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. 2015 Dec 31;14(2):92–109. doi: 10.1016/j.tmaid.2015.12.008

Table 2.

Prevalence of respiratory viruses in studies conducted among pilgrims irrespective of the respiratory status.

Year Study design Study population Type of sample Microbiological techniques Pathogens investigated Prevalence (%) Influenza vaccination (%) Reference
2003 Paired cohort survey UK pilgrims (n = 115) Serum before and after travel ELISA Influenza A-H1N1 2.6k 26.1 [31]
Influenza A-H3N2 36.5k
Influenza B 4.3k
Influenza overall 38.3k
Mixed viral infections 5.2k
No virus 61.7k
2007–2008 Paired cohort survey Iranian pilgrimsa (n = 338) Serum before and after travel ELISA Influenza 3.6k 84.0 [32]
Respiratory syncytial virus 7.4k
Adenovirus 23.7k
Mixed viral infections ND
No virus 65.4k
2009 Cross sectional ship port and airport survey (Egypt) Egyptian returning pilgrims (126 at ship port and 425 at airport) Nasopharyngeal swabs PCR Influenza A-H1N1pdm09 0 98.1 [33]
Influenza A-H1N1 1.0
Influenza A-H3N2 0
Mixed viral infections 0
No virus 99
2009 Cross sectional airport survey (Iran) Iranian returning pilgrimsb (n = 305) Pharyngeal swabs PCR Influenza A-H1N1pdm09 1.6 97.7 [34]
Influenza A-other 2.6
Influenza overall 4.2
Mixed viral infections 95.8
No virus 0
2009 Cross sectional airport survey (unpaired cohorts) (Saudi Arabia) Arriving (n = 519) and departing (n = 2699) pilgrimsc Nasopharyngeal and throat swabs PCR Influenza A-H1N1 0.2-0.1 53.3 (seasonal flu) and 38.8 (pdm09-H1N1) [35]
Influenza A-H3N2 0.2-0.3
Influenza B 0-0.1
Influenza overall 0.4-0.5
Parainfluenza 1 0-0
Parainfluenza 2 0-0
Parainfluenza 3 0-0.1
Parainfluenza 4 0-0
Parainfluenza overall 0-0.1
Adenovirus 0-0
Respiratory syncytial virus 0-0.3
CoV-229E 0-0.2
CoV-NL63 0.2-0.1
CoV-HKU1 0-0.1
CoV-OC43 0-0.6
CoV overall 0.2-1.0
Metapneumovirus 0-0.1
Rhinovirus 12.1–13.0
Bocavirus 0-0
Mixed viral infections 0-0.1
No virus 87.5–85.2
2009 Cross sectional survey (Saudi Arabia) Health care workers serving pilgrims, before and after the Hajj (n = 120) Combined nasal and throat swabs PCR Influenza A-H1N1 0-0 50.9 (seasonal flu), 21.7 (pdm09-H1N1 [36]
Influenza A-H3N2 0-0
Influenza B 0-0
Influenza overall 0-0
Parainfluenza 1 0-0
Parainfluenza 2 0-0
Parainfluenza 3 0-0
Parainfluenza 4 0-0
Parainfluenza overall 0-0
Adenovirus 0-0
Respiratory syncytial virus 0-0
CoV-229E 0-0.8
CoV-NL63 0-0
CoV-HKU1 0-0
CoV-OC43 0-0
CoV overall 0-0.8
Metapneumovirus 0-0
Rhinovirus 7.5–11.7
Bocavirus 0-0
Mixed viral infections 0-0
No virus 92.5–87.5
2010 Cross-sectional airport study (Saudi Arabia) Arriving pilgrimsd (n = 1600) Throat swabs PCR Influenza A-H1N1 pdm09 6.9 93.4 [37]
Influenza A-H1N1 non-pdm09 0.6
Influenza overall 7.5
Mixed viral infections –
No virus 92.5
2012 Paired cohort survey French pilgrims before arrival, during Hajj and at departuree
(n = 165)		 Nasal swabs PCR Influenza A-H1N1 0-0-0n 45.6 (2011) [ [6], [38]]
Influenza A-H3N2 0-8.6-0
Influenza B 0-0-1.3
Influenza C 0.6-1.4-0
Influenza overall 0.6-10.0-1.3
Adenovirus 0.6-1.4-1.9
Respiratory syncytial virus 0-1.4-0
MERS-Cov 0-0-0
Enterovirus 0.6-1.4-0.6
Metapneumovirus 0-1.4-0
Rhinovirus 3.0-27.1-8.4l
Mixed viral infections 0-4.3-1.2
No virus 95.7-61.4-89.0l
2013 Paired cohort survey French pilgrims before arrival and at departuref (n = 129) Nasal and throat swabs PCR Influenza A-H1N1 0-0.8o 44.2 (2012) [ [7], [39], [40]]
Influenza A-H3N2 0-6.2l
Influenza B 0-0.8
Influenza C 1.7–0
Influenza overall 1.7–7.8
Parainfluenza overall 3.3-0.8
Adenovirus 1.7-0.0
Respiratory syncytial virus 0-0.8
MERS-Cov 0-0
CoV-229E 0-12.4l
CoV-NL63 0-0.8
CoV-HKU1 0-3.9
CoV-OC43 0-3.9
CoV overall 0-20.9
Cytomegalovirus 0-0
Enterovirus 0.8-2.3
Metapneumovirus 1.7-0.8
Rhinovirus 14.0–14.7
Bocavirus 1.7–0
Parechovirus 0-0
Mixed viral infections 3.1–5.4
No virus 78.5-61.2l
2013 Cross sectional airport survey (unpaired cohorts) (Saudi Arabia) Arriving pilgrimsg (n = 3210) and departing pilgrimsg (n = 2025) Nasopharyngeal samples PCR MERS-CoV 0-0 22.0 [41]
Mixed viral infections –
No virus 100-100
2013 Cross-sectional airport study (Ghana) Returning Ghanaian pilgrimsh (n = 839) Nasopharyngeal swabs PCR Influenza A 1.3 [42]
Rhinovirus 16.8
Respiratory Syncitial virus 5.1
MERS-CoV 0
Mixed viral infections 1.9
No virus 78.7
2013 Paired cohort survey/Unpaired cohort survey Pilgrimsi at arrival and subsequently at Mina (n = 692)/Pilgrims at arrivali (n = 514) Pilgrims at Minaj (n = 470) Nasal swabs PCR Influenza A-H1N1 0.1–1.6/0.2-3.0m,l 21.9 [43]
Influenza A-H3N2 0.6-2.0/1.2-1.7
Influenza B 0-0/0-0.2
Influenza C 0-0/0-0
Influenza overall 0.7-3.6/1.4–4.9
Parainfluenza 1 0-0/0.4–0
Parainfluenza 2 0-0.3/0.2-0.4
Parainfluenza 3 0.3-0.1/0-0.2
Parainfluenza 4 0-0.1/0.2–0
Parainfluenza overall 0-0.5/0.8-0.6
Adenovirus 0-0.6/0-0.4
Respiratory syncytial virus 0.6-0.7/0.6-0.2
MERS-Cov 0-0/0-0
CoV-229E 0.9-14.6l/1.0-10.2l
CoV-NL63 0.3-2.0/0-0.2
CoV-HKU1 0.4-1.3/0.2-1.5l
CoV-OC43 0.1–1.6/0.4-1.9l
CoV overall 1.7–19.5/1.6–13.8
Cytomegalovirus 0-0/0-0
Enterovirus 0.6-0.4/0.8-1.1
Metapneumovirus 0-0.1/0.2-0.6
Rhinovirus 2.2-34.4l/3.1-30.9l
Bocavirus 0.1-0/0.2–0
Parechovirus 0-0/0-0
Mixed viral infections 10.4 overall
No virus 93.9-50.4l/91.4-54.9l
a

Prevalence of cough = 84.3%, hoarseness = 64.6%, sore throat = 62.0%, rhinorrea = 54.2%, wheezing = 53.3%, headache = 44.1%, myalgia = 38.4%, fever = 36.4%, dyspnea = 22.2%.

b

Prevalence of cough = 48.2%, sore throat = 46.2%, rhinorrhea = 60.7%, fever and cough = 10.5%.

c

Mainly from Middle-East.

d

Mainly from Indonesia, India, Algeria and Ivory Coast (prevalence of cough = 92.7% and sore-throat = 3.8%, smokers = 87.7%).

e

Prevalence of cough = 83.4%, sore throat = 79.7%, rhinorrhea = 68.5%, dyspnea = 19.6%, ILI (fever and cough and sore-throat) = 41.0%.

f

Prevalence of cough = 86.8%, sore throat = 82.9%, rhinorrhea = 72.1%, dyspnea = 21.7%, ILI (fever and cough and sore-throat) = 47.3%.

g

Mainly from Asia and Africa.

h

Prevalence of cough = 70.6%, sore throat = 40.9%, fever = 18.4%, runny-nose or sneezing = 18.1% and breathing difficulty = 14.8%.

i

From Albania, Bangladesh, Egypt, Ethiopia, India, Indonesia, Malaysia, Pakistan, Somalia, Tanzania, prevalence of ILI = 61.9% at Mina.

j

From Albania, Bangladesh, Egypt, Ethiopia, France, India, Indonesia, Malaysia, Nigeria, Pakistan, Somalia, Tanzania, prevalence of ILI = 61.9% at Mina.

k

Seroconversion rate.

l

Difference statistically significant (p < 0.005, chi-scared test).

m

Paired cohort at arrival-paired cohort at Mina/unpaired cohort at arrival-unpaired cohort at Mina.

n

Before arrival-during Hajj-at departure.

o

Before arrival-at departure (nasal swab)/before arrival-at departure (throat swab).