Summary of your 'study carrel' ============================== This is a summary of your Distant Reader 'study carrel'. The Distant Reader harvested & cached your content into a collection/corpus. It then applied sets of natural language processing and text mining against the collection. The results of this process was reduced to a database file -- a 'study carrel'. The study carrel can then be queried, thus bringing light specific characteristics for your collection. These characteristics can help you summarize the collection as well as enumerate things you might want to investigate more closely. This report is a terse narrative report, and when processing is complete you will be linked to a more complete narrative report. Eric Lease Morgan Number of items in the collection; 'How big is my corpus?' ---------------------------------------------------------- 40 Average length of all items measured in words; "More or less, how big is each item?" ------------------------------------------------------------------------------------ 3854 Average readability score of all items (0 = difficult; 100 = easy) ------------------------------------------------------------------ 5 Top 50 statistically significant keywords; "What is my collection about?" ------------------------------------------------------------------------- 39 Hajj 7 MERS 6 pilgrim 6 Saudi 5 respiratory 5 Arabia 4 gathering 3 mass 3 KSA 2 study 2 influenza 2 indonesian 2 health 2 Umrah 2 Mecca 2 ILI 1 virus 1 malaysian 1 iranian 1 hajj 1 facemask 1 event 1 disease 1 death 1 covid-19 1 cough 1 cap 1 app 1 Zika 1 World 1 Valley 1 Rift 1 Jeddah 1 HRV 1 HIV 1 H1N1 1 Ebola 1 Cup 1 China 1 Australian Top 50 lemmatized nouns; "What is discussed?" --------------------------------------------- 1711 pilgrim 1487 % 988 study 784 infection 783 influenza 735 disease 718 virus 698 health 508 gathering 438 case 437 risk 369 year 344 symptom 319 country 314 patient 310 event 305 pilgrimage 288 vaccine 261 surveillance 259 outbreak 258 mass 257 participant 253 time 246 vaccination 243 illness 242 measure 240 transmission 240 rate 238 datum 207 sample 206 pathogen 202 death 195 day 193 hospital 189 use 189 prevalence 182 cough 177 factor 175 number 174 review 167 pneumonia 165 fever 159 pneumoniae 155 hand 153 cohort 152 result 147 tract 147 care 146 coronavirus 145 population Top 50 proper nouns; "What are the names of persons or places?" -------------------------------------------------------------- 2102 Hajj 590 Saudi 548 Arabia 285 MERS 213 CoV 205 Mecca 194 TB 183 Health 173 KSA 136 H1N1 130 al 129 Umrah 122 East 115 Middle 113 S. 108 ILI 107 et 94 Makkah 88 World 85 Influenza 68 France 66 MG 65 Al 65 A 63 Kingdom 63 . 60 PCR 60 Mina 59 Jeddah 56 Muslims 56 Ministry 55 Table 55 Olympics 52 HRV 51 Africa 45 September 45 SARS 45 Australian 44 Iran 44 China 43 M. 40 Organization 40 Games 40 COVID-19 38 HCoV 38 HCWs 38 Egypt 37 Mass 37 Marseille 36 Zika Top 50 personal pronouns nouns; "To whom are things referred?" ------------------------------------------------------------- 282 it 190 we 165 they 62 them 18 he 12 themselves 7 you 7 itself 5 i 3 us 2 she 2 one 1 oneself 1 him 1 herself 1 her Top 50 lemmatized verbs; "What do things do?" --------------------------------------------- 4789 be 876 have 412 report 403 include 343 use 193 associate 167 show 147 return 147 increase 144 conduct 139 base 138 follow 136 find 136 do 134 occur 130 confirm 129 attend 123 identify 121 provide 108 detect 107 recommend 105 receive 105 consider 104 compare 102 collect 95 perform 94 acquire 89 take 87 cause 86 reduce 84 suggest 83 involve 82 test 82 define 81 present 79 require 79 relate 79 develop 75 remain 75 observe 75 need 74 travel 74 prevent 73 accord 69 make 65 describe 63 regard 62 complete 59 infect 59 emerge Top 50 lemmatized adjectives and adverbs; "How are things described?" --------------------------------------------------------------------- 1037 respiratory 449 not 414 - 349 other 313 high 281 more 279 public 255 also 248 most 237 such 200 mass 200 infectious 191 however 171 common 170 only 170 human 164 viral 157 large 156 medical 154 international 147 saudi 145 significant 145 preventive 142 positive 137 non 136 acute 135 well 133 first 125 global 114 clinical 111 zoonotic 111 pneumococcal 110 pre 110 low 105 severe 102 many 102 likely 99 as 98 religious 98 different 95 french 94 important 92 previous 87 potential 85 several 84 hajj 76 systematic 74 very 72 therefore 72 major Top 50 lemmatized superlative adjectives; "How are things described to the extreme?" ------------------------------------------------------------------------- 66 most 56 Most 51 large 35 least 23 good 19 high 10 common 6 late 6 great 6 big 3 low 3 holy 3 bad 2 fast 1 strong 1 secondholi 1 old 1 long 1 close Top 50 lemmatized superlative adverbs; "How do things do to the extreme?" ------------------------------------------------------------------------ 182 most 29 least 7 well 1 worst 1 lowest Top 50 Internet domains; "What Webbed places are alluded to in this corpus?" ---------------------------------------------------------------------------- 3 doi.org 1 www.stata.com 1 www.prismastatement.org 1 www.cebm.net 1 seb 1 orcid.org Top 50 URLs; "What is hyperlinked from this corpus?" ---------------------------------------------------- 1 http://www.stata.com 1 http://www.prismastatement.org 1 http://www.cebm.net/ 1 http://seb 1 http://orcid.org/0000-0002-8471-7011 1 http://doi.org/10.1016/j.tmaid.2020.101631 1 http://doi.org/10.1016/j.tmaid.2019.07.007 1 http://doi.org/10.1016/j.tmaid.2017 Top 50 email addresses; "Who are you gonna call?" ------------------------------------------------- 1 wongv@cuhk.edu.hk Top 50 positive assertions; "What sentences are in the shape of noun-verb-noun?" ------------------------------------------------------------------------------- 5 pilgrims were aware 4 % took antibiotics 4 % were female 4 countries including saudi 4 hajj have not 4 hajj took place 4 pilgrims are elderly 4 pilgrims attending mina 4 pilgrims were not 4 viruses were not 3 % had influenza 3 % were pilgrims 3 hajj was not 3 infections are very 3 outbreaks were common 3 participants had influenza 3 participants were positive 3 pilgrims attending hajj 3 pilgrims were more 3 studies provide complementary 3 symptoms were less 3 symptoms were respiratory 3 vaccine was not 3 viruses were human 2 % reported respiratory 2 % used disposable 2 % used hand 2 % were current 2 % were influenza 2 arabia using arima 2 cases was not 2 cases were due 2 cases were positive 2 countries shows trivalent 2 disease was equally 2 hajj are already 2 hajj is complex 2 hajj were also 2 infections had influenza 2 measures were also 2 participants reported high 2 participants were willing 2 patients were elderly 2 pilgrims are not 2 pilgrims had higher 2 pilgrims had influenza 2 pilgrims used antibiotics 2 pilgrims were female 2 pilgrims were symptomatic 2 studies are thus Top 50 negative assertions; "What sentences are in the shape of noun-verb-no|not-noun?" --------------------------------------------------------------------------------------- 2 pilgrims were not aware 1 % had no accurate 1 case was not possible 1 cases were not fully 1 diseases were not allergic 1 events showed no clear 1 gatherings is not presently 1 gatherings was not previously 1 hajj is not well 1 infections have not previously 1 influenza had no significant 1 measures had no significant 1 outbreaks are not frequently 1 vaccination is not mandatory 1 vaccine was not available 1 vaccine was not statistically 1 virus were not significantly 1 viruses were not uncommon A rudimentary bibliography -------------------------- id = cord-261303-xjbz9fw9 author = Ahmed, Qanta A. title = From the “Madding Crowd” to mass gatherings-religion, sport, culture and public health date = 2018-06-04 keywords = Cup; Hajj; World; event; gathering; mass summary = Today Mass Gathering Medicine focuses on the public health challenges to hosting events attended by a large enough number of people, at a specific site, for a defined period of time, likely to strain both the planning and response to the mass gathering of a community, state, or nation. Today mass gathering medicine focuses on the public health challenges to hosting events attended by a large enough number of people at a specific site for a defined period of time to strain the planning and response of a community, state, or nation. But it is useful to consider the World Cup as a sporting event on a par with the Summer Olympics and the more recently developed Para-Olympics while the Hajj as a mass gathering centering on Islamic belief is better understood within the context of other mass gatherings centered on other theist belief systems including the Hindu Kumbh Mehla, World Youth Day and other pilgrimages [8] [9] [10] . doi = 10.1016/j.tmaid.2018.06.001 id = cord-314421-j5psma9i author = Ahmed, Qanta A. title = The cancellation of mass gatherings (MGs)? Decision making in the time of COVID-19 date = 2020-03-14 keywords = China; Hajj; KSA summary = While health care workers (HCWs) will be familiar with these measures, and Hajj pilgrims are always escorted by Hajj tour agencies who also provide basic education in infection control, the Umrah pilgrim (the traveler making the mini-pilgrimage to Mecca sometimes on the spur of the moment and at any time of the year) and the general public will not have experience in hand hygiene education. Similarly when KSA has faced the extremely delicate balance of welcoming religious pilgrims for both Hajj and Umrah this year many of whom have waited a life time to enact their religious rites, and weighing the impact of propagating outbreaks, difficult and unpopular decisions have to be made to safeguard not only the mass gathering but also the wider global community. doi = 10.1016/j.tmaid.2020.101631 id = cord-255339-oudj079q author = Al-Tayib, Omar A. title = An Overview of the Most Significant Zoonotic Viral Pathogens Transmitted from Animal to Human in Saudi Arabia date = 2019-02-22 keywords = Arabia; Hajj; Jeddah; MERS; Rift; Saudi; Valley; virus summary = The most important zoonotic viral diseases of which eight were diagnosed (in dead or diseased animals or through antibody detection) on the Arabian Peninsula over the last years include rabies, Middle East Respiratory Syndrome (MERS-CoV), influenza virus (IFV), Alkhurma hemorrhagic fever, Crimean-Congo hemorrhagic fever (CCHF), Rift Valley fever (RVF), West Nile fever (WNV), and dengue fever virus. The same WHO epidemiological data suggest that in these 22 countries including Saudi Arabia, in recent years, there has been report of steadily increasing number of sporadic human cases, incidence, and outbreaks of the virus [122] . Surprisingly, the current review showed that during an outbreak, each of these eight most zoonotic viruses (rabies, MERS-CoV, influenza, AHFV, CCHFV, RVFV, DHFV, and WNV) which occurred and/or cases confirmed in Saudi Arabia particularly from (Jeddah and/or Makkah) areas with at least one or all of these eight zoonotic viral pathogenic diseases [33, 44, 46, 78, [96] [97] [98] [99] 121, 130, 156, 171] . doi = 10.3390/pathogens8010025 id = cord-323455-26xi2lqf author = AlBarrak, Ali title = Proportion of adult community-acquired pneumonia cases attributable to Streptococcus pneumoniae among Hajj pilgrims in 2016 date = 2018-02-21 keywords = Hajj; cap summary = This study was performed to evaluate the proportion of adult community-acquired pneumonia (CAP) cases attributable to Streptococcus pneumoniae among Hajj pilgrims in 2016. METHODS: Adult subjects hospitalized with X-ray-confirmed CAP were enrolled prospectively from all general hospitals designated to treat Hajj pilgrims in the holy cities of Mecca and Medina. RESULTS: From August 23 to September 23, 2016, a total of 266 patients with CAP were enrolled in the study, 70.6% of whom were admitted to hospitals in Mecca; 53% of the cases were admitted after the peak of Hajj. pneumoniae among adult Hajj pilgrims in 2016, using the urine antigen test as well as standard culture-based tests, in order to determine the clinical burden of disease associated with Hajj and inform vaccination policy-making. General pattern of community-acquired pneumonia (CAP) case admissions to hospitals during the study period. It was aimed to systematically enroll all hospitalized X-ray-confirmed CAP cases among Hajj pilgrims during the study period. doi = 10.1016/j.ijid.2018.02.008 id = cord-302784-jkjdglns author = Alotaibi, Badriah title = Management of hospitalized drug sensitive pulmonary tuberculosis patients during the Hajj mass gathering: A cross sectional study date = 2019-07-13 keywords = HIV; Hajj summary = title: Management of hospitalized drug sensitive pulmonary tuberculosis patients during the Hajj mass gathering: A cross sectional study This study documents the management of drug-sensitive TB patients during Hajj and explores the compliance of healthcare providers with the KSA TB management guidelines in the Ministry of Health (MOH) hospitals in Makkah during the mass gathering. The management of TB patients was documented using a specifically designed data collection form which included patients'' demographics data, underlying health conditions and TB risk factors as well as clinical data including various aspects of TB management such as patients'' screening, infection prevention and control (IPC), TB diagnosis and treatment and case notification and outcome. The result showed high level of compliance with the assessed TB management guidelines indices for systematic screening of TB suspects as well as IPC and surveillance, but low compliance scores were obtained for prompt TB diagnosis and use of standardized treatment regimen for drug-susceptible TB. doi = 10.1016/j.tmaid.2019.07.007 id = cord-310557-d33ll0ka author = Alotaibi, Badriah M. title = Strengthening health security at the Hajj mass gatherings: characteristics of the infectious diseases surveillance systems operational during the 2015 Hajj date = 2017-02-26 keywords = Hajj; disease; health summary = Method: We reviewed documents, including guidelines and reports from the Saudi Ministry of Health''s database, to describe the characteristics of the infectious diseases surveillance systems that were operational during the 2015 Hajj, highlighting best practices and gaps and proposing strategies for strengthening and improvement. During Hajj, enhanced indicator-based notifiable diseases surveillance systems complement the existing surveillance tool to ensure timely reporting of event information for appropriate action by public health officials. 10 The use of appropriate surveillance systems during mass gatherings ensures the timely collection, analysis and interpretation of health data for effective planning and response to infectious diseases threats. 14 Furthermore, there is need to sustain the enhanced surveillance system and other public health interventions at key locations in the Kingdom, including the points of entry, after the Hajj, as a prevention and control strategy for the international spread of diseases during other mass gatherings with international dimensions, principally the Umrah pilgrimage. doi = 10.1093/jtm/taw087 id = cord-319784-lpmsalux author = Alqahtani, Amani S. title = Pilot use of a novel smartphone application to track traveller health behaviour and collect infectious disease data during a mass gathering: Hajj pilgrimage 2014 date = 2015-08-13 keywords = Hajj; MERS; app summary = title: Pilot use of a novel smartphone application to track traveller health behaviour and collect infectious disease data during a mass gathering: Hajj pilgrimage 2014 Pilot use of a novel smartphone application to track traveller health behaviour and collect infectious disease data during a mass gathering: Hajj pilgrimage 2014 1 Therefore, we conducted a pilot study using a smartphone app to examine its feasibility to track not only Hajj pilgrim KAP regarding preventive measures, but also symptom onset and participation in high-risk activities before, during, and after Hajj 2014. The first screen (first phase) is the pre-Hajj questionnaire, including data on participant demographics, pre-existing chronic diseases, vaccinations received before travel, factors influencing vaccination decision and uptake, perception of the risk of respiratory infection during Hajj, willingness to participate in highrisk activities, such as drinking unpasteurised milk, and awareness of official health recommendations provided by Saudi Arabian authorities. doi = 10.1016/j.jegh.2015.07.005 id = cord-331980-m6dflwmm author = Alqahtani, Amani S. title = Association between Australian Hajj Pilgrims’ awareness of MERS-CoV, and their compliance with preventive measures and exposure to camels date = 2016-07-18 keywords = Hajj; MERS summary = title: Association between Australian Hajj Pilgrims'' awareness of MERS-CoV, and their compliance with preventive measures and exposure to camels Through a prospective cohort study the relationship between travellers'' awareness of MERS-CoV, and compliance with preventive measures and exposure to camels was evaluated among Australian Hajj pilgrims who attended Hajj in 2015. [7] [8] [9] However, no study has attempted to investigate the association between Hajj pilgrims'' awareness of MERS-CoV, and their compliance with preventive measures and exposure to camels. This study shows that only 28% of Australian pilgrims were aware of MERS-CoV before attending the Hajj 2015, with some engaging in high risk behaviours such as exposure to camels (2%), and non-compliance with preventive measures. 8, 9 Importantly, this study showed that pilgrims who were aware of MERS-CoV were twice more likely to intend to avoid contact with camels and consume their raw products during Hajj than those who were unaware. doi = 10.1093/jtm/taw046 id = cord-347907-0nrejsgr author = Alqahtani, Amani S. title = Exploring barriers to and facilitators of preventive measures against infectious diseases among Australian Hajj pilgrims: cross-sectional studies before and after Hajj date = 2016-02-10 keywords = Australian; Hajj; pilgrim summary = 1, 2 Hajj presents a public health challenge for Saudi Arabia, as the authorities need to cater for an increasing number of pilgrims and respond to emerging infections such as the Middle East respiratory syndrome coronavirus (MERS-CoV). In an effort to reduce the risk of infectious diseases at Hajj, an array of preventive measures have been recommended by the Saudi Arabian Ministry of Health (MoH), which include vaccination and hygiene measures (Table 1) . 8 A French study demonstrated that less than half of pilgrims were aware of social distancing and facemask use as precautions against respiratory infections, 9 but no study has explored the barriers to and facilitators of the uptake of preventive measures. To address these questions, two cross-sectional surveys were conducted among Australian pilgrims, one before and one after the Hajj 2014, to identify what preventive advice and interventions pilgrims received before travel, and what factors influenced their compliance with these measures while they were there. doi = 10.1016/j.ijid.2016.02.005 id = cord-305460-wln758og author = Alqahtani, Amani Salem title = Tracking Australian Hajj Pilgrims’ Health Behavior before, during and after Hajj, and the Effective Use of Preventive Measures in Reducing Hajj-Related Illness: A Cohort Study date = 2020-05-04 keywords = Hajj; ILI; pilgrim summary = This study assessed Australian Hajj pilgrims'' knowledge, attitude and practices throughout their Hajj journey to understand their health behaviors, use of preventative measures and development of illness symptoms. Similarly, hand hygiene and other preventative practices also vary among pilgrims, making it more difficult for researchers to ascertain whether vaccine uptake and health behaviors overall have improved in comparison to previous years or studies [5] [6] [7] . To address these research gaps, we conducted a cohort study to explore Australian Hajj pilgrims'' knowledge about the risk of diseases during Hajj, assess their preparedness and use of preventive measures at three times points (before, during and after Hajj) , investigate the factors affecting their preventive health behavior, and determine the number of reported infections during and after Hajj. This cohort study captured and compared the health behavior, knowledge, attitudes and practices of Australian Hajj pilgrims regarding preventative measures against communicable diseases throughout the course of Hajj travel (before, during and after the journey). doi = 10.3390/pharmacy8020078 id = cord-255901-nl9k8uwd author = Barasheed, Osamah title = Uptake and effectiveness of facemask against respiratory infections at mass gatherings: a systematic review date = 2016-03-29 keywords = Hajj; facemask; respiratory; study summary = Studies conducted in community or health care settings found facemasks to be generally effective against influenza-like illness (ILI) or even against severe acute respiratory syndrome (SARS) but its effectiveness against respiratory infections at MGs remains unknown. 15, 17 A review of non-pharmaceutical interventions against respiratory tract infections among Hajj pilgrims presented data on the uptake of facemask and acknowledged that compliance was generally poor, but did not evaluate its effectiveness during Hajj. A few studies showed that providing educational session on protective measures against respiratory infections (including facemask) before Hajj was associated with significantly higher uptake of facemasks among pilgrims. 68 Focused studies are required to investigate factors influencing facemask compliance among attendees of Hajj and other MGs. In this systematic review, pooled data of facemask effectiveness showed that participants who used facemask during Hajj are about 20% less likely to suffer from respiratory infections compared to those who do not use it. doi = 10.1016/j.ijid.2016.03.023 id = cord-275605-mbiojk39 author = Benkouiten, Samir title = Clinical respiratory infections and pneumonia during the Hajj pilgrimage: A systematic review date = 2018-12-04 keywords = Hajj; ILI; pilgrim; respiratory summary = METHOD: The MEDLINE/PubMed and Scopus databases were searched for all relevant papers published prior to February 2018 that evaluated the prevalence of clinical symptoms of respiratory infections, including pneumonia, among Hajj pilgrims, as well as their influenza and pneumococcal vaccination status. We carried out a systematic review of cohort and hospital studies that reported the prevalence of clinical symptoms of respiratory infections and pneumonia among pilgrims during the Hajj, and both their influenza and pneumococcal vaccination status, with the aim to provide data allowing the investigation of the impact of this large mass-gathering event on public health policies and services and to identify potential targets for preventive measures. For inclusion, the article had to meet the following criteria: (1) Original study involving Hajj pilgrims; (2) detailed description of the study population, including influenza and pneumococcal vaccination status when available; (3) clinical or self-reported respiratory symptoms and diseases. doi = 10.1016/j.tmaid.2018.12.002 id = cord-329275-cd71wttk author = Benkouiten, Samir title = Respiratory Viruses and Bacteria among Pilgrims during the 2013 Hajj date = 2014-11-17 keywords = Arabia; Saudi; hajj summary = Nasal swab samples were independently tested as described (5) for influenza virus A/H3N2 (16), influenza B virus (16), influenza C virus (17) , and A(H1N1)pdm09 virus (18) ; human adenovirus (19) ; human bocavirus (20) , human cytomegalovirus (21) ; human coronaviruses (HCoVs); human enterovirus (22) ; human metapneumovirus (23); human parainfluenza viruses (HPIVs); human parechovirus (24); human respiratory syncytial virus (25) ; and human rhinovirus (HRV) (26) by using real-time reverse transcription PCRs. HCoVs and human HPIVs were detected by using an HCoV/HPIV R-Gene Kit (Argene/bioMérieux, Marcy l''Etoile, France) (27) . Of 19 participants whose post-Hajj specimens were positive for HRV, 17 (89.5%) had acquired the infection during their stay in Saudi Arabia (Figure 1 ). Of 50 participants whose post-Hajj specimens were positive for ≥1 respiratory virus, 43 (86.0%) reported ≥1 respiratory symptom during their stay in Saudi Arabia, of whom 37 (86.0%) still had respiratory symptoms at the time of sampling. Also, of 79 participants whose post-Hajj specimens were negative for respiratory viruses, 74 (93.7%) reported ≥1 respiratory symptom during their stay Saudi Arabia, of whom 53 (71.6%) still had respiratory symptoms at the time of sampling. doi = 10.3201/eid2011.140600 id = cord-354011-v9t2b2ca author = Benkouiten, Samir title = Circulation of Respiratory Viruses Among Pilgrims During the 2012 Hajj Pilgrimage date = 2013-10-01 keywords = HRV; Hajj; KSA summary = We performed a prospective survey among a cohort of pilgrims departing from Marseille, France, to Mecca in the Kingdom of Saudi Arabia (KSA) for the 2012 Hajj season. This study suggests a rapid acquisition of respiratory viruses among pilgrims during their stay in the KSA, most notably rhinovirus, and highlights the potential of spreading these infections in the pilgrims'' home countries upon their return. This study, including sample collection and laboratory methods, was conducted among a cohort of pilgrims departing from Marseille, France, to Mecca in the KSA for the 2012 Hajj season. Each sample was tested for the following viruses by real-time reverse transcription polymerase chain reaction (rRT-PCR): influenza A (FLUA) [11] , influenza B (FLUB) [11] , influenza C (FLUC), and A/2009/H1N1 [12] viruses; human respiratory syncytial virus A and B (RSVB) [13] ; human metapneumovirus (HMPV) [14] ; human rhinovirus (HRV) [15] ; MS2 bacteriophage; human adenovirus (HAdV) [16] ; and human enterovirus (HEV) [17] . doi = 10.1093/cid/cit446 id = cord-267427-kg84j802 author = Dao, Thi Loi title = Epidemiology of human common coronavirus acquisition in pilgrims date = 2020-08-14 keywords = Hajj summary = We revisited our data by investigating the prevalence of common HCoVs in the Hajj and Grand Magal pilgrims and studying the potential risk factors for HCoV acquisition in a large number of individuals. Symptoms were more frequent in Hajj pilgrims as compared to Grand Magal pilgrims (Supplementary Table 1) . In univariate analysis, acquisition of HCoVs was higher in Hajj pilgrims than in Grand Magal pilgrims. In addition, HCoVs acquisition was more frequent in pilgrims reporting respiratory symptoms, although this was not significant in univariate analysis. This report reveals the role of participation in a large gathering in common HCoVs acquisition and related infections. Significant acquisition of HCoVs following participation in the Hajj pilgrimage has been reported by several authors due to overcrowded conditions encouraging the person-to-person spread of respiratory viruses including HCoVs [3] . doi = 10.1016/j.tmaid.2020.101845 id = cord-293247-ltxt2dfv author = Elachola, Habida title = Advancing the global health security agenda in light of the 2015 annual Hajj pilgrimage and other mass gatherings date = 2015-10-09 keywords = Hajj; gathering summary = title: Advancing the global health security agenda in light of the 2015 annual Hajj pilgrimage and other mass gatherings Although current GHSA is yet to specifically highlight mass gathering preparedness as a strategic priority even in countries with high participant contribution to mass gatherings, the 12 Global Health Security Agenda action packages and the strategies to minimize the implications of mass gathering on public health are similar. Given that two-thirds of the emerging diseases are zoonotic, human-animal interaction during some mass gatherings such as the Hajj further increases the risk, and Saudi Arabia imports sacrifice animals from 6 countries. Mass gatherings offer opportunities to implement, test, and assess GHSA objectives in its entirety and can contribute significantly to health security of individuals, nations, and the world. Mass gatherings medicine and global health security doi = 10.1016/j.ijid.2015.10.003 id = cord-299440-y6o5e2k5 author = Elachola, Habida title = A crucial time for public health preparedness: Zika virus and the 2016 Olympics, Umrah, and Hajj date = 2016-02-07 keywords = Arabia; Hajj; Zika summary = Although winter temperatures mean that mosquito density is expected to be low in Brazil at the time of the Olympics, given the summer time mosquito density in the northern hemisphere, including in Saudi Arabia, the introduction of a few infections to the mosquito population might be suffi cient to cause outbreaks of Zika virus in other countries. 11 Although both countries may have robust vector control eff orts, no single approach is adequate to prevent mosquito bites and non-vector modes of Zika virus transmission; a combination of measures is needed at personal, community, and policy levels. Given that pilgrim fl ow to Saudi Arabia is continuous, these eff orts will help minimise current transmission of Zika virus as well. 4, 13 Lessons from Saudi Arabia''s success with hosting Hajj during declared pandemics can be helpful to Brazil and the Olympics organisers. Liraglutide safety and effi cacy in patients with non-alcoholic steatohepatitis (LEAN): a multicentre, double-blind, randomised, placebo-controlled phase 2 study doi = 10.1016/s0140-6736(16)00274-9 id = cord-265363-xw56intn author = Gautret, P. title = Incidence of Hajj-associated febrile cough episodes among French pilgrims: a prospective cohort study on the influence of statin use and risk factors date = 2014-12-12 keywords = Hajj; Saudi; cough summary = A prospective epidemiological study was conducted to evaluate the incidence of febrile cough episodes among adult Muslims travelling from Marseille to Saudi Arabia during the Hajj pilgrimage and to assess if use of statin had an influence on this incidence. This result suggests that while treatment with a statin has been demonstrated to reduce the mortality from severe sepsis associated with respiratory tract infections, it probably does not play a role in the outcome of regular febrile cough episodes as observed in the cohort studied here. The pre-travel questionnaire included demographic factors (age, gender, location of residence), indicators of immigration status (country of birth and duration of stay in France), socio-economic indicators (level of education, employment, type of housing, rooms per person and household, complementary health insurance modalities), health status indicators (diabetes, hypertension, chronic respiratory diseases, statin use, vaccination coverage against influenza) and number of previous travels to Saudi Arabia. doi = 10.1111/j.1469-0691.2009.02816.x id = cord-259966-szkiilb1 author = Gautret, Philippe title = International mass gatherings and travel-associated illness: A GeoSentinel cross-sectional, observational study date = 2019-11-09 keywords = Hajj; Umrah summary = METHODS: Investigators evaluated ill travelers returning from a mass gathering, and presenting to a GeoSentinel site between August 2015 and April 2019, and collected data on the nature of the event and the relation between final diagnoses and the mass gathering. CONCLUSIONS: Despite this surveillance being limited to patients presenting to GeoSentinel sites, our findings highlight the importance of respiratory diseases at mass gatherings, the need for pre-travel consultations before mass gatherings, and consideration of vaccination against influenza and pneumococcal disease. Diagnoses related to attendance at the three most common MGs -Umrah or Hajj, World Scout Jamboree, and Olympics -are presented in Table 1 . Ill MG attendees seen at a GeoSentinel site most frequently attended Umrah or Hajj, likely due to the large number of travelers to these pilgrimages. doi = 10.1016/j.tmaid.2019.101504 id = cord-286654-sox98pp3 author = Gautret, Philippe title = The inevitable Hajj cough: Surveillance data in French pilgrims, 2012–2014 date = 2015-10-03 keywords = Hajj; pilgrim summary = To better characterize the "Hajj cough" symptoms and its outcome, this study provides a clinical description of respiratory symptoms experienced by a cohort of French Hajj pilgrims during three consecutive Hajj seasons. The "Hajj cough" affected all individuals independently on their age, comorbidities, vaccination status and use of individual non-pharmaceutical preventive measures against respiratory tract infections. At the moment, none of the usual preventive measures against respiratory tract infection have been proven effective, including vaccination against influenza which is recommended for all Hajj pilgrims by French authorities and vaccination against pneumococcal infections which is recommended for at risk pilgrims suffering chronic conditions and or for those aged 60 years and over [27] . Nevertheless, prescription of antibiotics to Hajj pilgrims suffering mild respiratory symptoms is frequent in local health care structures: 95-99% patients consulting at the Ear, Nose and Throat clinic of a Hospital in Mecca were prescribed antibiotics while 85-92% presented with upper tract respiratory infection including pharyngitis and tonsillitis [28, 29] . doi = 10.1016/j.tmaid.2015.09.008 id = cord-326768-uo6482ah author = Hashem, Anwar M. title = MERS‐CoV, influenza and other respiratory viruses among symptomatic pilgrims during 2014 Hajj season date = 2019-02-20 keywords = Hajj; MERS summary = The aim here was to screen symptomatic pilgrims for Middle East respiratory syndrome coronavirus (MERS‐CoV) and other viral etiologies. 2, [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] The emergence of the novel Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia, its endemicity, and high mortality rates (35%-40%) clearly represent another major public health concern, especially during Hajj. High prevalence of common respiratory viruses and no evidence of Middle East respiratory syndrome coronavirus in Hajj pilgrims returning to Ghana Detection of respiratory viruses among pilgrims in Saudi Arabia during the time of a declared influenza A(H1N1) pandemic MERS-CoV but positive influenza viruses in returning Hajj pilgrims, China Cross-sectional survey and surveillance for influenza viruses and MERS-CoV among Egyptian pilgrims returning from Hajj during 2012-2015. Middle east respiratory syndrome coronavirus (MERS-CoV) infections in two returning travellers in the Netherlands MERS-CoV, influenza and other respiratory viruses among symptomatic pilgrims during 2014 Hajj season doi = 10.1002/jmv.25424 id = cord-007030-mewo9w43 author = Hashim, Suhana title = The prevalence and preventive measures of the respiratory illness among Malaysian pilgrims in 2013 hajj season date = 2016-02-08 keywords = Hajj; malaysian; respiratory summary = The purpose of this study is to determine the prevalence of respiratory illness and its associated factors among Malaysian hajj pilgrims in 2013 and to describe its preventive measures. Malaysian hajj pilgrims with previous experience of hajj (OR 0.24; 95% CI 0.10–0.56) or umrah (OR 0.19; 95% CI 0.07–0.52) and those who have practiced good hand hygiene (OR 0.35; 95% CI 0.16–0.79) were found to be significantly associated with lower risk of having respiratory illness. All preventive measures which include hand hygiene, wearing face masks and influenza vaccination must be practiced together as bundle of care to reduce respiratory illness effectively. Data based on the social demographic, co-morbid illness, smoking habits, symptoms of respiratory illness, history of contact with respiratory ill patients, previous experience of hajj or umrah, the practice of preventive measures, influenza and pneumococcal vaccination and supplement intake against respiratory illness were obtained by a self-administered proforma. doi = 10.1093/jtm/tav019 id = cord-339124-m7choyr6 author = Hoang, Van-Thuan title = Hajj and Umrah Mass Gatherings and COVID-19 Infection date = 2020-11-03 keywords = Hajj; Umrah; covid-19 summary = In order to avoid a COVID-19 outbreak with potential spreading to many countries through returning pilgrims, Saudi Arabia suspended the Umrah, and access to the 2020 Hajj was very limited. The KSA Ministry of Health recommends individual preventive measures such as use of face mask and disposable handkerchiefs and hand hygiene to mitigate the risk of RTIs. However, the efficacy of these measures against RTIs is debated [35] , and there have been no reliable controlled studies investigating their efficacy on the incidence of Hajj-related RTIs. The use of face masks may not provide optimal protection from infection, but that may reduce the spread of smallsized saliva droplets around when coughing or sneezing which is the main mode of transmission of most RTIs. Mandatory use of face mask in public places is considered one of the effective measures in controlling the COVID-19 pandemic [54] [55] [56] , but no investigation has been conducted in the context of MGs so far. doi = 10.1007/s40475-020-00218-x id = cord-349956-h4i2t2cr author = Hoang, Van-Thuan title = The dynamics and interactions of respiratory pathogen carriage among French pilgrims during the 2018 Hajj date = 2019-11-21 keywords = Hajj; respiratory summary = We conducted this study to describe the dynamics of the acquisition of respiratory pathogens, their potential interactions and risk factors for possible lower respiratory tract infection symptoms (LRTI) among French pilgrims during the 2018 Hajj. showed that human rhinovirus (HRV) and influenza viruses were the most common viral respiratory pathogens isolated from ill Hajj pilgrims [6] . Unadjusted associations between respiratory pathogen carriage with multiples factors: sociodemographic characteristics (gender, ≥60 years), chronic respiratory disease, BMI classification, smoking status; individual preventive measures (vaccination against influenza, vaccination against IPD, use of a face mask, hand washing, disinfectant gel and disposable handkerchiefs); antibiotic intake 10 days before each sample; respiratory virus or bacteria and dual carriage were analysed by univariable analysis. aureus carriage increase and the initial wave of respiratory symptoms, suggests that this pathogen association was responsible for the RTIs that affected most pilgrims soon after arriving in Mecca. doi = 10.1080/22221751.2019.1693247 id = cord-356048-nku844kt author = Hoang, Van-Thuan title = Infectious Diseases and Mass Gatherings date = 2018-08-28 keywords = Arabia; Hajj; Saudi; pilgrim summary = RECENT FINDINGS: In the context of Hajj, one of the largest religious MGs at Mecca, Saudi Arabia, respiratory tract infections are the leading cause of infectious diseases in pilgrims with a prevalence of 50–93%. In this review, we summarize recent findings in the field of infectious diseases associated with international MGs. The Hajj (Table 1) The Hajj, an annual Muslim pilgrimage to Mecca, Saudi Arabia, is one of the largest religious MGs in the world with about two million pilgrims from 185 countries [4] . The predominance of bacterial pathogens in Hajj-related gastrointestinal infections poses a major risk to public health through the potential emergence and transmission of antimicrobial-resistant bacteria [53] . (Table 1) Although numerous gastrointestinal and respiratory outbreaks have been documented at large-scale open-air festivals, particularly music festivals, with thousands of participants, these events are probably neglected, in terms of public health attention, as well as surveillance and prevention of infectious disease strategies, compared to other categories of MGs [78] . doi = 10.1007/s11908-018-0650-9 id = cord-258781-peppszqx author = Ishola, David A. title = Could influenza transmission be reduced by restricting mass gatherings? Towards an evidence-based policy framework date = 2011-08-18 keywords = Hajj; gathering; influenza; mass; study summary = The findings of the review may be able to help inform policy statements on the effectiveness of mass gathering restriction interventions that may be deployed to help reduce influenza virus spread during a pandemic. The other five observational studies were similarly designed, involving groups of intending Hajj pilgrims who were recruited in their home regions or countries prior to the event, and then re-assessed This was a well-organized systematic prospective influenza surveillance program, described by the authors as the first of its type at a large Games event Limitations include: A number of studies [18] [19] [20] [21] [22] have consistently demonstrated, over a number of years, that respiratory virus transmission occurs amongst pilgrims attending the annual Hajj in Saudi Arabia, and it is recognized as an issue of international public health significance [43] [44] [45] [46] that could be particularly important in a pandemic situation. doi = 10.1016/j.jegh.2011.06.004 id = cord-258611-uzzs8w1j author = Ma, Xuezheng title = No MERS-CoV but positive influenza viruses in returning Hajj pilgrims, China, 2013–2015 date = 2017-11-10 keywords = Hajj; MERS summary = BACKGROUND: There is global health concern that the mass movement of pilgrims to and from Mecca annually could contribute to the international spread of Middle East Respiratory Syndrome Coronavirus (MERS-CoV). DISCUSSION AND CONCLUSION: The MERS-CoV and respiratory viruses detection results at points of entry in China from 2013 to 2015 indicated that there were no MERS-CoV infection but a 5.7% positive influenza viruses in returning Chinese pilgrims. As of November 2015, there had been 1618 laboratoryconfirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection reported to the World Health Organization, and at least 579 cases had died [1, 2] . Two hypotheses were tested: (1) There is a significant difference in the positive and negative rates of influenza virus detection between Hajj pilgrims with symptoms and those without. In this study, we did not detect any cases of MERS-CoV infection but respiratory virus infections including influenza A and B, hMPV, hRSV, and human coronavirus were detected among Hajj pilgrims returning to China. doi = 10.1186/s12879-017-2791-0 id = cord-291821-ovfqfurf author = Memish, Ziad A title = Emergence of medicine for mass gatherings: lessons from the Hajj date = 2011-12-19 keywords = Arabia; Hajj; Mecca; Saudi; health; pilgrim summary = Among all MGs, the public health issues, associated with the Hajj (an annual pilgrimage to Mecca, Saudi Arabia) is clearly the best reported—probably because of its international or even intercontinental implications in terms of the spread of infectious disease. Imperial organisations linked cholera morbus, a non-epidemic diarrhoea, to Hajj, allowing a public health industry to develop that used health concerns to control immigration, pilgrim passports, proof of suffi cient funds to allow return travel, maritime regulation, and vessel quarantine procedures. Effi cient reorganization of the pilgrimage in every direction is needed and should be facilitated by the governments of the large number of the countries involved." 34 By the early 20th century, non-Muslim European powers were heavily engaged in the management of the Hajj and would remain so until modern Saudi Arabia came into existence and acquired fi nancial independence through petrochemical wealth. doi = 10.1016/s1473-3099(11)70337-1 id = cord-259111-hffy6xtm author = Memish, Ziad A. title = The Hajj in The Time of an Ebola outbreak in West Africa date = 2014-10-31 keywords = Ebola; Hajj summary = This issue of Travel Medicine and Infectious Disease has a number of papers pertinent to infectious disease risks for pilgrims attending Hajj, one of the largest annual recurring mass gathering events that takes place in the Kingdom of Saudi Arabia (KSA). The number of Muslims and the average number of pilgrims from the four countries in West Africa involved in the current Ebola Virus Disease (EVD) outbreak are shown in Table 1 . And long before the WHO announcement about PHEIC, the Saudi MOH after careful review by its national infectious diseases committee had asked in April 2014 that the respective authorities to suspend issuing the Hajj and Umrah''s visas for the people of Guinea, Sierra Leone and Liberia [2, 7] . Based on risk assessment in 2012, the Saudi Ministry of Health excluded pilgrims from Uganda and the Democratic Republic of the Congo due to the occurrence of an Ebola outbreak at that time [8] . doi = 10.1016/j.tmaid.2014.09.003 id = cord-314607-bcocsjij author = Memish, Ziad A. title = The prevalance of respiratory viruses among healthcare workers serving pilgrims in Makkah during the 2009 influenza A (H1N1) pandemic date = 2011-12-23 keywords = H1N1; Hajj; influenza summary = The prevalance of respiratory viruses among healthcare workers serving pilgrims in Makkah during the 2009 influenza A (H1N1) pandemic KEYWORDS Hajj; Viral; Respiratory; Healthcare workers; H1N1 Summary Despite the high risk of acquiring respiratory infections, healthcare workers who treat pilgrims at Hajj have not been studied in previous research on respiratory diseases during Hajj. The objective of this study was to determine the prevalence of different respiratory viruses among healthcare workers who treated pilgrims during Hajj 2009, the year of the influenza A H1N1 pandemic. The objective of this study was to determine the prevalence of different respiratory viruses among healthcare workers who treated pilgrims during Hajj 2009, the year of the influenza A H1N1 pandemic. Among the 18 circulating respiratory virus types and subtypes, only two were detected in the healthcare workers in the pre-and post-Hajj period: rhinovirus (N Z 21, 12.6%) and coronavirus 229E (N Z 1, 0.6%) . doi = 10.1016/j.tmaid.2011.11.002 id = cord-318315-r6wqywwe author = Memish, Ziad A. title = Etiology of severe community-acquired pneumonia during the 2013 Hajj—part of the MERS-CoV surveillance program date = 2014-06-23 keywords = Hajj; MERS summary = We aimed to screen Hajj pilgrims admitted to healthcare facilities in 2013 with severe community-acquired pneumonia (CAP) for MERS-CoV and to determine other etiologies. METHODS: Sputum samples were collected from all pilgrims admitted to 15 healthcare facilities in the cities of Makkah and Medina, Saudi Arabia, who were diagnosed with severe CAP on admission, presenting with bilateral pneumonia. 7, 10 In recent years, the Middle East respiratory syndrome coronavirus (MERS-CoV) has also emerged as a cause of serious illness including severe pneumonia. Respiratory tract infections are common illnesses during the Hajj, 15 and pneumonia is the leading cause of hospital admission, including admission to the ICU, during the pilgrimage. 16 In the current study, as part of the Saudi MoH MERS-CoV surveillance, we investigated the etiology of severe CAP in pilgrims attending the 2013 Hajj requiring hospitalization. 7,10 Studies performed during previous Hajj seasons have reported the organism as a cause of respiratory tract infections including penumonia. doi = 10.1016/j.ijid.2014.06.003 id = cord-270408-4qqyb8sd author = Pane, Masdalina title = Causes of Mortality for Indonesian Hajj Pilgrims: Comparison between Routine Death Certificate and Verbal Autopsy Findings date = 2013-08-21 keywords = Hajj; death; indonesian summary = title: Causes of Mortality for Indonesian Hajj Pilgrims: Comparison between Routine Death Certificate and Verbal Autopsy Findings This study presents the patterns and causes of death for Indonesian pilgrims, and compares routine death certificates to verbal autopsy findings. In the last two decades, the mortality rate of Indonesian pilgrims, excluding years in which disasters such as stampedes occurred, fluctuated between 200-380 deaths per 100,000 persons during the ten-week Hajj period [5] . The cause of death based on this verbal autopsy method was then recorded in the database and compared to that reported by the hospital or flight doctor death certificate. A greater proportion of deaths were attributed to cardiovascular disease by the flight doctor or hospital death certificate (66%) compared to the cause of death ascertained using the verbal autopsy method (49%, p<0.001). Based on both the death certificates and verbal autopsy categories, cardiovascular disease was the leading cause of Indonesian pilgrim mortality in 2008. doi = 10.1371/journal.pone.0073243 id = cord-324215-1tzbvgyr author = Pane, Masdalina title = Indonesian Hajj Cohorts and Mortality in Saudi Arabia from 2004 to 2011 date = 2019-03-17 keywords = Hajj; indonesian summary = This report uses data extracted from the Indonesian Hajj surveillance to provide a descriptive overview of mortality patterns in each cohort of pilgrims from 2004 to 2011 (winter Hajj season) to identify health issues of pilgrims for further research planning. Demographic variables collected include name, age, sex, home address, employment, flight group, travel route, date of arrival into Saudi Arabia, and cause of death (if any), according to the hospital medical record or flight doctor death certificate. Public health surveillance was conducted as the morbidity and mortality surveillance in Hajj by the Indonesian public health authorities accompanying pilgrims to Saudi Arabia with daily reporting of hospitalizations and deaths. Database variables included name, age, sex, home address, employment, flight group, travel route, date of arrival into Saudi Arabia, and cause of death as obtained from the hospital medical record or flight doctor''s death certificate. doi = 10.2991/jegh.k.181231.001 id = cord-316727-ktrlohm9 author = Razavi, Seyed Mansour title = Treatment and prevention of acute respiratory infections among Iranian hajj pilgrims: a 5-year follow up study and review of the literature date = 2014-05-10 keywords = Hajj; iranian; respiratory summary = title: Treatment and prevention of acute respiratory infections among Iranian hajj pilgrims: a 5-year follow up study and review of the literature Background Respiratory diseases/syndromes are the most common causes of referring to physicians among pilgrims in Hajj. The main aim of our study was to determine types, frequencies, etiologies, and epidemiologic factors of respiratory diseases among Iranian Hajj pilgrims and to suggest some preventive and treatment strategies. The aim of our study was to determine types, frequencies, etiologies, and some of other epidemiologic factors of respiratory diseases among Iranian Hajj pilgrims and to suggest some preventive and treatment strategies based on our 10 years of experience and literature review. We used the results of above mentioned studies and reviewed the literature, and offered a guideline for the treatment and prevention of acute respiratory infections (ARIs) in Hajj.  Significant difference values of NBT test before and after travel showed that respiratory diseases of pilgrims might have infectious origins. doi = nan id = cord-268105-617qcgpe author = Refaey, Samir title = Cross‐sectional survey and surveillance for influenza viruses and MERS‐CoV among Egyptian pilgrims returning from Hajj during 2012‐2015 date = 2016-11-11 keywords = Hajj summary = title: Cross‐sectional survey and surveillance for influenza viruses and MERS‐CoV among Egyptian pilgrims returning from Hajj during 2012‐2015 The purpose of this study was to estimate influenza virus and MERS‐CoV prevalence among Egyptian pilgrims returning from Hajj. The MOHP has additionally conducted an annual survey among pilgrims returning from Hajj to explore the risk of influenza virus transmission to the broader community. T A B L E 1 The distribution of Egyptian pilgrims surveyed by season according to gender, age group, presence of influenza-like illness (ILI), vaccination status and influenza laboratory test result Middle East respiratory syndrome coronavirus (MERS-CoV) -Saudi Arabia Risk factors for primary middle east respiratory syndrome coronavirus illness in humans, Saudi Arabia High prevalence of common respiratory viruses and no evidence of Middle East respiratory syndrome coronavirus in Hajj pilgrims returning to Ghana Cross-sectional survey and surveillance for influenza viruses and MERS-CoV among Egyptian pilgrims returning from Hajj during 2012-2015 doi = 10.1111/irv.12429 id = cord-341775-mucatzaa author = Shafi, Shuja title = The annual Hajj pilgrimage—minimizing the risk of ill health in pilgrims from Europe and opportunity for driving the best prevention and health promotion guidelines date = 2016-06-22 keywords = Hajj; KSA summary = Mass gathering sporting and religious events pose important public health challenges, including the transmission of infectious diseases, exacerbation of non-communicable diseases, and disorders related to climate change. [1] [2] [3] [4] [5] Every year, the Kingdom of Saudi Arabia (KSA) hosts the Hajj pilgrimage, which is the largest mass gathering in the world held on a recurrent annual basis. Mass gatherings at religious events can pose major public health challenges, particularly the transmission of infectious diseases. Lethal infectious disease outbreaks were common during Hajj in the 19th and 20th centuries although they have now been controlled to a great extent by the huge investments made by the KSA into public health prevention and surveillance programs. Lethal infectious disease outbreaks were common during Hajj in the 19th and 20th centuries although they have now been controlled to a great extent by the huge investments made by the KSA into public health prevention and surveillance programs. doi = 10.1016/j.ijid.2016.06.013 id = cord-287159-bjccnp7u author = Yavarian, Jila title = Influenza virus but not MERS coronavirus circulation in Iran, 2013–2016: Comparison between pilgrims and general population date = 2017-10-12 keywords = Hajj; MERS summary = The aim of this study was to determine and compare the prevalence of Middle East respiratory syndrome coronavirus (MERS-CoV) and influenza virus infections among Iranian general population and pilgrims with severe acute respiratory infections (SARI) returning from Mecca and Karbala during 2013–2016. METHODS: During 2013–2016, a total of 42351 throat swabs were examined for presence of influenza viruses and MERS-CoV in Iranian general population and pilgrims returning from Mecca and Karbala with SARI by using one step RT-PCR kit. CONCLUSION: This study showed the prevalence of influenza infections among Iranian pilgrims and general population and suggests continuing surveillance, infection control and appropriate vaccination especially nowadays that the risk of influenza pandemic threatens the world, meanwhile accurate screening for MERS-CoV is also recommended. The National Influenza Center (NIC) in Iran, located at Virology Department, School of Public Health, Tehran University of Medical Sciences, examines clinical samples from patients with severe acute respiratory infections (SARI) for influenza virus surveillance throughout the year in general population and/or pilgrims. doi = 10.1016/j.tmaid.2017.10.007 id = cord-258711-3fqxr2yz author = Yezli, Saber title = Acquisition of respiratory and gastrointestinal pathogens among health care workers during the 2015 Hajj season date = 2019-09-30 keywords = Hajj; Mecca summary = Methods Two cohorts of HCWs, the first serving Hajj pilgrims in Mecca and the second serving patients in Al-Ahsa, were investigated for respiratory and gastrointestinal symptoms and pathogen carriage using multiplex polymerase chain reaction before and after the 2015 Hajj. 12 In a study conducted among 120 HCWs from the Saudi Ministry of Health (MOH) and other Hajj medical missions during the 2009 season, 10.6% reported respiratory symptoms during the Hajj, and 12.5% were found infected by at least 1 virus post-Hajj comparing to 7.5% pre-Hajj using a PCR assay. [13] [14] [15] Further studies are needed for a better understanding of the impact of Hajj-related illness among HCWs. Although no correlation was observed between clinical symptoms and detection of respiratory pathogens, we report that HCWs exposed to ill pilgrims carried and acquired a number of respiratory pathogens including acquisition of rhinovirus, enterovirus, respiratory syncytial virus, H influenzae, K pneumoniae, Moraxella catarrhalis, Staphylococcus aureus, and Streptococcus pneumoniae. doi = 10.1016/j.ajic.2019.02.033 id = cord-257200-q0vqlerz author = Zumla, A. title = What is the experience from previous mass gathering events? Lessons for Zika virus and the Olympics 2016 date = 2016-06-15 keywords = Hajj; gathering; mass summary = 5 All previous experiences from different mass gathering show that vaccine preventable diseases is the most important infections like influenza, hepatitis A, polio and meningitis. 5 All previous experiences from different mass gathering show that vaccine preventable diseases is the most important infections like influenza, hepatitis A, polio and meningitis. The spread of severe acute respiratory syndrome coronavirus (SARS-CoV) from China to Hong Kong and further to Canada was not due to a mass gathering, but to infected individuals travelling late in the incubation period or just after the onset of symptoms. A review in this issue discusses the need for vaccines for mass gatherings and draws attention to immunization against pneumococcal infections in elderly pilgrims and highlights that polio may be a risk. Communicable diseases as health risks at mass gatherings other than Hajj: what is the evidence? doi = 10.1016/j.ijid.2016.06.010 id = cord-311654-ixn65hxb author = Zumla, Alimuddin title = COVID-19 and the scaled-down 2020 Hajj Pilgrimage - Decisive, logical and prudent decision making by Saudi authorities overcomes pre-Hajj public health concerns date = 2020-08-08 keywords = Hajj; Saudi summary = Apart from generic prevention and control issues of public health and lockdown measures to limit epidemic spread, specific issues of Mass Gathering (MG) sporting and religious events came under specific spotlight (Alzahrani et al, 2020; Baloch et al, 2020; McCloskey et al, 2020; . WHO with global MG partners, developed comprehensive key recommendations for COVID-19, and since end of February, 2020, there was a stepwise increase in cancellation, temporary suspension or postponement of international and national religious, sporting, musical, and other MGs, as countries worldwide took public health and other measures (WHO, 2020b; McCloskey et al, 2020; Petersen, McCloskey et al, 2020) . The successful completion of the 2020 Hajj is a major tribute to the leadership and commitment of the Saudi authorities, and it reflects their extensive experience of organising the annual Hajj pilgrimage, and continued commitment to improvement public health issues related to mass gatherings events. doi = 10.1016/j.ijid.2020.08.014