@article{fdi:010074072,
  title = {{A}cquisition of enteric pathogens by pilgrims during the 2016 {H}ajj pilgrimage : a prospective cohort study},
  author = {{S}ow, {D}. and {D}ogue, {F}abiola and {E}douard, {S}. and {D}rali, {T}. and {P}rades, {S}. and {B}attery, {E}. and {Y}ezli, {S}. and {A}lotaibi, {B}. and {S}okhna, {C}heikh and {R}aoult, {D}. and {P}arola, {P}. and {G}autret, {P}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {D}iarrhea can be frequent among {H}ajj pilgrims; however, data on its etiology are very limited. {P}atients and methods: {A} prospective cohort study was conducted among {H}ajj pilgrims in 2016. {M}edical follow-up and systematic rectal swabing were performed before leaving {F}rance and before leaving {S}audi {A}rabia. {P}otential pathogens were identified using the {B}io{F}ire {F}ilm{A}rray ({R}) {G}astrointestinal multiplex qualitative {PCR} panel. {R}esults: 117 pilgrims were included and 13.7% experienced diarrhea during {H}ajj. {O}f the pre-{H}ajj samples, 32.5% were positive for at least one pathogen compared to 50% of post-{H}ajj samples (p = 0.0033). {D}iarrhea associated {E}scherichia coli. strains, notably enteropathogenic {E}. coli ({EPEC}), enteroaggregative {E}. coli ({EAEC}), and {S}higa-like toxin-producing {E}. coli, were acquired by 29.9%, 10.2%, and 6.5% pilgrims, respectively. {P}ilgrims with resolved diarrhea were significantly more likely to have post-{H}ajj {EAEC} positive samples, compared with those who did not suffer diarrhea (55.6% vs 16.5%). {W}e found a lower prevalence of {EPEC} (22.5%) in pilgrims who declared washing their hands more frequently at the {H}ajj than usually as compared to others (40.0%). {C}onclusion: {T}he acquisition of diarrhea associated {E} coli by {H}ajj pilgrims is of major concern given the high prevalence rate of third-generation cephalosporin-resistant {E}. coli in {S}audi {A}rabia.},
  keywords = {{H}ajj ; {M}ass gathering ; {D}iarrhea ; {E}scherichia coli ; {PCR} ; {ARABIE} {SAOUDITE} ; {FRANCE}},
  booktitle = {},
  journal = {{T}ravel {M}edicine and {I}nfectious {D}isease},
  volume = {25},
  numero = {},
  pages = {26--30},
  ISSN = {1477-8939},
  year = {2018},
  DOI = {10.1016/j.tmaid.2018.05.017},
  URL = {https://www.documentation.ird.fr/hor/fdi:010074072},
}