Viral respiratory infections among Hajj pilgrims in 2013

Middle East respiratory syndrome coronavirus (MERS-CoV) has emerged in the Arabian Gulf region, with its epicentre in Saudi Arabia, the host of the ‘Hajj’ which is the world’s the largest mass gathering. Transmission of MERS-CoV at such an event could lead to its rapid worldwide dissemination. Therefore, we studied the frequency of viruses causing influenza-like illnesses (ILI) among participants in a randomised controlled trial at the Hajj 2013. We recruited 1038 pilgrims from Saudi Arabia, Australia and Qatar during the first day of Hajj and followed them closely for four days. A nasal swab was collected from each pilgrim who developed ILI. Respiratory viruses were detected using multiplex RT-PCR. ILI occurred in 112/1038 (11%) pilgrims. Their mean age was 35 years, 49 (44%) were male and 35 (31%) had received the influenza vaccine pre-Hajj. Forty two (38%) pilgrims had laboratory-confirmed viral infections; 28 (25%) rhinovirus, 5 (4%) influenza A, 2 (2%) adenovirus, 2 (2%) human coronavirus OC43/229E, 2 (2%) parainfluenza virus 3, 1 (1%) parainfluenza virus 1, and 2 (2%) dual infections. No MERS-CoV was detected in any sample. Rhinovirus was the commonest cause of ILI among Hajj pilgrims in 2013. Infection control and appropriate vaccination are necessary to prevent transmission of respiratory viruses at Hajj and other mass gatherings.

[1]  U. Bauer,et al.  [Centers for Disease Control and Prevention (CDC)]. , 2000, Annales de dermatologie et de venereologie.

[2]  Z. Memish,et al.  Influenza and respiratory syncytial virus infections in British Hajj pilgrims , 2008, Emerging health threats journal.

[3]  R. Booy,et al.  Viral respiratory infections at the Hajj: comparison between UK and Saudi pilgrims , 2008, Clinical Microbiology and Infection.

[4]  Abdolvahab Alborzi,et al.  Viral etiology of acute respiratory infections among Iranian Hajj pilgrims, 2006. , 2009, Journal of travel medicine.

[5]  E. Lara-Padilla,et al.  Inside the Outbreak of the 2009 Influenza A (H1N1)v Virus in Mexico , 2010, PloS one.

[6]  L. Rombo,et al.  Influenza in travellers , 2010, Current opinion in infectious diseases.

[7]  I. Barr,et al.  Influenza Outbreaks during World Youth Day 2008 Mass Gathering , 2010, Emerging infectious diseases.

[8]  P. Simmonds,et al.  Epidemiology and Clinical Presentations of the Four Human Coronaviruses 229E, HKU1, NL63, and OC43 Detected over 3 Years Using a Novel Multiplex Real-Time PCR Method , 2010 .

[9]  N. Othman,et al.  The prevalence of acute respiratory symptoms and role of protective measures among Malaysian hajj pilgrims. , 2010, Journal of travel medicine.

[10]  P. Brouqui,et al.  Protective measures against acute respiratory symptoms in French pilgrims participating in the Hajj of 2009. , 2011, Journal of travel medicine.

[11]  T. Wolff,et al.  Assays for laboratory confirmation of novel human coronavirus (hCoV-EMC) infections. , 2012, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[12]  H. Agut,et al.  Clinical and Microbiological Evaluation of Travel‐Associated Respiratory Tract Infections in Travelers Returning From Countries Affected by Pandemic A(H1N1) 2009 Influenza , 2011, Journal of travel medicine.

[13]  Gwen Stephens,et al.  Detection of Respiratory Viruses Among Pilgrims in Saudi Arabia During the Time of a Declared Influenza A(H1N1) Pandemic , 2011, Journal of travel medicine.

[14]  B. Sibal,et al.  Evidence of person-to-person transmission within a family cluster of novel coronavirus infections, United Kingdom, February 2013. , 2013, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[15]  Z. Memish,et al.  Prevention of influenza at Hajj: applications for mass gatherings , 2013, Journal of the Royal Society of Medicine.

[16]  Philippe Brouqui,et al.  Circulation of Respiratory Viruses Among Pilgrims During the 2012 Hajj Pilgrimage , 2013, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[17]  M. Cetron,et al.  International travelers as sentinels for sustained influenza transmission during the 2009 influenza A(H1N1)pdm09 pandemic. , 2013, Journal of travel medicine.

[18]  R. Booy,et al.  Acute febrile respiratory infection symptoms in Australian Hajjis at risk of exposure to Middle East respiratory syndrome coronavirus , 2013, The Medical journal of Australia.

[19]  A. Hameed,et al.  Air Microbial Contamination at the Holy Mosque, Makkah, Saudi Arabia , 2013 .

[20]  G. Rimmelzwaan,et al.  Effect of Travel on Influenza Epidemiology , 2013, Emerging infectious diseases.

[21]  Z. Memish,et al.  Health conditions for travellers to Saudi Arabia for the Umra and pilgrimage to Mecca (Hajj) – 2014 , 2014, Journal of Epidemiology and Global Health.

[22]  A. Tsakris,et al.  A case of imported Middle East Respiratory Syndrome coronavirus infection and public health response, Greece, April 2014. , 2014, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[23]  S. Almalki,et al.  The pattern of Middle East respiratory syndrome coronavirus in Saudi Arabia: a descriptive epidemiological analysis of data from the Saudi Ministry of Health , 2014, International journal of general medicine.

[24]  Z. Memish,et al.  Prevalence of MERS-CoV Nasal Carriage and Compliance With the Saudi Health Recommendations Among Pilgrims Attending the 2013 Hajj , 2014, The Journal of infectious diseases.

[25]  C. Blyth,et al.  Pandemic clinical case definitions are non-specific: multiple respiratory viruses circulating in the early phases of the 2009 influenza pandemic in New South Wales, Australia , 2014, Virology Journal.

[26]  Z. Memish,et al.  Emerging respiratory viral infections: MERS-CoV and influenza , 2013, The Lancet Respiratory Medicine.

[27]  Clive Brown,et al.  First Confirmed Cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection in the United States, Updated Information on the Epidemiology of MERS-CoV Infection, and Guidance for the Public, Clinicians, and Public Health Authorities — May 2014 , 2014, American Journal of Transplantation.

[28]  D. Dwyer,et al.  Pilot Randomised Controlled Trial to Test Effectiveness of Facemasks in Preventing Influenza-like Illness Transmission among Australian Hajj Pilgrims in 2011. , 2014, Infectious disorders drug targets.

[29]  R. Booy,et al.  Has Hajj‐associated Middle East Respiratory Syndrome Coronavirus transmission occurred? The case for effective post‐Hajj surveillance for infection , 2014, Clinical Microbiology and Infection.

[30]  R. Charrel,et al.  From the Hajj: it's the flu, idiot , 2013, Clinical Microbiology and Infection.

[31]  S. Zainah,et al.  Laboratory-confirmed case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in Malaysia: preparedness and response, April 2014. , 2014, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[32]  Z. Memish,et al.  Respiratory Tract Samples, Viral Load, and Genome Fraction Yield in Patients With Middle East Respiratory Syndrome , 2014, The Journal of infectious diseases.

[33]  M. Ison,et al.  Respiratory viral infections among hospitalized adults: experience of a single tertiary healthcare hospital , 2014, Influenza and other respiratory viruses.

[34]  R. Charrel,et al.  Lack of MERS Coronavirus but Prevalence of Influenza Virus in French Pilgrims after 2013 Hajj , 2014, Emerging infectious diseases.

[35]  R. Charrel,et al.  Respiratory Viruses and Bacteria among Pilgrims during the 2013 Hajj , 2014, Emerging infectious diseases.

[36]  R. Charrel,et al.  Comparison of nasal swabs with throat swabs for the detection of respiratory viruses by real-time reverse transcriptase PCR in adult Hajj pilgrims , 2014, Journal of Infection.

[37]  E. Holmes,et al.  A cluster-randomised controlled trial to test the efficacy of facemasks in preventing respiratory viral infection among Hajj pilgrims , 2014, Journal of Epidemiology and Global Health.