Respiratory Tract Infection During the Haj

Source: El-Sheikh SM, et al. Trop Med Int Health 1998;3:205-209.

The transmission of infectious agents during mass migration of peoples is of concern. El-Sheikh and associates assessed the frequency of bacterial and viral infection in travelers with respiratory-tract infection (RTI) participating in the 1991 and 1992 pilgrimage seasons in Makka, Saudi Arabia. A total of 761 throat swabs and 395 sputum specimens were cultured for bacteria; all throat swabs were also screened for seven common RTI-causing viruses by monoclonal assay.

The only significant bacterial pathogen isolated from throat swabs was Streptococcus pyogenes (1%), but viruses, of which influenza A and adenovirus were the most common, were detected in 19.5% of the specimens. Bacteria were isolated from 30% of sputum specimens. Haemophilus influenzae was the most frequent (10%) pathogen isolated in 1991, whereas Klebsiella pneumoniae was predominant (15.1%) in 1992. Streptococcus pneumoniae, Staphylococcus aureus, and S. pyogenes were each isolated with diminishing frequency.

One percent of specimens grew M. tuberculosis-not surprising considering a recent report that tuberculosis is the most frequent cause of pneumonia (20%) in travelers requiring hospitalization during the Haj (Alzeer A, et al. J Infect 1998;36:303-306).

Pilgrimages represent an ideal venue for large outbreaks of infectious agents, such as influenza, as well as for the widespread transmission of other respiratory pathogens, especially TB. In addition to these, because of a high risk of meningococcal disease, this vaccine is now required for anyone entering Saudi Arabia during the Haj.