The dynamics and interactions of respiratory pathogen carriage among French pilgrims during the 2018 Hajj
Authors: Tran Duc Anh Ly
Pierre-Edouard Fournier
Kamel Larbi Chaht
Badriah Alotaibi
Philippe Gautret
Saber Yezli
Tassadit Drali
Van-Thuan Hoang
Philippe Parola
Vincent Pommier de Santi
Didier Raoult
Bakridine Mmadi Mrenda
Thi-Loi Dao
Khadidja Belhouchat
Jean Gaudart
Journal: Emerging Microbes & Infections (2019)
Discipline: MICROBIOLOGY
Keywords: Hajj; pathogen interaction; pilgrims; respiratory tract infections.
Affiliations: Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France, IHU-M√©diterran√©e Infection, Marseille, France, Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam, Aix Marseille Univ, INSERM, IRD, SESSTIM UMR1252, Faculty of Medicine Marseille, France, APHM, La Timone Hospital, Biostatistics & ICT Marseille, France, French Military Centre for Epidemiology and Public Health, Marseille, France, The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia, Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France

Abstract:  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. Each participant underwent four successive systematic nasopharyngeal swabs before and during their stay in Saudi Arabia. Carriage of the main respiratory pathogens was assessed by PCR. 121 pilgrims were included and 93.4% reported respiratory symptoms during the study period. The acquisition of rhinovirus, coronaviruses and Staphylococcus aureus occurred soon after arrival in Saudi Arabia and rates decreased gradually after days 5 and 6. In contrast, Streptococcus pneumoniae and Klebsiella pneumoniae carriage increased progressively until the end of the stay in Saudi Arabia. Haemophilus influenzae and Moraxella catarrhalis carriage increased starting around days 12 and 13, following an initial clearance. Influenza viruses were rarely isolated. We observed an independent positive mutual association between S. aureus and rhinovirus carriage and between H. influenzae and M. catarrhalis carriage. Dual carriage of H. influenzae and M. catarrhalis was strongly associated with S. pneumoniae carriage (OR = 6.22). Finally, our model showed that M. catarrhalis carriage was negatively associated with K. pneumoniae carriage. Chronic respiratory disease was associated with symptoms of LRTI. K. pneumoniae, M. catarrhalis-S. aureus and H. influenzae-rhinovirus dual carriage was associated with LRTI symptoms. Our data suggest that RTIs at the Hajj are a result of complex interactions between a number of respiratory viruses and bacteria. 

Retracted: No

PubPeer comments:
 Several articles have been published in different high impact factor journals concerning the results of a protocol on muslims who participated in the 2013-2017 Hajj (extended to 2018 in some articles). In all these publications, the same protocol authorized by an IRB under the number 2013-A00961u201344 on July 23, 2013 has been used. But there is serious concern on the compliance of this study to the Helsinki Declaration. Authors mentioned that the study has been approved by IRB in July 23, 2013 and started in September 2013. The protocol was approved by the Aix Marseille Universitu00e9 institutional review board (July 23, 2013; reference no. 2013-A00961u201344). There is several discrepancies in these information. **Did The study start in 2012 before the ethics committee approval ?** In another journal, the Travel Medicine and Infectious Disease journal, certains of the same authors published the results of this protocol, with the same reference number. [Antibiotic use for respiratory infections among Hajj pilgrims: A cohort survey and review of the literature] For information, one of the authors is also Associate Editor in the Travel Medicine and Infectious Disease journal. In article published in Travel Medicine and Infectious Disease journal, you can note that the same protocol started in 2012 and get the ethics committee approval after (on July 23, 2013). I quote: * Pilgrims from Marseille, France participating in the Hajj from 2012 to 2017 were recruited at a specialized travel agency organizing trips to Mecca. * * The protocol was approved by the Aix-Marseille University institutional review board (**July 23rd, 2013**; reference no. 2013-A00961-44). * This is not a spelling mistake. As mentioned in the study and annexes, 169 pilgrims have been recruited in 2012 and data are provided for this year with the same protocol. As the authors mentioned themselves in the Travel Medicine and Infectious Disease journal that the protocol reference no. 2013-A00961u201344 started in 2012, the Year 2012 should be considered as the study start date for all articles related to the protocol approved under the reference #2013-A00961u201344 A study cannot be published in a scientific journal if it started before to get the proper Ethics Committee approval. Retrospective ethics committee approval is a serious breach of the Helsinski Declaration. Furthermore, I would like to note that only certified IRB (aka CPP in France) can authorize prospective interventional studies in France. Aix Marseille Universitu00e9 Ethics Committee is not a certified IRB in France. The format of the reference # is a RCB ID. This # (2013-A00961u201344) is delivered by the French Health Agency. Not by a certified IRB (CPP). As a consequence, there is a ground for serious and legitimate concerns about the study start date and the ethic committee approval. With regards of the Helsinki Declaration, Editors should consider this matter and clarify this situation asap. **List of articles related to the protocol authorized under the number 2013-A00961u201344 on July 23, 2013** 1 - [Antibiotic use for respiratory infections among Hajj pilgrims: A cohort survey and review of the literature] 2 - [Respiratory Viruses and Bacteria among Pilgrims during the 2013 Hajj] 3 - [Lack of MERS Coronavirus but Prevalence of Influenza Virus in French Pilgrims after 2013 Hajj] 4 - [The dynamics and interactions of respiratory pathogen carriage among French pilgrims during the 2018 Hajj] 5 - [Gastrointestinal symptoms and the acquisition of enteric pathogens in Hajj pilgrims: a 3-year prospective cohort study] 6 - [Acquisition of multidrug-resistant bacteria and encoding genes among French pilgrims during the 2017 and 2018 Hajj] 7 - [Comparative genomics of two Shewanella xiamenensis strains isolated from a pilgrim before and during travels to the Hajj] 8 - [High Prevalence of Mycoplasma faucium DNA in the Human Oropharynx] 9 - [Comparison of nasal swabs with throat swabs for the detection of respiratory viruses by real-time reverse transcriptase PCR in adult Hajj pilgrims] 10 - [Respiratory tract infections among French Hajj pilgrims from 2014 to 2017] ,