• Farah Al-Ansari, Mustafa Al Ansari, Grant A Hill-Cawthorne, Mohammed Saeed Abdulzahra, Mohammad Basim Al-Ansari, Basma Al-Ansari, Harunor Rashid, Joel Negin, and Katherine M Conigrave.
• University of Sydney, Faculty of Medicine and Health, Central Clinical School, Camperdown, 2006, NSW, Australia. Electronic address: farah.alansari@sydney.edu.au.
• Travel Med Infect Dis. 2020 May 1; 35: 101546.

BackgroundArbaeen is an annual religious procession in Iraq with an estimated 17-20 million participants. Public health risks associated with such a mass gathering can be serious at both local and global levels. This is the first quantitative examination of risk factors for, and symptoms of, infectious disease among Arbaeen participants.MethodsA cross-sectional survey was conducted of a convenience sample of 191 Arbaeen participants in 2017. Interviewers administered a structured questionnaire. Questions included food sources, preventive measures used and symptoms of infectious diseases during the procession.ResultsData were collected for 191 participants (143 males, 58 females). The most prevalent symptoms were respiratory (runny nose: 22.6%, cough: 22.5%). Diarrhoea was reported by 12.6% of participants, with a strong association with high-income country origin and eating (commercial) street food (odds ratios 6.1 and 4.1, respectively, p < 0.05). All symptoms investigated, except breathlessness, were more prevalent in high-income country participants (p < 0.05).ConclusionStreet food and high-income country origin were independent risk factors for respiratory or gastrointestinal infection symptoms in this sample of Arbaeen participants. However, these results cannot be generalised due to possible selection bias. Further studies are required to inform policy development and health system preparedness to reduce Arbaeen-associated health risks.Copyright © 2019 Elsevier Ltd. All rights reserved.

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