Detection of Respiratory Viruses Among Pilgrims in Saudi Arabia During the Time of a Declared Influenza A(H1N1) Pandemic

Abstract Background The objectives of this study were to determine whether pilgrim attendance at the Hajj was associated with an increased risk of acquiring influenza, and other respiratory viruses, and to evaluate the compliance of pilgrims with influenza vaccination and other recommended preventive measures. Methods A cross‐sectional survey was conducted among pilgrims as they arrived at the King Abdulaziz International Airport in Jeddah for the 2009 Hajj and as they departed from the same airport during the week after the Hajj. Nasopharyngeal and throat swabs were tested for 18 respiratory virus types and subtypes using the xTAG Respiratory Viral Panel FAST assay. Results A total of 519 arriving pilgrims and 2,699 departing pilgrims were examined. Their mean age was 49 years and 58% were male. In all, 30% of pilgrims stated that they had received pandemic influenza A(H1N1) vaccine before leaving for the Hajj and 35% of arriving pilgrims reported wearing a face mask. Only 50% of arriving pilgrims were aware of preventive measures such as hand hygiene and wearing a mask. The prevalence of any respiratory‐virus infection was 14.5% (12.5% among arriving pilgrims and 14.8% among departing pilgrims). The main viruses detected (both groups combined) were rhinovirus‐enterovirus (N = 414, 12.9%), coronaviruses (N = 27, 0.8%), respiratory syncytial virus (N = 8, 0.2%), and influenza A virus (N = 8, 0.2%) including pandemic influenza A(H1N1) (N = 3, 0.1%). The prevalence of pandemic influenza A(H1N1) was 0.2% (N = 1) among arriving pilgrims and 0.1% (N = 2) among departing pilgrims. The prevalence of any respiratory virus infection was lower among those who said they received H1N1 vaccine compared to those who said they did not receive it (11.8% vs 15.6%, respectively, p = 0.009). Conclusion We found very low pandemic influenza A(H1N1) prevalence among arriving pilgrims and no evidence that amplification of transmission had occurred among departing pilgrims.

[1]  T. Madani.  Preventive strategies to keep Saudi Arabia SARS-free☆ , 2004, American Journal of Infection Control.

[2]  N. Khamis,et al.  Epidemiological pattern of diseases and risk behaviors of pilgrims attending mina hospitals, hajj 1427 h (2007 g). , 2008, The Journal of the Egyptian Public Health Association.

[3]  A. Turkistani,et al.  Hajj-associated acute respiratory infection among hajjis from Riyadh. , 2006, Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit.

[4]  J. Brownstein,et al.  Global public health implications of a mass gathering in Mecca, Saudi Arabia during the midst of an influenza pandemic. , 2010, Journal of travel medicine.

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

[6]  Hanan H Balkhy,et al.  Influenza a common viral infection among Hajj pilgrims: time for routine surveillance and vaccination. , 2006, Journal of travel medicine.

[7]  I. Mackay.  Human rhinoviruses: The cold wars resume , 2008, Journal of Clinical Virology.

[8]  Aziz Sheikh,et al.  Hajj and the risk of influenza , 2006, BMJ : British Medical Journal.

[9]  A. Alzeer.  Respiratory tract infection during Hajj , 2009, Annals of thoracic medicine.

[10]  L. Finelli,et al.  Emergence of a novel swine-origin influenza A (H1N1) virus in humans. , 2009, The New England journal of medicine.

[11]  F. Mahoney,et al.  Establishment of public health security in Saudi Arabia for the 2009 Hajj in response to pandemic influenza A H1N1 , 2009, The Lancet.

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

[13]  H. Balkhy,et al.  Acceptance and Adverse Effects of H1N1 Vaccinations Among a Cohort of National Guard Health Care Workers during the 2009 Hajj Season , 2011, BMC Research Notes.

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

[15]  Ziad A Memish,et al.  Health risks at the Hajj , 2006, The Lancet.

[16]  Z. Memish,et al.  Pandemic H1N1 influenza at the 2009 Hajj: understanding the unexpectedly low H1N1 burden , 2010, Journal of the Royal Society of Medicine.

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

[18]  P. Chong,et al.  Acute respiratory symptoms in adults in general practice , 2004, Family practice.

[19]  R. Booy,et al.  Prevention of pandemic influenza after mass gatherings – learning from Hajj , 2010, Journal of the Royal Society of Medicine.

[20]  French Guiana.  Health conditions for travellers to Saudi Arabia for the pilgrimage to Mecca (Hajj). , 2008, Releve epidemiologique hebdomadaire.

[21]  Ziad A Memish,et al.  Mecca bound: the challenges ahead. , 2006, Journal of travel medicine.

[22]  S M El-Sheikh,et al.  Bacteria and viruses that cause respiratory tract infections during the pilgrimage (Haj) season in Makkah, Saudi Arabia , 1998, Tropical medicine & international health : TM & IH.

[23]  Z. Memish,et al.  Travel epidemiology: the Saudi perspective. , 2003, International journal of antimicrobial agents.

[24]  Hisham O Akbar,et al.  Pattern of admission to hospitals during muslim pilgrimage (Hajj). , 2003, Saudi medical journal.