The prevalance of respiratory viruses among healthcare workers serving pilgrims in Makkah during the 2009 influenza A (H1N1) pandemic

Abstract

Despite the high risk of acquiring respiratory infections, healthcare workers who treat pilgrims at Hajj have not been studied in previous research on respiratory diseases during Hajj. The objective of this study was to determine the prevalence of different respiratory viruses among healthcare workers who treated pilgrims during Hajj 2009, the year of the influenza A H1N1 pandemic. A cross-sectional study was performed just before and after Hajj (25-29 November, 2009). Nasal and throat swabs were tested for 18 respiratory virus types and subtypes. A total of 184 healthcare workers were examined. Most were men (85%) with an average age of 41 years. Before the Hajj, rates of seasonal influenza vaccination were higher (51%) than rates of pandemic influenza A H1N1 vaccination (22%). After the Hajj, participants reported high rates of maintaining hand hygiene (98%), cough etiquette (89%), and wearing a face mask (90%). Among all the viruses tested, only two were detected: rhinovirus was detected in 12.6% and Coronavirus 229E in 0.6%. Rhinovirus was detected in 21% of those who had respiratory symptoms during Hajj. Influenza A (including H1N1), influenza B. respiratory syncytial virus, other coronaviruses, parainfluenza viruses, human metapneumovirus, adenovirus, and human bocavirus were not detected. The finding of high rates of rhinovirus infection corresponds to their frequent occurrence in adults. None of the participants had influenza A H1N1 2009, possibly because it was also infrequent among the 2009 pilgrims.

Acquisition of respiratory and gastrointestinal pathogens among health care workers during the 2015 Hajj season

“…12 In a study conducted among 120 HCWs from the Saudi Ministry of Health (MOH) and other Hajj medical missions during the 2009 season, 10.6% reported respiratory symptoms during the Hajj, and 12.5% were found infected by at least 1 virus post-Hajj comparing to 7.5% pre-Hajj using a PCR assay. 6 All positive cases were due to rhinovirus, but 1 post-Hajj case was due to coronavirus 229E. 6 We confirm in the current work that HCWs attending ill Hajj pilgrims present frequently with respiratory symptoms (29%) during and soon after the Hajj period.…”

“…6 All positive cases were due to rhinovirus, but 1 post-Hajj case was due to coronavirus 229E. 6 We confirm in the current work that HCWs attending ill Hajj pilgrims present frequently with respiratory symptoms (29%) during and soon after the Hajj period. Additionally, we show that diarrhea is rare (3%).…”

“…One study investigated respiratory viruses among HCWs treating pilgrims during the 2009 Hajj and detected rhinovirus and coronavirus 229E in 12.6% and 0.6% of the participants, respectively. 6 Rhinovirus was detected in 21% of those who had respiratory symptoms during Hajj.…”

Influenza viral infections among the Iranian Hajj pilgrims returning to Shiraz, Fars province, Iran

“…The authors, however, have failed to explain the low prevalence of seasonal influenza in their study 8 . In a separate study, the authors have further claimed that none of the 184 healthcare workers they tested before and after the Hajj had influenza 12 . Interestingly, pH1N1 was not the dominant strain among Iranian pilgrims and was reported in only 1·8% pilgrims even though they were unvaccinated.…”

“…It is also interesting to note that the extremely low burden of pH1N1 with a high case‐fatality ratio (of 5%) reported by Saudi authorities has sparked controversy 14 . Most of the published studies including ours may have underestimated the actual burden of influenza as the recruitment occurred after the conclusion, or before the start of the Hajj 8,9,12 . Real‐time surveillance during the peak period of the Hajj would have revealed the true picture.…”