Ahead of Print -Respiratory Viruses and Bacteria among Pilgrims during the 2013 Hajj - Volume 20, Number 11—November 2014 - Emerging Infectious Disease journal - CDC
Volume 20, Number 11—November 2014
Respiratory Viruses and Bacteria among Pilgrims during the 2013 Hajj
More than 2 million Muslims gather annually in Saudi Arabia for a pilgrimage to the holy places of Islam known as the Hajj. The Hajj presents major public health and infection control challenges. Inevitable overcrowding within a confined area with persons from >180 countries in close contact with others, particularly during the circumambulation of the Kaaba (Tawaf) inside the Grand Mosque in Mecca, leads to a high risk pilgrims to acquire and spread infectious diseases during their time in Saudi Arabia (1), particularly respiratory diseases (2). Respiratory diseases are a major cause of consultation in primary health care facilities in Mina, Saudi Arabia, during the Hajj (3). Pneumonia is a leading cause of hospitalization in intensive care units (4).
Numerous studies have shown a high prevalence of respiratory symptoms among pilgrims (5–7). Respiratory viruses, especially influenza virus, are the most common cause of acute respiratory infections among pilgrims (8–11). We recently reported the acquisition of rhinovirus (5) and Streptococcus pneumoniae infections (12) by French pilgrims during the 2012 Hajj season and highlighted the potential for spread of these infections to home countries of pilgrims upon their return. However, none of the French pilgrims were positive for Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012 (13) and 2013 (14).
In this study, we collected paired nasal and throat swab specimens from adult pilgrims departing from Marseille, France to Mecca, Saudi Arabia, for the 2013 Hajj season. The primary objective was to determine the prevalence of the most common respiratory viruses and bacteria upon return of pilgrims from the Hajj. The secondary objective was to evaluate the potential yearly variation of the acquisition of these respiratory pathogens by comparing results from the 2012 and 2013 Hajj seasons.