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Respiratory Viruses and Bacteria among Pilgrims during the 2013 Hajj - Volume 20, Number 11—November 2014 - Emerging Infectious Disease journal - CDC


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

Samir Benkouiten, Rémi Charrel, Khadidja Belhouchat, Tassadit Drali, Antoine Nougairede, Nicolas Salez, Ziad A. Memish, Malak al Masri, Pierre-Edouard Fournier, Didier Raoult, Philippe Brouqui, Philippe Parola, and Philippe GautretComments to Author 
Author affiliations: Aix Marseille Université, Marseille, France (S. Benkouiten, R. Charrel, K. Belhouchat, T. Drali, A. Nougairede, N. Salez, P.-E. Fournier, D. Raoult, P. Brouqui, P. Parola, P. Gautret)Institut Hospitalo-Universitaire Méditerranée, Marseille (S. Benkouiten, R. Charrel, A. Nougairede, N. Salez, P.-E. Fournier, D. Raoult, P. Brouqui, P. Parola, P. Gautret)Saudi Ministry of Health, Riyadh, Saudi Arabia (Z.A. Memish, M. al Masri)Alfaisal University College of Medicine, Riyadh (Z.A. Memish)


Pilgrims returning from the Hajj might contribute to international spreading of respiratory pathogens. Nasal and throat swab specimens were obtained from 129 pilgrims in 2013 before they departed from France and before they left Saudi Arabia, and tested by PCR for respiratory viruses and bacteria. Overall, 21.5% and 38.8% of pre-Hajj and post-Hajj specimens, respectively, were positive for ≥1 virus (p = 0.003). One third (29.8%) of the participants acquired ≥1 virus, particularly rhinovirus (14.0%), coronavirus E229 (12.4%), and influenza A(H3N2) virus (6.2%) while in Saudi Arabia. None of the participants were positive for the Middle East respiratory syndrome coronavirus. In addition, 50.0% and 62.0% of pre-Hajj and post-Hajj specimens, respectively, were positive for Streptococcus pneumoniae (p = 0.053). One third (36.3%) of the participants had acquired S. pneumoniae during their stay. Our results confirm high acquisition rates of rhinovirus and S. pneumoniae in pilgrims and highlight the acquisition of coronavirus E229.
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 (57). Respiratory viruses, especially influenza virus, are the most common cause of acute respiratory infections among pilgrims (811). 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.

Dr Benkouiten is a researcher at the Institut Hospitalo–Universitaire Méditerranée Infection, Marseille, France. His research interests focus on the epidemiology of respiratory infections in the context of mass gatherings.


This study was supported by The Marseille Public Hospitals Authority.


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Suggested citation for this article: Benkouiten S, Charrel R, Belhouchat K, Drali T, Nougairede A, Salez N, et al. Respiratory viruses and bacteria among pilgrims during the 2013 Hajj. Emerg Infect Dis [Internet]. 2011 Nov [date cited].
DOI: 10.3201/eid2011.140600

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