Demographic distribution and transmission potential of influenza A and 2009 pandemic influenza A H1N1 in pilgrims

Abstract

Introduction: The World Health Organization's persistent reporting of global outbreaks of influenza A viruses, including the 2009 pandemic swine A H1N1 strain (H1N1pdm09), justified the targeted surveillance of pilgrims during their annual congregation that pools more than two million people from around 165 nations in a confined area of Makkah city in the Kingdom of Saudi Arabia (KSA). Methodology: A total of 1,600 pilgrims were included in the targeted surveillance of influenza A and the 2009 pandemic swine H1N1 strain in the Hajj (pilgrimage) season of 2010. Each pilgrim responded to a demographic and health questionnaire. Collected oropharyngeal swabs were analyzed by real-time PCR for influenza A viruses, and positive samples were further analyzed for the presence of H1N1pdm09. Fisher's exact test was applied in the analysis of the significance of the distribution of influenza-positive pilgrims according to demographic characters. Results: A total of 120 pilgrims (7.5%) tested positive for influenza A viruses by real-time PCR. Nine out of the 120 influenza-A-positive pilgrims (7.5%) were positive for H1N1pdm09. Demographics played a significant role in those pilgrims who tested positive for influenza A. Conclusions: The detection of H1N1pdm09 in pilgrims at their port of entry to the KSA was alarming, due to the high potential of transboundary transmission. This situation necessitates the implementation of specific prevention and control programs to limit infection by influenza A viruses.

Vaccinations against respiratory tract infections at Hajj

“…However, meta-analysis of the data from 6 studies which provided both laboratory results by vaccination status [10,14,16,22,25,33] shows that the influenza vaccine was significantly protective against laboratory-confirmed influenza among Hajj pilgrims (RR, 0.56; 95% CI, 0.41-0.75; p < 0.001) (Fig. 2).…”

“…Of these, 6 studies reported laboratory-confirmed influenza as an outcome [10,14,16,22,25,33], but only one study found influenza vaccine to be effective in reducing influenza (p < 0.001) [10]. However, meta-analysis of the data from 6 studies which provided both laboratory results by vaccination status [10,14,16,22,25,33] shows that the influenza vaccine was significantly protective against laboratory-confirmed influenza among Hajj pilgrims (RR, 0.56; 95% CI, 0.41-0.75; p < 0.001) (Fig.…”

“…Although 5 of the 6 included studies did not individually show a statistically significant protective effect of the vaccine [10,14,16,22,25,33], this is likely reflective of small sample sizes, as already acknowledged in one study [33]. All studies demonstrated non-significant point estimates of protection by the vaccine, and the pooled data confirm that the vaccine is To our knowledge, this is the first paper that has systematically reviewed the uptake and effectiveness of vaccinations against respiratory infections and provided metadata on the effectiveness of influenza vaccine against laboratory-confirmed influenza in Hajj pilgrims.…”

“…Of these, 17 studies reported on influenza vaccine uptake [9,[11][12][13]15,[17][18][19][20][26][27][28]35,45,[47][48][49], with the remaining 17 studies additionally assessing influenza vaccine effectiveness [10,14,16,[21][22][23][24][25][29][30][31][32][33][34]36,44,46].…”

Vaccination in Hajj: An overview of the recent findings

“…Rhinoviruses,[345] coronaviruses (E229 – SARS – MERS),[6] adenoviruses, both seasonal and pandemic influenza[7] including, influenza A (H3N2) and B,[3] influenza H1N1, parainfluenza viruses, respiratory syncytial viruses, herpes simplex virus,[589] meningococcal diseases[10] and meningococcal carrier state,[11] emerging hypervirulent strains, i.e., Streptococcus spp.,[10] Haemophilus influenzae ,[3] Bordetella pertussis ,[12] Chlamydophila pneumoniae , Legionella pneumophila , Mycoplasma pneumonia ,[3] and respiratory tuberculosis. [13]…”