MERS‐CoV, influenza and other respiratory viruses among symptomatic pilgrims during 2014 Hajj season

Abstract

More than two million Muslims visit Makkah, Saudi Arabia, annually to perform the religious rituals of Hajj where the risk of spreading respiratory infections is very common. The aim here was to screen symptomatic pilgrims for Middle East respiratory syndrome coronavirus (MERS‐CoV) and other viral etiologies. Thus, 132 nasopharyngeal samples were collected from pilgrims presenting with acute respiratory symptoms at the healthcare facilities in the holy sites during the 5 days of the 2014 Hajj season. Samples were tested using real‐time reverse transcription polymerase chain reactions and microarray. Demographic data including age, sex, and country of origin were obtained for all participants. While we did not detect MERS‐CoV in any of the samples, several other viruses were detected in 50.8% of the cases. Among the detected viruses, 64.2% of the cases were due to a single‐virus infection and 35.8% were due to the coinfections with up to four viruses. The most common respiratory virus was influenza A, followed by non‐MERS human coronaviruses, rhinoviruses, and influenza B. Together, we found that it was not MERS‐CoV but other respiratory viruses that caused acute respiratory symptoms among pilgrims. The observed high prevalence of influenza viruses underscores the need for more effective surveillance during the Hajj and adoption of stringent vaccination requirements from all pilgrims.

Pattern of Respiratory Viruses among Pilgrims during 2019 Hajj Season Who Sought Healthcare Due to Severe Respiratory Symptoms

“…Non-Middle East respiratory syndrome (MERS) HCoVs including CoV-OC43, CoV-HKU1, and CoV-NL63 were readily detected in this study, which also corresponds to previous reports ( Figure 3 ) ( Table 2 ) [ 8 , 9 , 11 , 17 ]. Unlike some published reports [ 8 , 18 , 19 , 20 , 21 , 22 , 23 ], our data showed most cases were significantly associated with pilgrims over 60 years of age ( Table 1 ). The vulnerability of elders to infections is probably due to a less efficient immune response, which is provoked by factors such as chronic diseases, and physical and mental stress [ 24 , 25 , 26 ].…”

“…Enterovirus, Bocavirus, and M. pneumoniae were not detected. As previously described [ 8 , 9 , 10 , 11 , 12 ], our study also shows that these respiratory viral infections are common during Hajj. However, the specific viral type, frequency, and combinations of viruses detected vary between studies due to differences in the study design, target population, and other variables [ 8 , 9 , 10 , 11 , 12 ].…”

“…HRV was the most commonly detected virus followed by influenza A (H1N1) then CoV-229E, and influenza A other than H1N1 ( Figure 3 ) ( Table 2 ). Several studies have shown similar trends [ 8 , 11 , 13 , 14 , 15 , 16 ]. Non-Middle East respiratory syndrome (MERS) HCoVs including CoV-OC43, CoV-HKU1, and CoV-NL63 were readily detected in this study, which also corresponds to previous reports ( Figure 3 ) ( Table 2 ) [ 8 , 9 , 11 , 17 ].…”

“…Several studies have shown similar trends [ 8 , 11 , 13 , 14 , 15 , 16 ]. Non-Middle East respiratory syndrome (MERS) HCoVs including CoV-OC43, CoV-HKU1, and CoV-NL63 were readily detected in this study, which also corresponds to previous reports ( Figure 3 ) ( Table 2 ) [ 8 , 9 , 11 , 17 ]. Unlike some published reports [ 8 , 18 , 19 , 20 , 21 , 22 , 23 ], our data showed most cases were significantly associated with pilgrims over 60 years of age ( Table 1 ).…”

“…Patients participating in this study descended from 37 countries, mainly from Asia ( n = 119; 64%) and Africa ( n = 56; 30.3%), followed by Europe ( n = 5; 2.70%), North America for each ( n = 4; 2.2%), then Oceania ( n = 1; 0.54%). Respiratory viruses have been more frequently detected in patients arriving from countries providing annually the highest number of pilgrims [ 8 ]. Pilgrims from Indonesia followed by India and Egypt represented the most positive cases of respiratory viruses (more than 10 cases).…”