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J Med Virol. 2019 Feb 6. doi: 10.1002/jmv.25424. [Epub ahead of print]

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

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Special Infectious Agent Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.
Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Biochemistry Department, Faculty of Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
Regional Laboratory, Ministry of Health, Makkah, Saudi Arabia.
Department of medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.


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 five-days of the 2014 Hajj season. Samples were tested using RT-PCR and microarray. Demographic data including age, gender 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. Amongst the detected viruses, 64.2% of the cases were due to a single-virus infection and 35.8% were due to co-infections with up to 4 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 Hajj and adoption of stringent vaccination requirements from all pilgrims. This article is protected by copyright. All rights reserved.


Hajj; MERS-CoV; Saudi Arabia; influenza; respiratory infections; viruses


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