Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia.
Int J Infect Dis. 2018 Apr;69:68-74. doi: 10.1016/j.ijid.2018.02.008. Epub 2018 Feb 21.
The Hajj mass gathering is a risk for pneumococcal disease. This study was performed to evaluate the proportion of adult community-acquired pneumonia (CAP) cases attributable to Streptococcus pneumoniae among Hajj pilgrims in 2016. To add sensitivity to etiological attribution, a urine antigen test was used in addition to culture-based 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. Patients were treated according to local standard of care and administered the BinaxNow S. pneumoniae urine antigen test.
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. Patients originated from 43 countries. Their mean age was 65.3 years and the male to female ratio was 2:1. Just over 36% of the cases had diabetes, 10% declared that they were smokers, and 45.4% of cases were treated in the intensive care unit (ICU). The overall case-fatality rate was 10.1%, but was higher among those treated in the ICU and in those with invasive disease. The proportion of CAP cases positive for S. pneumoniae, based on culture or urine antigen test, was 18.0% (95% confidence interval 13.9-23.1%).
CAP during Hajj has an important clinical impact. A proportion of CAP cases among Hajj pilgrims were attributable to S. pneumoniae, a pathogen for which vaccines are available. Additional studies to determine the serotypes causing pneumococcal disease could further inform vaccine policy for Hajj pilgrims.
朝觐人群聚集是导致肺炎球菌病的一个风险因素。本研究旨在评估 2016 年朝觐朝圣者中社区获得性肺炎（CAP）成人病例归因于肺炎链球菌的比例。为了增加病因归因的敏感性，除了基于培养的方法外，还使用了尿液抗原检测。
从麦加和麦地那的所有指定收治朝觐朝圣者的综合医院中，前瞻性纳入经 X 射线证实患有 CAP 的成年住院患者。患者根据当地标准进行治疗，并接受 BinaxNow S. pneumoniae 尿液抗原检测。
2016 年 8 月 23 日至 9 月 23 日，共有 266 例 CAP 患者入组本研究，其中 70.6%的患者入住麦加的医院；53%的病例发生在朝觐高峰期之后。患者来自 43 个国家。他们的平均年龄为 65.3 岁，男女比例为 2:1。超过 36%的病例患有糖尿病，10%的病例报告自己是吸烟者，45.4%的病例在重症监护病房（ICU）接受治疗。总的病死率为 10.1%，但 ICU 治疗和侵袭性疾病的病死率更高。基于培养或尿液抗原检测，CAP 病例中肺炎链球菌阳性的比例为 18.0%（95%置信区间 13.9-23.1%）。
朝觐期间的 CAP 具有重要的临床影响。朝觐朝圣者中 CAP 病例的一部分归因于肺炎球菌，这种病原体有疫苗可用。进一步开展研究以确定引起肺炎球菌病的血清型可以为朝觐朝圣者的疫苗接种政策提供进一步的信息。
