• Samir Benkouiten, Rémi Charrel, Khadidja Belhouchat, Tassadit Drali, Nicolas Salez, Antoine Nougairede, Christine Zandotti, Ziad A Memish, Malak al Masri, Catherine Gaillard, Philippe Parola, Philippe Brouqui, and Philippe Gautret.
• Aix Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Unité Mixte de Recherche (UMR) 63, Centre National de la Recherche Scientifique (CNRS) 7278, Institut de Recherche pour le Développement (IRD) 198, Institut National de la Santé et de la Recherche Médicale (INSERM) 1095.
• Clin. Infect. Dis. 2013 Oct 1; 57 (7): 992-1000.

BackgroundThe Hajj is the oldest and largest annual mass gathering in the world and may increase the risk of spread of respiratory viruses.MethodsWe performed a prospective survey among a cohort of pilgrims departing from Marseille, France, to Mecca in the Kingdom of Saudi Arabia (KSA) for the 2012 Hajj season. Nasal swabs were collected from participants and tested for 11 respiratory viruses by real-time reverse transcription polymerase chain reaction.ResultsOf 165 participants sampled before departing to the KSA, 8 (4.8%) were positive for at least 1 virus (5 rhinovirus, 1 influenza C, 1 adenovirus, and 1 enterovirus). Seventy symptomatic pilgrims underwent additional nasal swabs during their pilgrimage in the KSA, of which 27 (38.6%) were positive for at least 1 virus (19 rhinovirus, 6 influenza A, 1 influenza C, 1 respiratory syncytial virus B, 1 metapneumovirus, 1 adenovirus, and 1 enterovirus). This was significantly higher than the 4.8% who were positive before departing for the KSA (P < .001). Of 154 pilgrims sampled before leaving the KSA, 17 (11%) were positive for at least 1 virus (13 rhinovirus, 3 adenovirus, 2 influenza B, and 1 enterovirus), which was also significantly higher than the percentage of positive pilgrims (4.8%), before departing for the KSA (P = .040).ConclusionsThis study suggests a rapid acquisition of respiratory viruses among pilgrims during their stay in the KSA, most notably rhinovirus, and highlights the potential of spreading these infections in the pilgrims' home countries upon their return.

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