Respiratory symptoms, preventive practices, and antibiotic use during Hajj: A post-pandemic cross-sectional survey among Malaysian pilgrims.

Objectives: Hajj is a major international mass gathering associated with high respiratory symptom burden. After coronavirus disease 2019, preventive behaviors such as vaccination, mask use, hand hygiene, gargling, and cough etiquette may have changed. This study described respiratory symptoms, preventive practices, antibiotic use, and functional impact among Malaysian Hajj pilgrims in 2023. Methods: A cross-sectional online survey was conducted from September to December 2023 among Malaysian adults who performed Hajj in 2023. Data included comorbidities, vaccination status, preventive practices, respiratory symptoms, antibiotic use, and impact on daily activities. Symptoms were self-reported and not clinically or microbiologically confirmed. Descriptive and logistic regression analyses were performed. Results: Among 743 respondents, 619 (83.3%) reported at least one respiratory symptom. Common symptoms were cough with phlegm (70.0%), runny nose (62.0%), sore throat (57.7%), and fever (43.5%). Most respondents received both influenza and pneumococcal vaccines (77.8%). Mask use (79.5%), cough etiquette (67.8%), and handwashing (64.3%) were common, whereas regular hand sanitizer use (25.6%) and gargling were less frequent. Antibiotics were used by 58.8% of symptomatic respondents. Chronic disease increased symptom odds, whereas frequent hand sanitizer use reduced odds. Conclusion: Respiratory symptoms remained common post-pandemic despite high vaccination uptake and preventive practices. Findings support strengthened pre-Hajj health optimization, respiratory hygiene education, and prudent antibiotic use.