The Risk of a Cholera Outbreak during the Hajj

Millions of pilgrims attend the annual Hajj to the holy city of Mecca and because of the mass gatherings involved, there is often a high potential of public health challenges coming up. The large influx of people from across the globe and the considerable amount of time that they spend in close proximity to one another leads to a situation where there is a high risk of disease transmission (1). The transmission of such disease is not only a matter of concern for the pilgrims, but also for the local population. The introduction of such disease as cholera can end up putting the entire public health system of Saudi Arabia, as well as those of the home countries of the pilgrims at a compromise because they might bring back this disease with them on their return. It is therefore extremely pertinent to ensure that there is an effective understanding of the cholera epidemic and the manner through which it has affected the Hajj pilgrims in the past and its potential of return in future events.

Cholera epidemics in Mecca have been recorded since the nineteenth century with the first recorded case appearing in 1831 (2). However, these epidemics developed in the Hejaz region but since 1912, there have been no reported epidemics that have developed in Mecca and its environs. It is important to note that prior to the use of steam ships in 1866 to transport pilgrims, caravan transport was the most common means of transportation (3). Because of the latter, it was possible for epidemics to die out prior to the pilgrims’ arrival in Mecca because of the long duration of their journeys (4, 5). Steam navigation that was used to transport pilgrims from Egypt and India to the Hejaz not only led to considerable proximity, but also the increase in the likelihood of individuals carrying epidemics to Mecca and back to their home countries (6). It is important to note that despite epidemics arising from time to time in the subsequent years, the most recent cholera outbreak took place in the Hajj of 1989, which is an extremely important public health victory for the Saudi government. During the latter outbreak, about 102 pilgrims were affected, and the disease was contained (7).

Despite the precautions that have been taken by the Saudi government, it is important to note that the country is still at risk of a cholera epidemic. This is especially considering that there is currently a cholera epidemic in neighboring Yemen, which has affected more than 300,000 people (8). Thus, the potential of this epidemic spreading during the Hajj to Mecca is highly significant because it could end up spreading to the rest of the world as pilgrims return home. In recent years, the pilgrimage has drawn between 2 and 4 million individuals from all over the world. The outbreak of cholera in Yemen as well as in some African countries might end up presenting a serious risk to all pilgrims during the Hajj and after returning to their countries (9, 10). It is however noteworthy that because of the strict measures that it has taken; Saudi Arabia has not had a cholera outbreak in many years. This situation therefore means that the government has taken appropriate measures to counter the potential of the disease appearing in its borders, especially during the Hajj.

It is therefore important to consider the potential of cholera during the Hajj a serious threat. By putting such considerations at the forefront of public health policy, the government of Saudi Arabia can work hand in hand with its partners, especially the countries from which pilgrims originate, to ensure that threats are discovered early and eliminated prior to the Hajj (11). Furthermore, Saudi Arabia can make sure to reinforce its surveillance and rapid test system in order to detect cases early (12). The latter system has worked extremely well in recent years because outbreaks of cholera have not been recorded in decades. Also, the Saudi government should work hand in hand with the World Health Organization (WHO) in order to undertake a joint risk assessment of the situation so that they can develop recommendations to curb any potential outbreak in a manner that is clinically, operationally, and financially sustainable (13). Such measures, as well as the strict implementation of WHO guidelines to prevent cholera, and also undertaking campaigns to raise awareness about this disease during the Hajj could go a long way towards its prevention. Finally, Saudi Arabia should work towards enhancing its measures to protect both pilgrims and locals through regular screenings and testing from the potential of cholera outbreaks.

There is a threat of a #cholera epidemic in #Mariupol

Centralized water supply/sewerage is not working.the city is drowning in garbage and sewage.Almost every yard has mass burials and the summer heat has accelerated the decomposition of thousands of corpses under the rubble

— Надія (@Hope_grayblonde) June 7, 2022

Reference List

1.         Niu S, Xu M. Impact of Hajj on Global Health Security. Journal of religion and health. 2019;58(1):289-302.

2.         Omar W. The Mecca Pilgrimage: Its Epidemiological Significance and Control. Postgraduate medical journal. 1952;28(319):269.

3.         Miller M, editor The Business of the Hajj: Seaborne Commerce and the Movement of Peoples. Seascapes, Littoral Cultures, and Trans-Oceanic Exchanges” Washington, DC: Library of Congress; 2003.

4.         Brower BC. The Hajj by Land. The Hajj: Pilgrimage in Islam. 2015:87.

5.         Low MC. Empire and the Hajj: pilgrims, plagues, and pan-Islam under British surveillance, 1865–1908. International Journal of Middle East Studies. 2008;40(2):269-90.

6.         Boyle SA. Cholera, Colonialism, and Pilgrimage: Exploring Global/Local Exchange in the Central Egyptian Delta, 1848-1907. Journal of World History. 2015:581-604.

7.         Ahmed QA, Arabi YM, Memish ZA. Health risks at the Hajj. The Lancet. 2006;367(9515):1008-15.

8.         VOA. WHO Warns of Cholera Risk at Hajj, Praises Saudi Preparedness. VOA; 2017.

9.         Green A. Cholera outbreak in the horn of Africa. The Lancet. 2017;389(10085):2179.

10.       Almutairi MM, Alsalem WS, Hassanain M, Hotez PJ. Hajj, Umrah, and the neglected tropical diseases. PLoS neglected tropical diseases. 2018;12(8):e0006539.

11.       Al-Tawfiq JA, Memish ZA. The Hajj 2019 Vaccine Requirements and Possible New Challenges. Journal of epidemiology and global health. 2019.

12.       Alotaibi BM, Yezli S, Bin Saeed A-AA, Turkestani A, Alawam AH, Bieh KL. Strengthening health security at the Hajj mass gatherings: characteristics of the infectious diseases surveillance systems operational during the 2015 Hajj. Journal of travel medicine. 2017;24(3):1-6.

13.       Zumla A, McCloskey B, Endericks T, Azhar EI, Petersen E. The challenges of cholera at the 2017 Hajj pilgrimage. The Lancet Infectious Diseases. 2017;17(9):895-7.

The Role of Communication in Patient Safety

In nursing, communication is one of the most essential elements in ensuring that the safety of the patients has been met, because without it, then the patient outcome rates will be considerably low. For many years, effective communication has been linked to the positive outcomes of patients. It has been noticed that nurse communication has an effect on the length in which patients stay in hospital as well as the efficiency of their treatment. Adequate nurse communication in medical centers has the outcome of decreasing the duration of patients’ stay in hospital. It has also been found that there is a decrease in the number of medical errors made concerning patients. Furthermore, adequate communication also has an impact on nurses because they become more motivated in their work, which increases their efficiency. This efficiency helps the patient as it improves the care which they are given, and this leads to the patient’s swift recovery.

One of the factors which influence communication between nurses and patients is the complexity of the hospital and nursing systems, so that the larger and more complex they are, the higher the risk that the potential for patient errors will be increased. It is therefore necessary to ensure that adequate communication between the various hospital systems is instituted so that the number of such errors can be reduced or done away with. The quality of care depends completely on the accuracy and completeness of information being available to the nurses who care for the patients. While this is important, it should be noted that the accuracy of the information becomes outdated over time and this is the reason why more, up to date information has to be collected to ensure that the caregivers provide the best service possible to the patient.

Errors tend to occur when during the communication of a patient’s medication. This usually happens when there is a misinterpretation of the various abbreviations or acronyms to the drugs which have been prescribed to the patient. This creates a situation where there is the potential of a patient taking the wrong drugs, taking the drugs at the wrong time of the day, or even worse, taking an overdose of the prescribed drugs. It is therefore necessary to ensure that errors in the writing down of instructions for the patient or caregiver are avoided and that the person writing the said instructions is alert at all times to the potential of making mistakes. Among the recommendations that can be made is that there must be a standardization of all the abbreviations and acronyms for the drugs used in the medical field so that there can be no confusion over the type of drugs that have been prescribed. It has been found that many drugs have similar names which may lead to the nurse giving the patient the wrong medicine. To prevent such incidences, it has been recommended that capital and small letters be used to differentiate the drugs with similar names to avoid confusion. This will work to ensure that there is uniformity in the communication of medication and this will ultimately promote the safety of the patients to whom the medication is prescribed. With uniformity in communication, the work of the nurses will become less cumbersome because they will be able to be accurate in their administration of medication.

In many hospital systems, there is always a breakdown in communication due to the fact that the nursing staff is usually afraid to report errors because of the potential of being punished. This fear has made it difficult for errors to be corrected and has ensured that the outcome for patients is greatly diminished. The lack of adequate communication has created a scenario where nurses are not able to conduct their activities efficiently and this has come to have a devastating impact on the safety of the patients. Hospital management should create an environment where nurses and other hospital staff are comfortable enough to report any errors which they find without any fear of punishment. In order to achieve this, the management of the hospital should have frequent communication with the nurses who deal directly with the patients and know firsthand the needs and requirement of the latter. Such regular communication ensures that the nursing staff is free with the management, and because of this, errors which would not otherwise have been pointed out come to be dealt with quickly to ensure the safety of the patients involved.

The effort of the healthcare industry to improve the safety of patients is being hampered because of the poor communication between caregivers and patients as well as the lack of adequate tools for measuring the safety of patients. Furthermore, despite the availability of a wide array of medical equipment and practices, they cannot be effective without there being adequate communication between the caregivers and the patients. In order to make sure that medical care is efficient, there is a need for the establishment of mechanisms or structures which will enable medical staff to communicate with patients. This will ensure that medical staff  to acquire adequate and accurate data to help them make the correct judgment concerning how to deal with patients. This will create a situation where the number of errors are reduced and the effectiveness of treatment, hence patient safety.

While a few decades ago the incidents of errors being made by hospital staff were low, today, such errors have become common and the biggest cause of this is poor communication. This has become so widespread that it is a constant worry for the management of hospitals. The best way through which caregiver can ensure the safety of their patients is when they have adequate knowledge of the condition of their patient. This ensure that the caregiver is better able to communicate with the patient and it creates an environment where the patient is confident  in his or her caregiver and this helps to improve patient outcome.

Communication is an important factor in ensuring the safety and high outcome for patients and it is essential that nurses develop their communication skills. Communication is one of the most common problems facing the medical profession today and it is because of this that the number of errors has, over time, increased. It is therefore necessary for adequate communication to be developed with patients to ensure that they have a high standard of safety.

Pneumonia

Pneumonia is a medical state that affects the air sacs in the lungs identified as alveoli and it can be defined further as an inflammatory lung condition. This condition is tends to be caused by either viral or bacterial infections, as well as certain microorganisms or some drugs which individuals are ingesting. In addition, pneumonia might be caused by autoimmune diseases which make it easier for infections to occur in the lungs. Among the most typical symptoms of this condition coughs, pain in the chest, a certain amount of fever, as well as the person infected having difficulty in breathing. There are various tools which are used in diagnosing this condition and these include the use of x-rays, or taking a sample of sputum for testing. There are various types of vaccines available for the prevention of pneumonia and these are complemented by the treatment measures available for those who suffer from the infection. The treatment of this condition depends on the agent that caused it, whether it is viral or bacterial. If the infection is caused by bacteria, then the condition is treated using antibiotics but if the condition is caused by a virus, on the other hand, the most common treatment used are neuraminidase inhibitors. When an infection is deemed to be severe, the most likely cause of action that doctors tend to take is to have the patient admitted to hospital because if left untreated, this condition often proves to be fatal. It is estimated that on an annual basis, pneumonia affects over four hundred million people and of these, about four million meet their deaths from the condition. While this condition has been made treatable with the advancement of the development of antibiotic therapy as well as vaccines, pneumonia still remains one of the most dangerous as well as the a leading cause of death, especially in developing countries. The people, in these countries, who are at the most risk of infection, tend to be the young, the elderly, and those who are extremely ill.

Those who are infected by pneumonia tend to display certain symptoms which provide the evidence that they have indeed been infected. Among the symptoms that they display include coughing, a fever, a stabbing pain in the chest when taking deep breaths, and most of all, an increase in the rate of respiration because of the shortness of breath that they experience. One of the most prominent symptoms that is displayed by older people is that of being confused. Among children, on the other hand, there is often a fever, coughing, as well as difficulty in breathing. When making a diagnosis of the condition, too much insistence should not be put on the detection of a fever because this is a common symptom that can be found in quite a number of diseases such as malaria among other severe diseases. In addition, coughs should also not be considered to be a common symptom among children who are less than a year old and instead, more severe signs should be looked out for. Among the severe symptoms of this condition is the appearance of a blue tinge on the skin, a decrease in the infected person’s thirst, convulsions, and the most severe of all, a decrease in consciousness level. Whatever the source of infection, whether bacterial or viral, the victims of pneumonia often display the same symptoms and this is the reason why specific tests have to be carried out to ensure that the correct treatment is prescribed to a patient.

While pneumonia is often caused by either bacterial or viral infections, it is not uncommon to find that even fungi and other parasites can cause this condition. It has, however been estimated that of the over one hundred agents that can potentially cause pneumonia, only a few of these agents are actually responsible for the majority of the cases involved. In a little more than 45% of the cases studied in children, it has been found that the causing agents have been a mixture of bacterial and viral infections. Among adults, on the other hand, the potential for there being a mixed bacterial and viral infection as a cause for pneumonia has been estimated to be about 15%. The causing agent of an infection cannot be identified in more than half of the cases tested, despite the tests being conducted carefully. This is the reason why pneumonia has come to be a all-purpose term for any illness that causes the inflammation of the lungs. There are various factors which influence the development of pneumonia and these include the following: smoking, chronic kidney disease, immunodeficiency among other factors. The use of medications that are meant for the suppression of acids as well as old age are risk factors that also expose individuals to pneumonia.

The diagnosis of pneumonia is often done using a combination of both the physical symptoms as well as the conducting of a chest x-ray but despite these; the underlying causative agents of this condition are difficult to determine. This is because of the fact that definitive tests for the determination of the causative agents of this condition have yet to be made. According to the World Health Organization, this condition in children is defined as their having coughs or difficulty in breathing as well as having a rapid respiratory rate. The latter is defined as rapid when the rate of breathing is more than sixty breaths a minute, especially in children who are less than two months old. It has been found that in children, it is much more effective to check for an increased respiratory rate and chest in drawing than having to listen to their chest crackles using a stethoscope. Among adults, it is not necessary to conduct investigations in cases where there are mild symptoms, as long as all the vital signs of the individual are normal. Among those people who require hospitalization after infection, it is recommended that chest radiography and blood tests should be conducted. It is a fact that many of the viral infections that cause pneumonia are based on influenza, and because of this, it must not only be confirmed by symptoms, but also through the conducting of tests.

Among the best ways that have been found to prevent pneumonia is the use of vaccines as well as taking measures which are appropriate for the treatment of other health problems that might be a cause of the condition. It has been estimated that if preventive measures are to be taken to deal with the condition, the quite a large number of children, nearly half a million, would be saved from death per annum. It has also been found that if the necessary treatment for the condition is made available, especially for children, worldwide, then the mortality rates would be reduced by another half a million, meaning that a combination of preventative measures as well as treatments would ensure that the mortality rates among children would be brought down by a million, an extremely significant reduction indeed. Pneumonia vaccines prevent some infections that are either caused by viruses or bacteria in the entire human population, but influenza vaccines have also been found to be effective in preventing infections. It is recommended that individuals who are over six months old should undergo vaccination every year so that the risk of infection, especially those caused by viruses, can be reduced.

It is recommended that those people who smoke cease to do so because they are at a higher risk of getting infected than other people. Furthermore, the reduction of indoor air pollution goes a long way in preventing the development of pneumonia, and to achieve this end, indoor cooking using such fuels as wood should cease. Other preventative measures include the keeping of good general hygiene as well as coughing into ones sleeve in order to prevent any possible infection from getting transferred to others. It is further recommended that those people who are infected by the condition wear surgical masks because to do so will ensure that the risk of the infection being spread within the population is greatly reduced. Pneumonia is sometimes caused by underlying diseases such as HIV or malnutrition, and as a preventative measure, these diseases have to be treated appropriately so that this risk can be reduced. Mothers who exclusively breastfeed their children who are less than six months old ensure that the risk of their contracting pneumonia is reduced, and that if these children are infected, then there is a reduction in the severity of the condition.

When a specialist in the infections that cause pneumonia is making a treatment plan, he or she should also consider other possible treatments for the condition apart from the administration of oral antibiotics. If there is no improvement in the condition of the patient through home care, and the symptoms he or she displays seem to worsen, then it will be necessary for such a person to be hospitalized so that he can receive specialized care. There are times when the only option left for specialists is to design a treatment plan which include the trial of new drugs or treatment methods for their patients. Such options tend to come about especially in situations where other treatments have failed to work. While these new treatments are designed to help the patients involved, they also help in the assessment of how different drugs work on them. This helps in future research, which comes up with even better treatments for pneumonia. In conclusion, it can be said that pneumonia is a medical condition that has plagued the human population for a long time, and it can affect anyone, no matter how young or old they are. Because of this, it is essential to ensure that enough funding is provided so that research in the treatment of this condition can be advanced. In almost every instance that one develops this disease, it comes to affect everyone who is close to them. In severe cases, it is quite possible that an infected person might transmit the condition to those around them, and this is something which is highly undesirable. There are times when treatment for the condition while the patient resides at home proves to be difficult, and the solution is often to have then hospitalized. It is, therefore, essential that the specialist involved in the treatment of the disease to provide the patient with all the treatment options available for them, so that the patient is aware of all the possible ways that their condition might be treated. After doing this, it is the duty of the specialist to advice the patient on what the best treatment options for them are available. When the patient is aware of all the treatment options open to them, it will be immensely easy for them to adjust their lifestyle so that they can dedicate themselves to their recovery.

The re-emergence of disease once believed eradicated or controlled in modern society

Chugh (2008) states that one of the biggest health threats to the public is the reemergence of diseases once believed to have been either eradicated or controlled due to the fact that common bacteria are increasingly developing resistance to antibiotics. This new threat has the ability to reverse all the progress that has been made against diseases since the development of penicillin, due to the fact that diseases such as gonorrhea, meningitis and tuberculosis are developing strains which are drug resistant. A possible reason for this is the current overuse of antibiotics as well as the use of antibiotics on livestock in order to promote their growth. It is a very difficult task to track down these new drug resistant strains of diseases and there is yet to be agreement on how best to deal with this situation. Bettelheim (1999) states that these new strains, after tests were done, were shown to have acquired genetic traits which enabled them to evade most of the conventional lines of pharmaceutical attack, and if left unchecked, they could severely limit the ability of doctors to control dangerous infections. Furthermore, these drug resistant strains would make even the simplest operations into potentially life threatening situations.

There has been news of outbreaks of infectious diseases not only in the United States but also all over the world. According to Krause (1992) diseases which were once thought to have been eradicated, such as polio, are slowly reemerging and very little can be done to stop then due to the fact that they are drug resistant. There are increasing cases of new infections by such strains everyday and these contagions have been making powerful impressions all across the world and many states have chosen to give them special attention in order to develop new ways of eradicating them. Cherry (2010) declares that in the United States, there have been cases of whooping cough especially in California in 2010 where over nine thousand cases were reported with several infant deaths. Kim (2007) states that the most common symptoms of whooping cough are having a runny nose, sneezing, low grade fever, and a mild occasional cough which is similar to the one experienced when having a common cold. Later there develop numerous bursts of coughing accompanied by a long effort to breath in. between episodes, the person infected may appear to be in a normal condition, but in infants, they appear to be very ill. There have been cases where immunization programs have been interrupted due to the belief that the fight against the various infectious diseases has been won and this has enabled the reemergence of these diseases that have resisted the drugs available. Furthermore, the resistance against such diseases has been greatly reduced because of the lack of resistance in human beings.

There are several reasons why the diseases which were once thought to have been eradicated or controlled are reemerging. Esmaeil (2008) states that one of these is the fact that some disease causing bacteria have acquired genes which enable them to resist the drugs which are administered to eradicate them. Another reason is that there is an abundant use of antibiotics and this has enabled the bacteria to develop resistance to drugs. Lastly, the use of antibiotics in livestock to encourage their growth has enabled bacteria which were previously confined to animals to get transmitted to human beings and these have transferred their genes to human bacteria enabling them to survive. Examples of these drug resistant diseases that are reemerging are the tuberculosis and poliomyelitis. Wang (2012) says that there have been cases of doctors refusing to give any medical care to children who have not been immunized because their parents were concerned that vaccines causes autism and other medical problems. The refusal of these parents to have their children vaccinated leaves them vulnerable to attacks from new strains of diseases which can turn out to be infectious and life threatening not only to these children and to others.

Tuberculosis was once a major health problem whose prevalence declined dramatically due to the development of vaccines against it. According to Shields (2005) with the emergence of HIV, tuberculosis has reemerged as an opportunistic infection, developing new drug resistant strains which physicians are finding difficult to treat. This disease has developed resistance to many of the antibiotics which are used to treat it mainly through genetic exchange or mutation or the long term use of antibiotics.

Governmental entities all over the world are finding it very hard to control the reemergence of diseases once thought to have been controlled. Moyers (2012) declares that the cultural and religious beliefs of people tend to influence them into resisting the use of vaccines because of the suspicion that some of these cultures have against them. There are religious practices which do not allow the use of vaccines because of the belief that it is the will of God if one gets a disease and it is not the responsibility of human beings to go against his will. This belief is especially prevalent in the religious practices of the Middle East and the Taliban influenced Afghanistan. European views concerning vaccination are also beginning to change with many parents believing that vaccines negatively affects the health and well being of their children and this increases the resistance to vaccination.

. In conclusion, it is best to educate and get the public to be aware of the existence of these reemerging diseases so that they are better able to protect themselves. State and federal laws should be put in place to ensure that parents are not allowed to opt out of vaccinating their children in order to reduce the risk of a rapid spread of reemerging diseases. There is a risk of the developing of more reemerging diseases and we should be ready for them by the provision of more information to the public concerning the benefits of preventative vaccination.

Cited Works

Bettelheim, A. (1999). Drug-resistant bacteria. CQ Researcher, 9, 473-496. Retrieved from http://0-library.cqpress.com.alice.dvc.edu/cqresearcher/

Chugh, T. D. (2008). Emerging and re-emerging bacterial diseases in India. Journal of Biosciences, 33(4), 549-55.

Kim, C. (2007). Pertusis: A re-emerging threat. The Journal for Nurse Practioners,

Krause, R. (1992). The origin of plagues: old and new. Science 257:1073-1078,

Cherry, J. (2010). The present and future control of pertusis. Editorial Commentary,

Retrieved from http://cid.oxfordjournals.org

Esmaeil, Z. (2008). Emerging and re-emerging zoo noses. Iranian Journal of Clinical Infectious Diseases, 2008(3(2):109-115), www.middle-east-online/english/?id=51041

Moyers, B. (2012). The risk of contagion nation. Middle East online, Retrieved from http:w Caladrillo, P. S. (2005). American law & economic association annual meetings. Vanishing Vaccinations: Why are so many Americans opting out of vaccinating their children?

Shields, B. M. (2005). The bioarchaeology of tuberculosis: A global view on a reemerging disease. Southeastern Archaeology,24(2), 235-0_4. Retrieved from http://0-search.proquest.com.alice.dvc.edu/docview/207213529?accountid=38376

Wang, S. (2012, February 15). More Doctors 'Fire' Vaccine Refusers. The Wall Street Journal.