Viral respiratory infections among Hajj pilgrims in 2013

Abstract

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.

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

“…Accumulating evidence suggests higher prevalence and rapid acquisition of respiratory viruses among pilgrims during Hajj compared with their status before departing their home countries . Indeed, our report as well as others have shown a high prevalence of at least one respiratory virus in more than 50% of symptomatic pilgrims during several Hajj seasons, although lower rates were reported in some studies .…”

No evidence of MERS‐CoV in Ghanaian Hajj pilgrims: cautious interpretation is needed

“…In 2013, the virus spread to a number of countries, including by Umrah performers/returnees . There were several surveillance studies performed at Hajj 2013, referenced by Annan et al ., but others not been cited even though they add to our understanding (Table ).…”

“…In contrast, studies by Barasheed et al . and Benkouiten et al . were conducted at the main Hajj locations (Makkah and Mina) during the peak period of Hajj with daily follow‐up.…”

Response to the letter to the editor: Barasheed et al., ‘No evidence of MERS‐CoV in Ghanaian Hajj pilgrims: cautious interpretation is needed’

“…Barasheed et al cite two more studies on surveillance of MERS-CoV in returning Hajj pilgrims, both of which were published after the submission of our manuscript, thus highlighting the interest of MERS-CoV surveillance of Hajj pilgrims that is obviously perceived in the scientific community at the moment [1][2][3][4].…”

“…Furthermore, Barasheed et al comment on a lack of the prevalence of influenza-like illness (ILI) in our study. In their table, they provide details on the definitions used in the studies by Barasheed et al and Benkoutien et al [2,4] to assess ILI, both of which include subjective fever and respiratory symptoms such as cough, sore throat and rhinorrhea in their definition without assessing the date of onset. According to the WHO, influenza-like illness is defined as 'measured fever of ≥ 38°C and cough with onset within the last 10 days' [6].…”