed from further afield, including Europe.

Prevalence of MERS-CoV nasal carriage and compliance with the Saudi health recommendations among pilgrims attending the 2013 Hajj.

BACKGROUND: Annually, Saudi Arabia is the host of the Hajj mass gathering. We aimed to determine the Middle East respiratory syndrome coronavirus (MERS-CoV) nasal carriage rate among pilgrims performing the 2013 Hajj and to describe the compliance with the Saudi Ministry of Health vaccine recommendations. METHOD: Nasopharyngeal samples were collected from 5235 adult pilgrims from 22 countries and screened for MERS-CoV using reverse transcriptase-polymerase chain reaction. Information regarding the participants' age, gender, country of origin, medical conditions, and vaccination history were obtained. RESULTS: The mean age of the screened population was 51.8 years (range, 18-93 years) with a male/female ratio of 1.17:1. MERS-CoV was not detected in any of the samples tested (3210 pre-Hajj and 2025 post-Hajj screening). According to the vaccination documents, all participants had received meningococcal vaccination and the majority of those from at-risk countries were vaccinated against yellow fever and polio. Only 22% of the pilgrims (17.5% of those ≥65 years and 36.3% of diabetics) had flu vaccination, and 4.4% had pneumococcal vaccination. CONCLUSION: There was no evidence of MERS-CoV nasal carriage among Hajj pilgrims. While rates of compulsory vaccinations uptake were high, uptake of pneumococcal and flu seasonal vaccinations were low, including among the high-risk population.