Prevalence of MERS-CoV nasal carriage and compliance with the Saudi health recommendations among pilgrims attending the 2013 Hajj

J Infect Dis. 2014 Oct 1;210(7):1067-72. doi: 10.1093/infdis/jiu150. Epub 2014 Mar 11.


Background: Annually, Saudi Arabia is the host of the Hajj mass gathering. We aimed to determine the Middle East respiratory syndrome coronavirus (MERS-CoV) nasal carriage rate among pilgrims performing the 2013 Hajj and to describe the compliance with the Saudi Ministry of Health vaccine recommendations.

Method: Nasopharyngeal samples were collected from 5235 adult pilgrims from 22 countries and screened for MERS-CoV using reverse transcriptase-polymerase chain reaction. Information regarding the participants' age, gender, country of origin, medical conditions, and vaccination history were obtained.

Results: The mean age of the screened population was 51.8 years (range, 18-93 years) with a male/female ratio of 1.17:1. MERS-CoV was not detected in any of the samples tested (3210 pre-Hajj and 2025 post-Hajj screening). According to the vaccination documents, all participants had received meningococcal vaccination and the majority of those from at-risk countries were vaccinated against yellow fever and polio. Only 22% of the pilgrims (17.5% of those ≥65 years and 36.3% of diabetics) had flu vaccination, and 4.4% had pneumococcal vaccination.

Conclusion: There was no evidence of MERS-CoV nasal carriage among Hajj pilgrims. While rates of compulsory vaccinations uptake were high, uptake of pneumococcal and flu seasonal vaccinations were low, including among the high-risk population.

Keywords: Hajj pilgrimage; MERS-CoV; nasal carriage; screening; vaccination.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Carrier State / epidemiology*
  • Carrier State / virology
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / virology
  • Crowding*
  • Demography
  • Female
  • Guideline Adherence
  • Humans
  • Male
  • Middle Aged
  • Middle East Respiratory Syndrome Coronavirus / isolation & purification*
  • Nasopharynx / virology*
  • Prevalence
  • Saudi Arabia / epidemiology
  • Vaccination / statistics & numerical data
  • Young Adult