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. 2019 Jun;91(6):911-917.
doi: 10.1002/jmv.25424. Epub 2019 Feb 20.

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

Anwar M Hashem  1   2 , Tagreed L Al-Subhi  1 , Nassrin A Badroon  1 , Ahmed M Hassan  1 , Leena Hussein M Bajrai  1   3 , Talib M Banassir  4 , Khalid M Alquthami  4 , Esam I Azhar  1   5
Affiliations

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

Anwar M Hashem et al. J Med Virol. 2019 Jun.

Abstract

More than two million Muslims visit Makkah, Saudi Arabia, annually to perform the religious rituals of Hajj where the risk of spreading respiratory infections is very common. The aim here was to screen symptomatic pilgrims for Middle East respiratory syndrome coronavirus (MERS-CoV) and other viral etiologies. Thus, 132 nasopharyngeal samples were collected from pilgrims presenting with acute respiratory symptoms at the healthcare facilities in the holy sites during the 5 days of the 2014 Hajj season. Samples were tested using real-time reverse transcription polymerase chain reactions and microarray. Demographic data including age, sex, and country of origin were obtained for all participants. While we did not detect MERS-CoV in any of the samples, several other viruses were detected in 50.8% of the cases. Among the detected viruses, 64.2% of the cases were due to a single-virus infection and 35.8% were due to the coinfections with up to four viruses. The most common respiratory virus was influenza A, followed by non-MERS human coronaviruses, rhinoviruses, and influenza B. Together, we found that it was not MERS-CoV but other respiratory viruses that caused acute respiratory symptoms among pilgrims. The observed high prevalence of influenza viruses underscores the need for more effective surveillance during the Hajj and adoption of stringent vaccination requirements from all pilgrims.

Keywords: Hajj; Middle East respiratory syndrome-coronavirus; Saudi Arabia; influenza; respiratory infections; viruses.

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Conflict of interest statement

The authors declared that there is no conflict of interests.

Figures

Figure 1
Figure 1
Geographical distribution of infected and noninfected pilgrims according to their country of origin
Figure 2
Figure 2
Patterns of reported respiratory symptoms and detected respiratory viruses during Hajj days. A, Bar graph showing the number of pilgrims presented with respiratory symptoms and tested for respiratory viruses with numbers of those tested positive or negative for any virus during daily. B, Bar graph showing the number of viruses detected from positive cases during the 5 days of Hajj. Day 1, Makkah then Mina in the afternoon; day 2, Arafat in the morning then Muzdalifah at night; day 3, Muzdalifah then Mina in the morning; day 4, Mina, Makkah then Mina; and day 5, Mina
See this image and copyright information in PMC

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