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Hajj pilgrimage led to acquisition, spread of respiratory infections
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Pilgrims embarking on the annual hajj to Saudi Arabia are at risk of contracting various respiratory infections during their journey and subsequently importing these infections to their home countries and contributing to the global spread of disease, according to recent findings.
“More than 2 million Muslims gather annually in Saudi Arabia for a pilgrimage to the holy places of Islam known as the hajj,” researchers wrote in Emerging Infectious Diseases. “The hajj presents major public health and infection control challenges.”
In a retrospective cohort study, the researchers enrolled 129 residents of Marseilles, France who planned to travel to Saudi Arabia for the 2013 hajj. Prior to leaving France for Saudi Arabia, the participants provided nasal and throat swab specimens and completed a pre-travel questionnaire. The questionnaire sought information on the participants’ demographics and medical history. A post-travel questionnaire, conducted in person 2 days before the return trip to France, gathered clinical information, as well as data on vaccination status and preventive measures. A physician traveling with the pilgrims also chronicled all health problems that occurred during the trip to Saudi Arabia.
The researchers defined influenza-like illness as the existence of cough, sore throat and subjective signs of fever.
Using PCR testing, the nasal swabs were assayed for the following:
influenza A(H3N2), influenza B, influenza C, influenza A(H1N1)pdm09, human adenovirus, bocavirus, cytomegalovirus, coronaviruses, enterovirus, metapneumovirus, parainfluenza viruses, parechovirus, respiratory syncytial virus, and rhinovirus.
The throat swab samples were tested for Streptococcus pneumoniae, Neisseria meningitidis, Bordetella pertussis, and Mycoplasma pneumoniae.
The researchers found that 21.5% of pre-hajj specimens and 38.8% of post-hajj specimens were positive for at least one virus (P=.003). While in Saudi Arabia, almost one-third (29.8%) of the participants acquired at least one virus. The most commonly-acquired viruses were rhinovirus (14%), coronavirus E229 (12.4%) and influenza A(H3N2) virus (6.2%). None of the pilgrims tested positive for Middle East respiratory syndrome, or MERS, coronavirus.
Half of pre-hajj specimens and 62% of post-hajj specimens were positive for S. pneumoniae (P=.053). According to the records kept during the trip, more than one-third (36.3%) of the participants acquired S. pneumoniae while in Saudi Arabia.
According to the researchers, influenza vaccination and the use of hand sanitizer were associated with lower prevalence of respiratory infections.
“Interventional studies are urgently needed that evaluate efficacy of influenza and pneumococcal vaccines and use of hand sanitizer and closely monitor respiratory symptoms and carriage of respiratory pathogens in large cohorts of pilgrims,” the researchers wrote. “It is expected that results of such studies will lead to implementation of evidence-based recommendations about preventive measures during the hajj.”
Disclosure: The researchers report no relevant disclosures.
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