Viral respiratory infections at the Hajj: comparison between UK and Saudi pilgrims

Abstract

A high incidence of respiratory infection, including influenza, has been reported at the Hajj in Mecca, Saudi Arabia. Reported rates of influenza have been higher among UK than among domestic pilgrims, but this could be explained by methodological differences among studies. Accordingly, the present study compared the frequencies of respiratory viruses among UK and Saudi pilgrims using the same study design. Pilgrims with upper respiratory tract symptoms were recruited from Mecca and the neighbouring valley Mina during the Hajj 2006. Nasal swabs were used for point-of-care influenza testing and real-time RT-PCR (rtRT-PCR) tests for influenza virus, rhinovirus, parainfluenza virus, adenovirus, human metapneumovirus and respiratory syncytial virus. Of 260 pilgrims investigated, 150 were from the UK and 110 were Saudi; of these, 38 (25%) UK pilgrims and 14 (13%) Saudi pilgrims had respiratory infections detectable by rtRT-PCR (p 0.01). In the UK group, there were 19 (13%) cases of rhinovirus infection, 15 (10%) cases of influenza virus infection, two (1%) cases of dual infections with influenza virus and rhinovirus, one (3%) case of parainfluenza virus infection, and one (1%) case of respiratory syncytial virus infection. Fifty-six (37%) UK pilgrims had been vaccinated against influenza virus, with the rates of influenza in the vaccinated and unvaccinated group being 7% and 14%, respectively (p 0.19). In the Saudi group, there were three (3%) cases of rhinovirus infection and 11 (10%) cases of influenza. Only four (4%) Saudi pilgrims had been vaccinated against influenza virus, and none of these was infected with influenza virus. Overall, a significantly higher proportion of the UK pilgrims had detectable respiratory infections (25% vs. 13%, p 0.01). Influenza rates were similar in both groups, but the reported rates of influenza vaccination differed.

Vaccinations against respiratory tract infections at Hajj

“…As the 2013 Hajj took place in midOctober none of the pilgrims in the French cohort reported receiving the vaccine of that season, however 44.2% reported receiving the vaccine in the previous northern winter season [44]. Among UK pilgrims, three studies reported the uptake between [22,32,33]. The latter compared the data between British and Saudi pilgrims with a reported uptake of 55% among 'at risk' and 29% among 'not at risk' UK pilgrims [32].…”

“…In 1998 and M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 9 conducted in Mina (Mecca) reporting a vaccine uptake of 4.4% among international and local pilgrims [18]. In 2006, a comparative study between the UK and Saudi Arabian pilgrims reported uptake of influenza vaccine among Saudi pilgrims of only 4%, compared to the uptake among UK pilgrims of 37% [32].…”

“…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].…”

“…Among the 34 studies that investigated influenza vaccine uptake, 6 were conducted among Saudi Arabian pilgrims between 1998 and 2009 [11][12][13]15,18,32], with vaccine uptake ranging from 0.7% in 2002 to 94.4% in 2009 [12,15]. In 1998 and M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 9 conducted in Mina (Mecca) reporting a vaccine uptake of 4.4% among international and local pilgrims [18].…”

Determining the Types of Diseases and Emergency Issues in Pilgrims During Hajj: A Literature Review

“…diarrhea, food poisoning, etc. are examples of communicable diseases [10,11,12,13]. Due to the physical exertion and overcrowding situation, some pre-existing chronic diseases such as asthma, heart disease, chronic chest conditions, diabetes, renal and liver disease may become harmful for pilgrims especially elderly which eventually favors the spread of communicable namely non-chronic diseases or infectious disease [14].…”