Isoenzyme characterisation of Entamoeba histolytica into pathogenic and non-pathogenic zymodemes substantiated previously held views that this parasite con5titutes two distinct strains or even sub-species that are morphologically identical but vary in their pathogenicity. A reappraisal of the epidemiology of amoebiasis and investigation of the patho-physiological relationships between these pathogenic and non-pathogenic zymodemes and their host was therefore indicated. Only pathogenic zymodemes were isolated from hospitalised patients with amoebic liver abscess (ALA) and amoebic dysentery (AD). In the amoebiasis endemic peri-urban population of Durban, I. histolytica occurred at an overall prevalence of 10%. Carriers of non-pathogenic zymodemes constituted 9% of the population. A key observation was that asymptomatic infections with pathogenic zymodemes occurred at a prevalence of 1%. Higher prevalence of E. histolytica occurred in association with poor sanitary conditions. Furthermore., both pathogenic and non-pathogenic zymodemes tended to cluster into family units suggesting person-to-person transmission of the parasite by the faecal-oral route. Although invasive amoebiasis occurs far more frequently in males than females (8:1) both pathogenic and non-pathogenic zymodemes are equally distributed in male and female E. histolytica cyst passers. Ninety percent of carriers of pathogenic zymodemes spontaneously cleared their infections and remained asymptomatic throughout the study period of 2 years while 10% developed AD which required treatment with metronidazole. No spontaneous changes in zymodemes from the non-pathogenicto the pathogenic type was observed in a longitudinal study. The serological response of asymptomatic carriers of pathogenic zymodemes (100% seropositive) was identical to that of patients with ALA or AD with a high proportion (94-100%) of them being strongly seropositive. The prevalence of seropositivity amongst subjects who were not infected by E. histolytica (13% seropositive) was not statistically different (p>0,5) from that of the random population of this endemic area (19% seropositive) and carriers of non-pathogenic zymodemes (21% positive); the prevalence of strongly seropositive reactions among this group was only between 2-4%. It is concluded that a positive serological response is directly due to past or present contact with pathogenic zymodemes. This is further substantiated by the observation that the proportion of seropositive subjects was found to increase dramatically in a population near Cape Town where an outbreak of invasive amoebiasis (ALA and AD) occurred indicating a high prevalence of pathogenic zymodemes in this community. Another community in northern Transvaal (Gazankulu) where ALA and AD does not occur was, as expected, uniformly seronegative. Axenic growth of pathogenic zymodemes was possible but could not be accomplished with the non-pathogenic zymodemes. Even though monaxenic growth together with Trypanosoma cruzi was possible with both strains, the pathogenic zymodemes tended to grow more prolificly. No zymodeme changes from non-pathogenic to pathogenic and vice versa were observed with such changes in culture conditions. Cyst production by the pathogenic zymodemes in vivo was confirmed experimentally, thereby demonstrating the ability of pathogenic E. histolytica to independently complete their life-cycle thus giving it the ability to propagate itself successfully as a species. / Thesis (M.D.)-University of Natal, Durban, 1989.

Au Québec, en 2007, plus de 1 384 000 voyages internationaux ont été effectués. Ce nombre est 50 % plus élevé qu'il ne l'était en 2000. Conséquemment, le comité consultatif québécois sur la santé des voyageurs (CCQSV) a émis, comme priorité en 2008, de dresser un portrait actuel de l'épidémiologie et du fardeau lié aux maladies acquises en voyage. OBJECTIFS Décrire l'épidémiologie des 4 maladies à l'étude au Québec, entre 2004 et 2007. Secondairement, comparer certains résultats avec une étude antérieure pour 3 de ces maladies et valider une variable nommée "ÉPISODE ACQUIS HORS QUÉBEC" ajoutée au fichier provincial des maladies à déclaration obligatoire (MADO) en 2003. DEVIS : Étude descriptive transversale des cas de fièvre typhoïde, d'hépatite A, de malaria et de shigellose. DONNÉES ET MÉTHODOLOGIE: Les cas des quatre maladies à l'étude, inscrits dans le fichier MADO, entre les années 2004 et 2007, ont été analysés avec l'information disponible dans les enquêtes épidémiologiques. Pour les cas de shigellose, un échantillonnage a eu lieu. Les variables ont été colligées par un seul évaluateur à l'aide d'une grille pré-testée. La qualité des données a été validée par une double collecte et une double saisie. Lorsque possible, les données concernant l'ensemble des voyageurs, et non seulement les cas, ont été tirées des données sur les voyages internationaux de STATISTIQUE CANADA. La sensibilité et la spécificité de la variable "épisode acquis hors Québec" ont été calculées en comparant l'information inscrite au fichier MADO avec celle des questionnaires d'enquête épidémiologique des directions de santé publique, considérés comme l'étalon or. L'étude de Provost et al. (2006) a été utilisée aux fins de comparaisons. RÉSULTATS: La proportion de cas liés aux voyages a été calculée : malaria (78,3 %), fièvre typhoïde (73,4 %), shigellose (50 %) et hépatite A (35,8 %). Le nombre de cas déclarés durant la période varie de 55 cas pour la fièvre typhoïde à 760 cas pour la shigellose. L'incidence annuelle moyenne (par 100 000 personnes) liée aux voyages pour la période 2004-2007 est de 0,59 pour la malaria, 0,13 pour la fièvre typhoïde, 0,49 pour la shigellose et 0,44 pour l'hépatite A. Les immigrants qui retournent visiter la famille et les amis (VFA). sont importants en proportion chez les cas de malaria (52,9 %). Les cas d'hépatite A surviennent davantage durant les voyages de plus de deux semaines (75,6 %). Une proportion importante des cas d'hépatite A provient de l'Afrique (28,3 %). Le sous-continent indien obtient le rapport du nombre de cas sur le nombre de voyages le plus élevé pour la fièvre typhoïde, l'hépatite A et la shigellose. La shigellose se démarque des autres maladies avec une majorité de cas chez les touristes (76,1 %) et les cas surviennent principalement lors de courts séjours d'une semaine ou moins (39,6 %). La variable "ÉPISODE ACQUIS HORS QUÉBEC" du fichier MADO présente encore une proportion importante de dossiers ou l'information est inconnue (28,6 %) pour les maladies à l'étude. En excluant les données inconnues, la variable présente une sensibilité de 97,5 % et une spécificité de 98,5 %. Comparativement à la période 2000-2002, la proportion de cas chez les VFA a augmentée pour la malaria et la fièvre typhoïde. La proportion de cas de malaria contractés en Afrique sub-saharienne a aussi augmentée (87,2 % vs 72 % en 2000-2002). CONCLUSIONS Les 4 maladies à l'étude sont encore des maladies fréquentes chez les voyageurs internationaux québécois. Les voyageurs à destination de l'Afrique et du sous-continent indien méritent une attention spéciale, tout particulièrement les voyageurs du type VFA. Les touristes devraient être avisés du risque de shigellose malgré la vaccination contre d'autres maladies. Il est recommandé d'uniformiser le format des questionnaires d'enquête au niveau provincial et de sensibiliser les professionnels à l'importance de saisir le pays d'acquisition au fichier MADO. Malgré l'excellente sensibilité et spécificité de la variable, il est conseillé de l'utiliser avec prudence.

No description available.

Itraconazole is a triazole antifungal used in the treatment of allergic bronchopulmonary aspergillosis (ABPA) in patients with cystic fibrosis (CF) and for the prevention of invasive fungal infections in paediatric patients undergoing bone marrow transplants (BMT). The pharmacokinetic (PK) properties of this drug and its active metabolite have been described before; however, there is only sparse information available of the PK properties of this drug in the general paediatric population and CF patients in particular. Even though the target concentrations to obtain treatment success from this drug in ABPA have not been established, therapeutic drug monitoring has been shown to be necessary due to a high interpatient variability and low concentrations reported in these patient groups. The general aim of this thesis was to use modelling approaches to provide a better understanding of the PK of itraconazole, in particular to investigate the relative bioavailability of the two commercial formulations (capsule and oral solution), and to attempt to evaluate relationships between patient characteristics and parameters to enable better individualised therapy to maximise the benefits of this drug. The first study was a paediatric population PK (popPK) investigation of itraconazole and its active metabolite hydroxy-itraconazole in CF and BMT patients. All paediatric CF or BMT patients taking oral itraconazole for therapeutic reasons were eligible for the study. A minimum of two blood samples were drawn after the capsules and also after switching to oral solution, or vice versa. Itraconazole and hydroxy-itraconazole plasma concentrations were measured by a newly developed and validated high-performance liquid chromatography. A nonlinear mixed-effects modelling approach (NONMEM 5.1.1) was used to describe the PK of itraconazole and hydroxy-itraconazole simultaneously. A 1-compartment model with first order absorption and elimination best described itraconazole kinetics, with first order conversion to hydroxy-itraconazole. For itraconazole, the apparent clearance and volume of distribution was 35.5 L/h and 672 L, respectively; the absorption rate constant for the capsule formulation was 0.0901 h¯¹ and for the oral solution formulation it was 0.959 h¯&sup1. The relative bioavailability for the capsules was 0.55. Of several screened covariates, only allometrically scaled total body weight significantly improved the fit to the data. No difference between the two populations was found. High inter-patient variability confirmed previous data in CF, leukaemia and BMT patients. From the population model, simulations were performed to develop more adequate dosage regimens to achieve target therapeutic trough plasma concentration of 0.5 mg/L. Higher doses of itraconazole than presently used are needed in these patients, particularly when it is prescribed as capsules. To further support the aims of the thesis, a popPK study with oral itraconazole and its active metabolite in adult patients with CF for capsule and oral solution was performed. A D-optimal study design was developed in MATLAB using POPT v. 2.0, B, which was based on the administration of solution and capsules to 30 patients in a cross-over design. Eight blood samples were taken on two occasions as per the optimal sampling design and assayed by HPLC. NONMEM (5.1.1) was used for the popPK analysis. A total of 241 blood samples were collected, of which 94% were taken within the defined optimal sampling window. A 2-compartment model with first order absorption and elimination best described itraconazole kinetics, with first order formation for metabolism to the hydroxy-metabolite. Absorption rate constants for capsule and solution were 0.0315 h¯¹ and 0.125 h¯¹, respectively. The comparative bioavailability of the capsule to solution was 0.82 in this study. There was no evidence of nonlinearity in the PK of itraconazole and no screened covariate significantly improved the fit to the data. There was high inter-patient variability confirmed previous results in CF. The optimal design performed well for estimation of model parameters from a complex parent-metabolite popPK model. Due to the sampling windows, most of the samples could be collected within the daily hospital routine, but at times that were “near-optimal” for estimating the popPK parameters. Simulations from the final model showed that the current dosing regimen of 200 mg twice daily would provide a trough target concentration at steady state in only 35% of patients when administered as the solution, and 31% when administered as the capsules. The optimal dosing schedule was 500 mg b.d. for both formulations. Since the therapeutic target for itraconazole, is still unresolved, the potential risks of these dosing schedules need to be assessed on an individual basis. This thesis provides information on several methods and their applications to sparse sampling population pharmacokinetic studies and offers results and future directions to maximize the benefits of itraconazole therapy. The population modelling approach has been successfully applied to both clinical studies.

Diagnosis of paediatric HIV infection presents a spectrum of challenges particularly in countries where resources are constrained. This program of research aims to illuminate epidemiological and clinical aspects of HIV diagnosis in resource limited settings focusing in particular on the nation of Papua New Guinea (PNG). This body of work commences with an exploration of current literature pertaining to diagnosis of HIV infection in resource constrained settings. This exploration encompasses the current epidemiological data available on HIV infection in the paediatric population worldwide, currently available methods of diagnosis and other aspects of diagnosis of paediatric HIV infection in developing nations including sampling considerations, breast feeding, health services, human resources and the relationship between early diagnosis and early treatment. The next chapter presents an epidemiological analysis of the HIV epidemic in PNG and a description of the paediatric services at Port Moresby General Hospital (PMGH) the site for most of the research presented in the thesis. The original research presented in the thesis begins with a report (Chapter 3) of a survey of paediatric diagnosis and treatment services in PNG in comparison to other countries in the Asia Pacific region. This is followed by an exploratory retrospective study elucidating factors associated with HIV testing and HIV positive serostatus in children admitted to PMGH. Selection for testing was found to be significantly associated with age, length of hospital stay and diagnoses of diarrhoea, malnutrition and oral candidiasis. Tuberculosis was associated with HIV positive serostatus. In advance of a prospective study to ascertain clinical predictors of HIV infection, a study to evaluate acceptability of HIV testing amongst carers of children admitted to PMGH was undertaken. Testing was acceptable to the majority of carers interviewed. This program of research concludes with a prospective cross-sectional study revealing low weight for age, persistent fever, lymphadenopathy and oral candidiasis to be independent predictors of HIV infection in children admitted to PMGH. An algorithm for clinically directed screening of children for HIV infection in a hospital setting was subsequently developed. Finally evidence based clinical recommendations and suggestions for the direction of future research efforts were made.

Itraconazole is a triazole antifungal used in the treatment of allergic bronchopulmonary aspergillosis (ABPA) in patients with cystic fibrosis (CF) and for the prevention of invasive fungal infections in paediatric patients undergoing bone marrow transplants (BMT). The pharmacokinetic (PK) properties of this drug and its active metabolite have been described before; however, there is only sparse information available of the PK properties of this drug in the general paediatric population and CF patients in particular. Even though the target concentrations to obtain treatment success from this drug in ABPA have not been established, therapeutic drug monitoring has been shown to be necessary due to a high interpatient variability and low concentrations reported in these patient groups. The general aim of this thesis was to use modelling approaches to provide a better understanding of the PK of itraconazole, in particular to investigate the relative bioavailability of the two commercial formulations (capsule and oral solution), and to attempt to evaluate relationships between patient characteristics and parameters to enable better individualised therapy to maximise the benefits of this drug. The first study was a paediatric population PK (popPK) investigation of itraconazole and its active metabolite hydroxy-itraconazole in CF and BMT patients. All paediatric CF or BMT patients taking oral itraconazole for therapeutic reasons were eligible for the study. A minimum of two blood samples were drawn after the capsules and also after switching to oral solution, or vice versa. Itraconazole and hydroxy-itraconazole plasma concentrations were measured by a newly developed and validated high-performance liquid chromatography. A nonlinear mixed-effects modelling approach (NONMEM 5.1.1) was used to describe the PK of itraconazole and hydroxy-itraconazole simultaneously. A 1-compartment model with first order absorption and elimination best described itraconazole kinetics, with first order conversion to hydroxy-itraconazole. For itraconazole, the apparent clearance and volume of distribution was 35.5 L/h and 672 L, respectively; the absorption rate constant for the capsule formulation was 0.0901 h¯¹ and for the oral solution formulation it was 0.959 h¯&sup1. The relative bioavailability for the capsules was 0.55. Of several screened covariates, only allometrically scaled total body weight significantly improved the fit to the data. No difference between the two populations was found. High inter-patient variability confirmed previous data in CF, leukaemia and BMT patients. From the population model, simulations were performed to develop more adequate dosage regimens to achieve target therapeutic trough plasma concentration of 0.5 mg/L. Higher doses of itraconazole than presently used are needed in these patients, particularly when it is prescribed as capsules. To further support the aims of the thesis, a popPK study with oral itraconazole and its active metabolite in adult patients with CF for capsule and oral solution was performed. A D-optimal study design was developed in MATLAB using POPT v. 2.0, B, which was based on the administration of solution and capsules to 30 patients in a cross-over design. Eight blood samples were taken on two occasions as per the optimal sampling design and assayed by HPLC. NONMEM (5.1.1) was used for the popPK analysis. A total of 241 blood samples were collected, of which 94% were taken within the defined optimal sampling window. A 2-compartment model with first order absorption and elimination best described itraconazole kinetics, with first order formation for metabolism to the hydroxy-metabolite. Absorption rate constants for capsule and solution were 0.0315 h¯¹ and 0.125 h¯¹, respectively. The comparative bioavailability of the capsule to solution was 0.82 in this study. There was no evidence of nonlinearity in the PK of itraconazole and no screened covariate significantly improved the fit to the data. There was high inter-patient variability confirmed previous results in CF. The optimal design performed well for estimation of model parameters from a complex parent-metabolite popPK model. Due to the sampling windows, most of the samples could be collected within the daily hospital routine, but at times that were “near-optimal” for estimating the popPK parameters. Simulations from the final model showed that the current dosing regimen of 200 mg twice daily would provide a trough target concentration at steady state in only 35% of patients when administered as the solution, and 31% when administered as the capsules. The optimal dosing schedule was 500 mg b.d. for both formulations. Since the therapeutic target for itraconazole, is still unresolved, the potential risks of these dosing schedules need to be assessed on an individual basis. This thesis provides information on several methods and their applications to sparse sampling population pharmacokinetic studies and offers results and future directions to maximize the benefits of itraconazole therapy. The population modelling approach has been successfully applied to both clinical studies.

Infectious diseases are a major cause of morbidity and mortality worldwide. Streptococcus pneumoniae and Neisseria meningitidis are major causes of severe bacterial disease which can manifest as invasive disease such as bacteraemia and meningitis. Exposure to these pathogens is relatively widespread, yet only a minority of individuals develop invasive disease. A host genetic component to infectious disease susceptibility has been implied from twin and adoptee studies. A role for rare large effect genetic variants in predisposition to infection has been demonstrated through the study of individuals with primary immunodeficiencies. However, a majority of these studies have been undertaken in individuals with a history of recurrent disease or in multi-case families. The relative role of rare genetic variants of moderate to large effect at the population level has not been widely explored. This thesis presents effort made using next generation sequencing methods to identify rare genetic variants that lead to increased susceptibility to bacterial disease focussing on meningococcal disease, pleural infection(empyema), pneumococcal disease and sepsis phenotypes. Using an exome sequencing approach in 13 cases with invasive meningococcal disease, a novel mutation leading to a complement deficiency and increased risk of meningococcal infection was identified and functionally validated in one individual. This mutation in the CFP gene was demonstrated as leading to impaired properdin secretion. Further analysis implicated loss of function mutations in CD4 and ZAP70 as novel loci for meningococcal disease susceptibility. A case control association analysis for sepsis susceptibility highlighted the possible role for small Rho GTPases in sepsis pathology. By aggregating all rare predicted deleterious mutations in a gene, four genes in this pathway, (ROCK2, ARHGAP18, FYN and CDC42BPG) were implicated as having an excess of rare deleterious variants in sepsis samples compared to population controls. A similar approach identified low frequency genetic variants in the CD109 gene as predisposing to empyema susceptibility in children. Finally, preliminary evidence from adult individuals with invasive pneumococcal disease points to a potential role of the RNASE7 gene in invasive pneumococcal disease susceptibility. This association was primarily due to a predicted deleterious missense mutation present in cases and absent in controls. Taken together, these results have identified a number of potential loci with rare variants associated with susceptibility to severe phenotypes of bacterial diseases.

The effect of infectious diseases on the population in the developing countries is of utmost concern. Malaria, tuberculosis (TB) and human immunodeficiency virus (HIV) are the three major infectious disease threats. They account for approximately half of the mortality caused by infectious diseases, which is almost half of the mortality in the developing countries. With no vaccine likely in the foreseeable future, drugs remain the best means of controlling infectious diseases. In the industrialized nations at the present time, some 50% of all prescribed drugs are derived or synthesized from natural products (animals, marine species, plants and micro-organisms). It has been estimated that plants are the most important source of medicine for more than 80% of the world’s population. As previous work on the leaves of Croton steenkampianus gave promising results and revealed that it still contained bioactive compounds that could be isolated, it was chosen for further work. The bioassay guided fractionation of the ethanol crude extract using silica and Sephadex column chromatography resulted in the isolation of six compounds: three flavoniods (quercetin, tamarixetin and eriodictyol), one new indane (1) (2,6-dimethyl-1-oxo-4 indanecarboxylic acid) and two new diterpenes (steenkrotin A (2) and steenkrotin B (3)) with novel skeletons. The structure of the compounds was determined using NMR, IR, UV, MS and X-ray crystallography. Ethanol crude extract, quercetin, steenkrotin A, steenkrotin B and the indane were tested against four strains of Plasmodium falciparum (D6, D10, Dd2 and W2). Quercetin showed good antiplasmodial activity against the D10 and Dd2 strains. The antiplasmodial activity of steenkrotin A and crude extract were moderate. The antimalarial activity of steenkrotin A in particular is promising, as it showed more activity against resistant strains. The indane, and steekrotin B were not active against the strains of P. falciparum used (IC50 > 10 μg/m). The IC50 of the compounds improved when they were combined with chloroquine. However, the IC50 of chloroquine was still the lowest. The compounds showed moderate bioactivity against Bacillus cereus and Escherichia coli. The three new compounds (1, 2 and 3) tested against Mycobacterium (H37Rv) were not active (IC50 > 10 μg/ml). The indane (1) showed anti-HIV activity at 50 μg/ml against reverse transcriptase. The antioxidant activity of the compounds tested ranged from weak to excellent (>280.00 μg/ml for compound 1 and 2 to 0.05 μg/ml for quercetin). The cytotoxicity of the compounds and extract were determined against Vero cells lines. Their IC50 values ranged from 34.0 to 305.9 ìg/ml, which is higher and better than that of chloroquine. The IC50 values obtained are: chloroquine (25.0), quercetin (33.6), steenkrotin A (35.0), ethanol extract (45.0), tamarixetin (53.8), indane (248.2) and steenkrotin B (305.9). / Thesis (PhD)--University of Pretoria, 2009. / Plant Science / unrestricted

Background Active Learning using smartphone technology can be implemented as a tool for teaching medical students (MS) and residents (Rs). The use of technology would increase participation and enhance student learning by engaging them in solving ID clinical case scenarios. Our objective was to describe the methods used and to share the opinions of the users of such active learning methods. Methods The smartphone applications used were Socrative and WhatsApp. We used Socrative during the Universidad Peruana de Ciencias Aplicadas (UPC) ID course for MS in two different ways. In selected lectures (4 of 32), teacher paced questions were asked based on clinical scenarios related to the topic reviewed, and by voluntary homework questionnaires (student paced). At the British American Hospital (BAH) Medicine Department (MS and Rs) Socrative was used similarly: during some noon lectures (teacher paced questions) and during the baseline MS exam and Rs mid-year exam and voluntary homework questions (student paced). WhatsApp is currently used at the BAH with questions send from Monday to Friday. MS /Rs answer individually via WhatsApp to the mentor in charge. The right answer is given the next day. Questions using WhatsApp deal with recent cases seen at the Wards or in the outpatient clinic, and are designed so that the MS/Rs must do quick literature searches in order to provide the right answer. Results Forty-one MS/Rs answered the survey on Socrative use, 25 of 48 (52%) of UPC MS and 16 (89%) MS/Rs from the BAH. Forty (97%) believed using Socrative had influenced their learning and all but 2 believed it promoted participation from the class. 36 (87.8%) would like to have Socrative used in other lectures and 35 (85%) in other courses. Only one person voted against Socrative use in courses or lectures. With regards to WhatsApp use 16 MS/Rs from BAH answered the survey. Six had used before WhatsApp as a teaching tool. All felt the methodology was useful for learning and promoting reading and would recommend this methodology to promote learning on a student paced way. Conclusion Socrative and WhatsApp can be used for teaching ID through MS/Rs smartphones. Most MS/Rs who were surveyed recommended the use of such methods in their education.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfillment of the requirements for the degree of Master of Science in Nursing Johannesburg, 2017 / The Hajj is widely recognized as the world’s largest and globally most diverse kind of mass gathering. This annual five day gathering takes place in the city of Mecca and includes between 2.5 and 3.5 million participants. This poses a great concern by the organizers as the risk for the spread of infectious disease due to overcrowding is greatly increased. These diseases are increasingly being recognized as a potential threat to both local and international public health systems. The lack of understanding of the infectious diseases that originate and disseminate during the Hajj was raised in the Jeddah declaration. Furthermore, despite the protective measures put in place, poor health practices from selective use of the measures by the participants contributes to the increased risks. Exploring the health information needs of the pilgrims attending Hajj, would help in knowing what is required to reduce poor health practices and simplify and improve compliance with protective measures against infectious diseases before, during and after Hajj, and this will help in minimising the spread of infectious diseases in the Hajj. The aim of this study was to explore the health information needs of the pilgrims attending Hajj in order to know what was required to reduce poor health practices and simplify and improve compliance with protective measures against infectious diseases before, during and after Hajj, and this would help in minimizing the spread of infectious diseases in the Hajj. In this study, a qualitative research design was used and focus group discussion using semi-structured questions was conducted. The members were purposely recruited and divided into four groups, two groups of males and two of females. The division of participants into focus groups was in part done in compliance with the Muslim beliefs. Data were collected using a focus group discussion with semistructured questions that was recorded using a tape recorder. These discussions were transcribed verbatim before being analyzed using thematic analysis. The findings of the study showed that pilgrims need a holistic health educational program that addresses their experiences of illnesses and chosen format as educational pamphlets are no longer effective. The findings also revealed that collaboration, surveillance and screening of pilgrims for diseases prior to departure are useful as they help in spreading messages of health and diseases issues with simplicity and yield effective result as well as identifying those at risk of contracting infectious diseases, spreading infectious diseases and exacerbating their diseased conditions. The study recommends the use of digital technology such as an app for phone to send health information to participants and promptly identify and manage individuals who develop illness during mass gathering events like Hajj. It also recommends the incorporation of mass gathering medicine into the curriculum of Nursing program in order to effectively train and equip nurses with better preparation measures against infectious diseases during mass gatherings like Hajj / MT 2019