Respiratory viruses in returning Hajj & Umrah pilgrims with acute respiratory illness in 2014-2015
Identifieur interne : 000879 ( Pmc/Corpus ); précédent : 000878; suivant : 000880Respiratory viruses in returning Hajj & Umrah pilgrims with acute respiratory illness in 2014-2015
Auteurs : Parvaiz A. Koul ; Hyder Mir ; Siddhartha Saha ; Mandeep S. Chadha ; Varsha Potdar ; Marc-Alain Widdowson ; Renu B. Lal ; Anand KrishnanSource :
- The Indian Journal of Medical Research [ 0971-5916 ] ; 2018.
Abstract
Respiratory tract infections are common among Hajj and Umrah pilgrims which pose a public health risk of spread of respiratory infections. Influenza has been reported from Indian Hajj and Umrah returning pilgrims, but data on other respiratory pathogens are sparse in India. Here we report the presence of common respiratory viral pathogens in returning Hajj and Umrah pilgrims suffering from acute respiratory illness (ARI) in 2014-2015.
Respiratory specimens (nasopharyngeal and throat swabs) were collected from 300 consenting pilgrims with ARI in the past one week and tested for influenza and Middle East Respiratory Syndrome coronavirus (MERS-CoV) and other respiratory viruses using in-house standardized quantitative real-time reverse-transcription polymerase chain reaction. Clinical features among the pathogen positive and negative patients were compared. The patients received symptomatic treatment and antivirals where appropriate and were followed telephonically to collect data on illness outcome.
Ninety seven (32.3%) of the 300 participants were tested positive for any virus, most common being influenza viruses (n=33, 11%). Other respiratory viruses that were detected included human coronaviruses [n=26, 8.7%; OC43 (n=19, 6.3%) and C229E (n=7, 2.3%)], rhinovirus (n=20, 6%), adenoviruses (n=8, 2.6%), parainfluenza viruses (n=7, 2.3%), respiratory syncytial virus (n=3, 1%) and bocaviruses (n=2, 0.6%). Clinical features observed in pathogen positive and pathogen negative patients did not differ significantly. Eighteen influenza positive patients were treated with oseltamivir.
Pilgrims returning from mass gatherings are often afflicted with respiratory pathogens with a potential to facilitate transmission of respiratory pathogens across international borders. The study reinforces the need for better infection prevention and control measures such as vaccination, health education on cough etiquette and hand hygiene.
Url:
DOI: 10.4103/ijmr.IJMR_890_17
PubMed: 30425224
PubMed Central: 6251276
Links to Exploration step
PMC:6251276Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Respiratory viruses in returning Hajj & Umrah pilgrims with acute respiratory illness in 2014-2015</title><author><name sortKey="Koul, Parvaiz A" sort="Koul, Parvaiz A" uniqKey="Koul P" first="Parvaiz A." last="Koul">Parvaiz A. Koul</name><affiliation><nlm:aff id="aff1"><italic>Department of Internal & Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India</italic></nlm:aff></affiliation></author><author><name sortKey="Mir, Hyder" sort="Mir, Hyder" uniqKey="Mir H" first="Hyder" last="Mir">Hyder Mir</name><affiliation><nlm:aff id="aff1"><italic>Department of Internal & Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India</italic></nlm:aff></affiliation></author><author><name sortKey="Saha, Siddhartha" sort="Saha, Siddhartha" uniqKey="Saha S" first="Siddhartha" last="Saha">Siddhartha Saha</name><affiliation><nlm:aff id="aff4"><italic>Influenza Division, US Centers for Disease Control & Prevention, Atlanta, Georgia, USA</italic></nlm:aff></affiliation></author><author><name sortKey="Chadha, Mandeep S" sort="Chadha, Mandeep S" uniqKey="Chadha M" first="Mandeep S." last="Chadha">Mandeep S. Chadha</name><affiliation><nlm:aff id="aff2"><italic>Influenza Group, ICMR-National Institute of Virology, Pune, India</italic></nlm:aff></affiliation></author><author><name sortKey="Potdar, Varsha" sort="Potdar, Varsha" uniqKey="Potdar V" first="Varsha" last="Potdar">Varsha Potdar</name><affiliation><nlm:aff id="aff2"><italic>Influenza Group, ICMR-National Institute of Virology, Pune, India</italic></nlm:aff></affiliation></author><author><name sortKey="Widdowson, Marc Alain" sort="Widdowson, Marc Alain" uniqKey="Widdowson M" first="Marc-Alain" last="Widdowson">Marc-Alain Widdowson</name><affiliation><nlm:aff id="aff4"><italic>Influenza Division, US Centers for Disease Control & Prevention, Atlanta, Georgia, USA</italic></nlm:aff></affiliation></author><author><name sortKey="Lal, Renu B" sort="Lal, Renu B" uniqKey="Lal R" first="Renu B." last="Lal">Renu B. Lal</name><affiliation><nlm:aff id="aff4"><italic>Influenza Division, US Centers for Disease Control & Prevention, Atlanta, Georgia, USA</italic></nlm:aff></affiliation></author><author><name sortKey="Krishnan, Anand" sort="Krishnan, Anand" uniqKey="Krishnan A" first="Anand" last="Krishnan">Anand Krishnan</name><affiliation><nlm:aff id="aff3"><italic>Center for Community Medicine, All India Institute of Medical Sciences, New Delhi, India</italic></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">30425224</idno><idno type="pmc">6251276</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6251276</idno><idno type="RBID">PMC:6251276</idno><idno type="doi">10.4103/ijmr.IJMR_890_17</idno><date when="2018">2018</date><idno type="wicri:Area/Pmc/Corpus">000879</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000879</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Respiratory viruses in returning Hajj & Umrah pilgrims with acute respiratory illness in 2014-2015</title><author><name sortKey="Koul, Parvaiz A" sort="Koul, Parvaiz A" uniqKey="Koul P" first="Parvaiz A." last="Koul">Parvaiz A. Koul</name><affiliation><nlm:aff id="aff1"><italic>Department of Internal & Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India</italic></nlm:aff></affiliation></author><author><name sortKey="Mir, Hyder" sort="Mir, Hyder" uniqKey="Mir H" first="Hyder" last="Mir">Hyder Mir</name><affiliation><nlm:aff id="aff1"><italic>Department of Internal & Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India</italic></nlm:aff></affiliation></author><author><name sortKey="Saha, Siddhartha" sort="Saha, Siddhartha" uniqKey="Saha S" first="Siddhartha" last="Saha">Siddhartha Saha</name><affiliation><nlm:aff id="aff4"><italic>Influenza Division, US Centers for Disease Control & Prevention, Atlanta, Georgia, USA</italic></nlm:aff></affiliation></author><author><name sortKey="Chadha, Mandeep S" sort="Chadha, Mandeep S" uniqKey="Chadha M" first="Mandeep S." last="Chadha">Mandeep S. Chadha</name><affiliation><nlm:aff id="aff2"><italic>Influenza Group, ICMR-National Institute of Virology, Pune, India</italic></nlm:aff></affiliation></author><author><name sortKey="Potdar, Varsha" sort="Potdar, Varsha" uniqKey="Potdar V" first="Varsha" last="Potdar">Varsha Potdar</name><affiliation><nlm:aff id="aff2"><italic>Influenza Group, ICMR-National Institute of Virology, Pune, India</italic></nlm:aff></affiliation></author><author><name sortKey="Widdowson, Marc Alain" sort="Widdowson, Marc Alain" uniqKey="Widdowson M" first="Marc-Alain" last="Widdowson">Marc-Alain Widdowson</name><affiliation><nlm:aff id="aff4"><italic>Influenza Division, US Centers for Disease Control & Prevention, Atlanta, Georgia, USA</italic></nlm:aff></affiliation></author><author><name sortKey="Lal, Renu B" sort="Lal, Renu B" uniqKey="Lal R" first="Renu B." last="Lal">Renu B. Lal</name><affiliation><nlm:aff id="aff4"><italic>Influenza Division, US Centers for Disease Control & Prevention, Atlanta, Georgia, USA</italic></nlm:aff></affiliation></author><author><name sortKey="Krishnan, Anand" sort="Krishnan, Anand" uniqKey="Krishnan A" first="Anand" last="Krishnan">Anand Krishnan</name><affiliation><nlm:aff id="aff3"><italic>Center for Community Medicine, All India Institute of Medical Sciences, New Delhi, India</italic></nlm:aff></affiliation></author></analytic><series><title level="j">The Indian Journal of Medical Research</title><idno type="ISSN">0971-5916</idno><imprint><date when="2018">2018</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="st1"><title>Background & objectives:</title><p>Respiratory tract infections are common among Hajj and Umrah pilgrims which pose a public health risk of spread of respiratory infections. Influenza has been reported from Indian Hajj and Umrah returning pilgrims, but data on other respiratory pathogens are sparse in India. Here we report the presence of common respiratory viral pathogens in returning Hajj and Umrah pilgrims suffering from acute respiratory illness (ARI) in 2014-2015.</p></sec><sec id="st2"><title>Methods:</title><p>Respiratory specimens (nasopharyngeal and throat swabs) were collected from 300 consenting pilgrims with ARI in the past one week and tested for influenza and Middle East Respiratory Syndrome coronavirus (MERS-CoV) and other respiratory viruses using in-house standardized quantitative real-time reverse-transcription polymerase chain reaction. Clinical features among the pathogen positive and negative patients were compared. The patients received symptomatic treatment and antivirals where appropriate and were followed telephonically to collect data on illness outcome.</p></sec><sec id="st3"><title>Results:</title><p>Ninety seven (32.3%) of the 300 participants were tested positive for any virus, most common being influenza viruses (n=33, 11%). Other respiratory viruses that were detected included human coronaviruses [n=26, 8.7%; OC43 (n=19, 6.3%) and C229E (n=7, 2.3%)], rhinovirus (n=20, 6%), adenoviruses (n=8, 2.6%), parainfluenza viruses (n=7, 2.3%), respiratory syncytial virus (n=3, 1%) and bocaviruses (n=2, 0.6%). Clinical features observed in pathogen positive and pathogen negative patients did not differ significantly. Eighteen influenza positive patients were treated with oseltamivir.</p></sec><sec id="st4"><title>Interpretation & conclusions:</title><p>Pilgrims returning from mass gatherings are often afflicted with respiratory pathogens with a potential to facilitate transmission of respiratory pathogens across international borders. The study reinforces the need for better infection prevention and control measures such as vaccination, health education on cough etiquette and hand hygiene.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Memish, Za" uniqKey="Memish Z">ZA Memish</name></author><author><name sortKey="Zumla, A" uniqKey="Zumla A">A Zumla</name></author><author><name sortKey="Alhakeem, Rf" uniqKey="Alhakeem R">RF Alhakeem</name></author><author><name sortKey="Assiri, A" uniqKey="Assiri A">A Assiri</name></author><author><name sortKey="Turkestani, A" uniqKey="Turkestani A">A Turkestani</name></author><author><name sortKey="Al Harby, Kd" uniqKey="Al Harby K">KD Al Harby</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ahmed, Qa" uniqKey="Ahmed Q">QA Ahmed</name></author><author><name sortKey="Arabi, Ym" uniqKey="Arabi Y">YM Arabi</name></author><author><name sortKey="Memish, Za" uniqKey="Memish Z">ZA Memish</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Alzahrani, Ag" uniqKey="Alzahrani A">AG Alzahrani</name></author><author><name sortKey="Choudhry, Aj" uniqKey="Choudhry A">AJ Choudhry</name></author><author><name sortKey="Al Mazroa, Ma" uniqKey="Al Mazroa M">MA Al Mazroa</name></author><author><name sortKey="Turkistani, Ah" uniqKey="Turkistani A">AH Turkistani</name></author><author><name sortKey="Nouman, Gs" uniqKey="Nouman G">GS Nouman</name></author><author><name sortKey="Memish, Za" uniqKey="Memish Z">ZA Memish</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Al Tawfiq, Ja" uniqKey="Al Tawfiq J">JA Al-Tawfiq</name></author><author><name sortKey="Gautret, P" uniqKey="Gautret P">P Gautret</name></author><author><name sortKey="Benkouiten, S" uniqKey="Benkouiten S">S Benkouiten</name></author><author><name sortKey="Memish, Za" uniqKey="Memish Z">ZA Memish</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Haworth, E" uniqKey="Haworth E">E Haworth</name></author><author><name sortKey="Barasheed, O" uniqKey="Barasheed O">O Barasheed</name></author><author><name sortKey="Memish, Za" uniqKey="Memish Z">ZA Memish</name></author><author><name sortKey="Rashid, H" uniqKey="Rashid H">H Rashid</name></author><author><name sortKey="Booy, R" uniqKey="Booy R">R Booy</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Alfelali, M" uniqKey="Alfelali M">M Alfelali</name></author><author><name sortKey="Barasheed, O" uniqKey="Barasheed O">O Barasheed</name></author><author><name sortKey="Badahdah, Am" uniqKey="Badahdah A">AM Badahdah</name></author><author><name sortKey="Bokhary, H" uniqKey="Bokhary H">H Bokhary</name></author><author><name sortKey="Azeem, Mi" uniqKey="Azeem M">MI Azeem</name></author><author><name sortKey="Habeebullah, T" uniqKey="Habeebullah T">T Habeebullah</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Soliman, T" uniqKey="Soliman T">T Soliman</name></author><author><name sortKey="Cook, Ar" uniqKey="Cook A">AR Cook</name></author><author><name sortKey="Coker, Rj" uniqKey="Coker R">RJ Coker</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cho, Sy" uniqKey="Cho S">SY Cho</name></author><author><name sortKey="Kang, Jm" uniqKey="Kang J">JM Kang</name></author><author><name sortKey="Ha, Ye" uniqKey="Ha Y">YE Ha</name></author><author><name sortKey="Park, Ge" uniqKey="Park G">GE Park</name></author><author><name sortKey="Lee, Jy" uniqKey="Lee J">JY Lee</name></author><author><name sortKey="Ko, Jh" uniqKey="Ko J">JH Ko</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Koul, Pa" uniqKey="Koul P">PA Koul</name></author><author><name sortKey="Mir, H" uniqKey="Mir H">H Mir</name></author><author><name sortKey="Saha, S" uniqKey="Saha S">S Saha</name></author><author><name sortKey="Chadha, Ms" uniqKey="Chadha M">MS Chadha</name></author><author><name sortKey="Potdar, V" uniqKey="Potdar V">V Potdar</name></author><author><name sortKey="Widdowson, Ma" uniqKey="Widdowson M">MA Widdowson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Brittain Long, R" uniqKey="Brittain Long R">R Brittain-Long</name></author><author><name sortKey="Nord, S" uniqKey="Nord S">S Nord</name></author><author><name sortKey="Olofsson, S" uniqKey="Olofsson S">S Olofsson</name></author><author><name sortKey="Westin, J" uniqKey="Westin J">J Westin</name></author><author><name sortKey="Anderson, Lm" uniqKey="Anderson L">LM Anderson</name></author><author><name sortKey="Lindh, M" uniqKey="Lindh M">M Lindh</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Maertzdorf, J" uniqKey="Maertzdorf J">J Maertzdorf</name></author><author><name sortKey="Wang, Ck" uniqKey="Wang C">CK Wang</name></author><author><name sortKey="Brown, Jb" uniqKey="Brown J">JB Brown</name></author><author><name sortKey="Quinto, Jd" uniqKey="Quinto J">JD Quinto</name></author><author><name sortKey="Chu, M" uniqKey="Chu M">M Chu</name></author><author><name sortKey="De Graaf, M" uniqKey="De Graaf M">M de Graaf</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wang, Cy" uniqKey="Wang C">CY Wang</name></author><author><name sortKey="Arden, Ke" uniqKey="Arden K">KE Arden</name></author><author><name sortKey="Greer, R" uniqKey="Greer R">R Greer</name></author><author><name sortKey="Sloots, Tp" uniqKey="Sloots T">TP Sloots</name></author><author><name sortKey="Mackay, Im" uniqKey="Mackay I">IM Mackay</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wong, S" uniqKey="Wong S">S Wong</name></author><author><name sortKey="Pabbaraju, K" uniqKey="Pabbaraju K">K Pabbaraju</name></author><author><name sortKey="Pang, Xl" uniqKey="Pang X">XL Pang</name></author><author><name sortKey="Lee, Be" uniqKey="Lee B">BE Lee</name></author><author><name sortKey="Fox, Jd" uniqKey="Fox J">JD Fox</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Deng, Y" uniqKey="Deng Y">Y Deng</name></author><author><name sortKey="Gu, X" uniqKey="Gu X">X Gu</name></author><author><name sortKey="Zhao, X" uniqKey="Zhao X">X Zhao</name></author><author><name sortKey="Luo, J" uniqKey="Luo J">J Luo</name></author><author><name sortKey="Luo, Z" uniqKey="Luo Z">Z Luo</name></author><author><name sortKey="Wang, L" uniqKey="Wang L">L Wang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Van Elden, Lj" uniqKey="Van Elden L">LJ van Elden</name></author><author><name sortKey="Van Loon, Am" uniqKey="Van Loon A">AM van Loon</name></author><author><name sortKey="Van Alphen, F" uniqKey="Van Alphen F">F van Alphen</name></author><author><name sortKey="Hendriksen, Ka" uniqKey="Hendriksen K">KA Hendriksen</name></author><author><name sortKey="Hoepelman, Ai" uniqKey="Hoepelman A">AI Hoepelman</name></author><author><name sortKey="Van Kraaij, Mg" uniqKey="Van Kraaij M">MG van Kraaij</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gautret, P" uniqKey="Gautret P">P Gautret</name></author><author><name sortKey="Benkouiten, S" uniqKey="Benkouiten S">S Benkouiten</name></author><author><name sortKey="Al Tawfiq, Ja" uniqKey="Al Tawfiq J">JA Al-Tawfiq</name></author><author><name sortKey="Memish, Za" uniqKey="Memish Z">ZA Memish</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Koul, Pa" uniqKey="Koul P">PA Koul</name></author><author><name sortKey="Khan, Uh" uniqKey="Khan U">UH Khan</name></author><author><name sortKey="Asad, R" uniqKey="Asad R">R Asad</name></author><author><name sortKey="Yousuf, R" uniqKey="Yousuf R">R Yousuf</name></author><author><name sortKey="Broor, S" uniqKey="Broor S">S Broor</name></author><author><name sortKey="Lal, Rb" uniqKey="Lal R">RB Lal</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Koul, Pa" uniqKey="Koul P">PA Koul</name></author><author><name sortKey="Mir, H" uniqKey="Mir H">H Mir</name></author><author><name sortKey="Akram, S" uniqKey="Akram S">S Akram</name></author><author><name sortKey="Potdar, V" uniqKey="Potdar V">V Potdar</name></author><author><name sortKey="Chadha, Ms" uniqKey="Chadha M">MS Chadha</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Koul, Pa" uniqKey="Koul P">PA Koul</name></author><author><name sortKey="Broor, S" uniqKey="Broor S">S Broor</name></author><author><name sortKey="Saha, S" uniqKey="Saha S">S Saha</name></author><author><name sortKey="Barnes, J" uniqKey="Barnes J">J Barnes</name></author><author><name sortKey="Smith, C" uniqKey="Smith C">C Smith</name></author><author><name sortKey="Shaw, M" uniqKey="Shaw M">M Shaw</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Guery, B" uniqKey="Guery B">B Guery</name></author><author><name sortKey="Poissy, J" uniqKey="Poissy J">J Poissy</name></author><author><name sortKey="El Mansouf, L" uniqKey="El Mansouf L">L el Mansouf</name></author><author><name sortKey="Sejourne, C" uniqKey="Sejourne C">C Séjourné</name></author><author><name sortKey="Ettahar, N" uniqKey="Ettahar N">N Ettahar</name></author><author><name sortKey="Lemaire, X" uniqKey="Lemaire X">X Lemaire</name></author></analytic></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Indian J Med Res</journal-id><journal-id journal-id-type="iso-abbrev">Indian J. Med. Res</journal-id><journal-id journal-id-type="publisher-id">IJMR</journal-id><journal-title-group><journal-title>The Indian Journal of Medical Research</journal-title></journal-title-group><issn pub-type="ppub">0971-5916</issn><publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">30425224</article-id><article-id pub-id-type="pmc">6251276</article-id><article-id pub-id-type="publisher-id">IJMR-148-329</article-id><article-id pub-id-type="doi">10.4103/ijmr.IJMR_890_17</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Respiratory viruses in returning Hajj & Umrah pilgrims with acute respiratory illness in 2014-2015</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Koul</surname><given-names>Parvaiz A.</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Mir</surname><given-names>Hyder</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Saha</surname><given-names>Siddhartha</given-names></name><xref ref-type="aff" rid="aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Chadha</surname><given-names>Mandeep S.</given-names></name><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Potdar</surname><given-names>Varsha</given-names></name><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Widdowson</surname><given-names>Marc-Alain</given-names></name><xref ref-type="aff" rid="aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Lal</surname><given-names>Renu B.</given-names></name><xref ref-type="aff" rid="aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Krishnan</surname><given-names>Anand</given-names></name><xref ref-type="aff" rid="aff3">3</xref></contrib></contrib-group><aff id="aff1"><label>1</label><italic>Department of Internal & Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India</italic></aff><aff id="aff2"><label>2</label><italic>Influenza Group, ICMR-National Institute of Virology, Pune, India</italic></aff><aff id="aff3"><label>3</label><italic>Center for Community Medicine, All India Institute of Medical Sciences, New Delhi, India</italic></aff><aff id="aff4"><label>4</label><italic>Influenza Division, US Centers for Disease Control & Prevention, Atlanta, Georgia, USA</italic></aff><author-notes><corresp id="cor1"><italic>For correspondence:</italic> Dr Parvaiz A. Koul, Department of Internal & Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar 190 011, Jammu & Kashmir, India e-mail: <email xlink:href="parvaizk@gmail.com">parvaizk@gmail.com</email></corresp></author-notes><pub-date pub-type="ppub"><month>9</month><year>2018</year></pub-date><volume>148</volume><issue>3</issue><fpage>329</fpage><lpage>333</lpage><history><date date-type="received"><day>31</day><month>5</month><year>2017</year></date></history><permissions><copyright-statement>Copyright: © 2018 Indian Journal of Medical Research</copyright-statement><copyright-year>2018</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/4.0"><license-p>This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.</license-p></license></permissions><abstract><sec id="st1"><title>Background & objectives:</title><p>Respiratory tract infections are common among Hajj and Umrah pilgrims which pose a public health risk of spread of respiratory infections. Influenza has been reported from Indian Hajj and Umrah returning pilgrims, but data on other respiratory pathogens are sparse in India. Here we report the presence of common respiratory viral pathogens in returning Hajj and Umrah pilgrims suffering from acute respiratory illness (ARI) in 2014-2015.</p></sec><sec id="st2"><title>Methods:</title><p>Respiratory specimens (nasopharyngeal and throat swabs) were collected from 300 consenting pilgrims with ARI in the past one week and tested for influenza and Middle East Respiratory Syndrome coronavirus (MERS-CoV) and other respiratory viruses using in-house standardized quantitative real-time reverse-transcription polymerase chain reaction. Clinical features among the pathogen positive and negative patients were compared. The patients received symptomatic treatment and antivirals where appropriate and were followed telephonically to collect data on illness outcome.</p></sec><sec id="st3"><title>Results:</title><p>Ninety seven (32.3%) of the 300 participants were tested positive for any virus, most common being influenza viruses (n=33, 11%). Other respiratory viruses that were detected included human coronaviruses [n=26, 8.7%; OC43 (n=19, 6.3%) and C229E (n=7, 2.3%)], rhinovirus (n=20, 6%), adenoviruses (n=8, 2.6%), parainfluenza viruses (n=7, 2.3%), respiratory syncytial virus (n=3, 1%) and bocaviruses (n=2, 0.6%). Clinical features observed in pathogen positive and pathogen negative patients did not differ significantly. Eighteen influenza positive patients were treated with oseltamivir.</p></sec><sec id="st4"><title>Interpretation & conclusions:</title><p>Pilgrims returning from mass gatherings are often afflicted with respiratory pathogens with a potential to facilitate transmission of respiratory pathogens across international borders. The study reinforces the need for better infection prevention and control measures such as vaccination, health education on cough etiquette and hand hygiene.</p></sec></abstract><kwd-group><kwd>Acute respiratory infection</kwd><kwd>coronavirus</kwd><kwd>Hajj pilgrims</kwd><kwd>influenza virus</kwd><kwd>respiratory syncytial virus</kwd><kwd>respiratory viruses</kwd></kwd-group></article-meta></front><body><p>The annual pilgrimage of Hajj draws millions of pilgrims to Saudi Arabia during the 12<sup>th</sup> month of the lunar calendar, with pilgrims entering the country through any one of 16 ports of entry. The Hajj poses significant public health concern as a result of mandatory religious rituals that entail congregated situations for the pilgrims, particularly during the circumambulation of the holy Kaabah<xref rid="ref1" ref-type="bibr">1</xref> and the ritual of stoning the devil. A variety of bacterial and viral respiratory infections are common: 20-80 per cent of pilgrims may develop respiratory infection during the pilgrimage<xref rid="ref2" ref-type="bibr">2</xref><xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref4" ref-type="bibr">4</xref>. Investigators have reported an overall mean prevalence for influenza of 2.1 per cent (range, 0.6-7.5%) among all arriving pilgrims and 3.6 per cent (range, 0.5-7.8%) among visitors departing the Hajj<xref rid="ref5" ref-type="bibr">5</xref>; however, some recent studies suggest influenza prevalence to be as high as 4-14 per cent among hajj returnees<xref rid="ref6" ref-type="bibr">6</xref>. In the past few years, cases of Middle East Respiratory Syndrome coronavirus (MERS-CoV) have been reported from many countries<xref rid="ref7" ref-type="bibr">7</xref><xref rid="ref8" ref-type="bibr">8</xref><xref rid="ref9" ref-type="bibr">9</xref>, however, MERS-CoV among pilgrims travelling to Saudi Arabia has not been reported. The rapid spread in nosocomial settings suggests that person-to-person transmission can be efficient in certain settings<xref rid="ref8" ref-type="bibr">8</xref><xref rid="ref9" ref-type="bibr">9</xref>. There are scanty data on the carriage of respiratory viruses among Indian pilgrims returning from Hajj and Umrah pilgrimage. We have recently reported on the absence of MERS-CoV and presence of influenza infection among symptomatic returning pilgrims from Hajj and Umrah of 2014-2015<xref rid="ref10" ref-type="bibr">10</xref>. In this study, the work was extended by testing the same Hajj pilgrims for additional pathogens of public health importance.</p><sec id="sec1-2"><title>Material & Methods</title><p>The participants included pilgrims returning from Saudi Arabia after having completed Hajj or Umrah from October 2014 to April 2015. After in-flight announcement offering medical attention to those with fever or respiratory symptoms, consenting disembarking pilgrims were interviewed for respiratory symptoms, offered medical examination and testing for respiratory viruses by a medical team stationed in the arrival halls of the Srinagar International Airport, Jammu and Kashmir, India. The demographic and clinical features were recorded on a predefined case record form. Enrollment for testing was offered to those with respiratory symptoms (n=977); 300 consented. The study protocol was approved by the ethics committee of Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, India, and all 300 participants gave written informed consent. Twin swabs (nasopharyngeal and throat) were obtained from each participant, pooled in viral transport media; and then transported to the Influenza laboratory in SKIMS, within 3-4 h of collection. After testing for influenza and MERS-coV at SKIMS, the samples were transported to the ICMR-National Institute of Virology, Pune, where testing for respiratory viruses was performed using in-house standardized duplex real-time reverse transcriptase polymerase chain reaction (RT-PCR) using previously published primers and probes. Briefly, eight tubes duplex PCR was performed for respiratory syncytial virus (RSV), human metapneumovirus (hMPV)<xref rid="ref11" ref-type="bibr">11</xref><xref rid="ref12" ref-type="bibr">12</xref>, rhinovirus and ribonuclease protein (RNP)<xref rid="ref11" ref-type="bibr">11</xref>, parainfluenzaviruses (PIV) 1 and 2<xref rid="ref11" ref-type="bibr">11</xref><xref rid="ref13" ref-type="bibr">13</xref>, PIV 3 and 4<xref rid="ref11" ref-type="bibr">11</xref><xref rid="ref13" ref-type="bibr">13</xref>, adenovirus and boca virus<xref rid="ref11" ref-type="bibr">11</xref><xref rid="ref14" ref-type="bibr">14</xref><xref rid="ref15" ref-type="bibr">15</xref>, coronavirus OC 43 and NL 65<xref rid="ref11" ref-type="bibr">11</xref><xref rid="ref16" ref-type="bibr">16</xref>, corona virus 229E and enterovirus<xref rid="ref11" ref-type="bibr">11</xref><xref rid="ref13" ref-type="bibr">13</xref><xref rid="ref16" ref-type="bibr">16</xref>. From 100 μl clinical specimen RNA was extracted using the MagMax automated RNA extractor as per the manufacturer details. Real-time RT PCR assays were carried out using the Invitrogen Superscript III one-step quantitative RT-PCR kit (Invitrogen, Thermo Fisher Scientific, USA). Real-time RT-PCR assays were performed on ABI 7500 machine (Applied Biosystems Inc, USA) in a 25 μl PCR reaction containing 10 picomol of each forward and reverse primer, 5 picomol of TaqMan probe, 12.5 μl ×2 buffer, 0.5 μl Superscript III enzyme and 5 μl RNA extract. RT-PCR thermal cycling conditions were as follows: 50°C for 30 min, initial denaturation at 94°C for 10 min, 45 cycles of 15 sec at 94°C, 45 sec at 55°C. <italic>In vitro</italic> transcribed RNAs for all viruses to be detected were used as a positive control except enterovirus and bocavirus for which known positive clinical samples previously confirmed by additional conventional PCR and monoplex RT-PCR were used.</p><p>The patients were managed with symptomatic treatment and antiviral drugs where appropriate. Patients were followed telephonically at weekly intervals until two weeks to collect data on illness outcome.</p><p><italic>Statistical analysis</italic>: Descriptive statistics was used to assess various prevalence rates. Comparison of continuous variables was performed using Student's <italic>t</italic> test, whereas comparison of various proportions (clinical features and other variables among pathogen positive and pathogen negative participants) was performed by SPSS (Statistical Package for Social Sciences) Version 17 software (IBM Limited, USA). All values were expressed as percentages and <italic>P</italic><0.05 was considered significant.</p></sec><sec sec-type="results" id="sec1-3"><title>Results</title><p>Of the 300 participants 140 were males and 160 females with age ranging from 26 to 60 yr (median age 60 yr). Ninety seven (32.3%) were tested positive for any virus (<xref rid="T1" ref-type="table">Table</xref>), influenza viruses [n=33, A (H3N2)=13], A [(H1N1pdm09)=9 and B (Yamagata)=11] were the most frequent (<xref ref-type="fig" rid="F1">Figure</xref>)<xref rid="ref10" ref-type="bibr">10</xref>. Of the other viruses, human coronaviruses (n=26, 8.7%) were the most common detected consisting in OC43 (n=19, 6.3%) and C229E (n=7, 2.3%) subtypes. MERS-CoV was not detected in any of the patients<xref rid="ref10" ref-type="bibr">10</xref>. Human coronavirus (HCOV)-positive patients (15 males, age 32-75 yr, median 60 yr) presented with symptoms of 1-3 days (median 2 days) duration, with no significant differences in the age distribution and the symptomatology between HCOV-positive and negative patients. Co-infections of HCOV with other respiratory viruses were seen in five patients (aged 38-75 yr, median 60 yr, 4 males). These included HCOV OC43+ adenovirus (n=1), HCOV 229E + adenovirus + influenza B (Victoria) (n=1), HCOV 229E + influenza A (H3N2) (n=1), HCOV 229E + adenovirus (n=1) and HCOV 229E + influenza A (H1N1pdm09) (n=1). Human rhinovirus (HRV) was detected in 20 patients, and there were no significant differences between age distribution, co-morbidities and clinical features of HRV-positive and negative patients. Other respiratory viruses that were detected included adenoviruses (n=8, 2.6%), parainfluenza viruses (n=7, 2.3%), RSV (n=3, 1%) and bocaviruses (n=2, 0.6%) (<xref ref-type="fig" rid="F1">Figure</xref>). Co-infections were seen in two patients (aged 50 and 60 yr, both females): one each of enterovirus + adenovirus and adenovirus + PIV-1.</p><table-wrap id="T1" position="float"><label>Table</label><caption><p>Clinical symptoms and respiratory viruses detected among enrolled Hajj returnees (2014-2015, n=300)</p></caption><graphic xlink:href="IJMR-148-329-g001"></graphic></table-wrap><fig id="F1" position="float"><label>Figure</label><caption><p>Frequency of respiratory pathogens detected in pilgrims returning from Hajj/Umrah (2014-2015). *Denotes data reported previously for these viruses<xref rid="ref10" ref-type="bibr">10</xref>. HCOV, human coronavirus; PIV, para influenza virus; RSV, respiratory synctial virus; Inf, influenza virus.</p></caption><graphic xlink:href="IJMR-148-329-g002"></graphic></fig><p>All patients were given symptomatic treatment and advised about cough etiquette, hand hygiene and other infection control measures. Oseltamivir was used in 18 patients with laboratory-confirmed influenza viral infection who presented within 1-5 days (interquartile range 2-4 days) of the onset of the illness. None of the patients required hospitalization, and all had an uneventful recovery in 2-5 days.</p><p>Of the 300 participants, 216 (72%) had received trivalent inactivated influenza vaccine [comprising of A/California/7/2009 (H1N1)pdm09-like virus; A/Texas/50/2012 (H3N2)-like virus and B/Massachusetts/2/2012 (Yamagata)-like virus], 14-21 days (median 16 days) before embarking on the pilgrimage. The corresponding influenza infection detected included influenza A/H3N2 (n=13), A/H1N1pdm09 (n=9) and B/Yamagata (n=11)<xref rid="ref10" ref-type="bibr">10</xref>. The participants had received the influenza vaccine as a part of their travel advice. Twenty one (10%) of these developed influenza-positive respiratory illness in comparison to 14.3 per cent (n=12) of those not vaccinated before the pilgrimage. None had received pneumococcal vaccination.</p></sec><sec sec-type="discussion" id="sec1-4"><title>Discussion</title><p>Our data showed that apart from influenza, corona- and rhinoviruses were the most commonly detected viruses in Indian pilgrims returning from Hajj and Umrah in 2015. Coronaviruses OC43 and 229E have been known to be associated with upper respiratory infection<xref rid="ref17" ref-type="bibr">17</xref>. A systematic review of 31 studies showed that rhinoviruses were the most commonly isolated viruses from symptomatic patients during the Hajj (5.9-48.8% prevalence), followed by influenza viruses (4.5-13.9%) and coronaviruses (2.7-13.2%) with coronavirus 229E being the most common; other viruses were less frequently detected<xref rid="ref17" ref-type="bibr">17</xref>. The high prevalence of viruses such as influenza A (H1N1pdm09), influenza A (H3N2), rhinoviruses, coronaviruses (229E, HKU1 and OC43) in the study participants was similar to other such studies<xref rid="ref17" ref-type="bibr">17</xref>, however, the aetiopathogenetic contribution was not clear in the absence of assessing the asymptomatic carriage in a control group. The crowded conditions during pilgrimage likely facilitate transmission of these viruses and could contribute to the high frequency of respiratory illness, the most common symptoms among the pilgrims<xref rid="ref3" ref-type="bibr">3</xref>. Our data showed that respiratory virus infections were common among returning pilgrims with influenza, with corona and rhinoviruses being the most frequent and that clinical symptoms were not helpful in differentiating among respiratory infections.</p><p>Pilgrimage acquired viral infections are important for public health because these do not follow the traditional seasonality of any geography. We have earlier demonstrated that influenza and non-influenza respiratory viruses contribute significantly to acute exacerbations of COPD with a high level of activity during winter months in northern India, in a pattern that resembles the northern hemispherical pattern of circulation of influenza<xref rid="ref18" ref-type="bibr">18</xref><xref rid="ref19" ref-type="bibr">19</xref><xref rid="ref20" ref-type="bibr">20</xref>. However, since Hajj and Umrah are performed throughout the year with changing dates, the congregation of potentially infected individuals from all across the world with individual seasonality of circulation of these viruses makes the acquisition and transmission of the viruses possible. International gatherings have a potential of acquisition of communicable disease outbreaks and exportation of these pathogens and initiation of local chain of spread in home countries triggering local outbreaks. Although not reported in the context of Hajj, transmission of MERS-CoV has been reported in home countries after travelling to a MERS-CoV-affected country in several instances like in the UK<xref rid="ref21" ref-type="bibr">21</xref>, France<xref rid="ref22" ref-type="bibr">22</xref>, and South Korea<xref rid="ref9" ref-type="bibr">9</xref>.</p><p>Our study was limited by the fact that there was no information available about carriage of the viruses among those who did not have symptoms and the pre-pilgrimage status. However, all of the participants had been asymptomatic while before embarking on the pilgrimage. A control group of persons with a similar level of severity and without a recent history of travel, could have really brought out the difference in the viral spectrum, if any and given the quantitative impact of importation of viruses due to the pilgrimage. Furthermore, the patients represented a non-random selection that was, however, necessary in the unique circumstances of the recruitment.</p><p>Our study highlighted the potential for persons returning from mass gatherings to facilitate transmission of respiratory pathogens and reinforced the need for better infection prevention and control measures such as vaccination, health education on cough etiquette and hand hygiene, or use of facemasks<xref rid="ref23" ref-type="bibr">23</xref>. There is a need for larger studies for surveillance for the viruses among the pilgrims returning from mass religious gatherings as also international and multi-sectorial coordination and communication for effective surveillance among Hajj and Umrah pilgrims and continued evaluation of the implementation of the recommended guidance<xref rid="ref4" ref-type="bibr">4</xref><xref rid="ref18" ref-type="bibr">18</xref> for prevention of communicable health hazards among the pilgrims. An assessment of the burden of the viruses would also help public health and policy planners to devise appropriate public health response including infection control strategies during and after return from the pilgrimage.</p></sec></body><back><ack><title>Acknowledgment</title><p>The authors acknowledge the support of the Airport Authority of India, Srinagar, India.</p></ack><fn-group><fn fn-type="supported-by"><p><bold><italic>Financial support & sponsorship</italic>:</bold> This study was supported in part by cooperative agreement U01IP000206 from the Centers for Disease Control and Prevention, Atlanta, USA.</p></fn><fn fn-type="COI-statement"><p><bold><italic>Conflicts of Interest</italic>:</bold> None.</p></fn></fn-group><ref-list><ref id="ref1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Memish</surname><given-names>ZA</given-names></name><name><surname>Zumla</surname><given-names>A</given-names></name><name><surname>Alhakeem</surname><given-names>RF</given-names></name><name><surname>Assiri</surname><given-names>A</given-names></name><name><surname>Turkestani</surname><given-names>A</given-names></name><name><surname>Al Harby</surname><given-names>KD</given-names></name><etal></etal></person-group><article-title>Hajj: Infectious disease surveillance and control</article-title><source>Lancet</source><year>2014</year><volume>383</volume><fpage>2073</fpage><lpage>82</lpage><pub-id pub-id-type="pmid">24857703</pub-id></element-citation></ref><ref id="ref2"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ahmed</surname><given-names>QA</given-names></name><name><surname>Arabi</surname><given-names>YM</given-names></name><name><surname>Memish</surname><given-names>ZA</given-names></name></person-group><article-title>Health risks at the Hajj</article-title><source>Lancet</source><year>2006</year><volume>367</volume><fpage>1008</fpage><lpage>15</lpage><pub-id pub-id-type="pmid">16564364</pub-id></element-citation></ref><ref id="ref3"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Alzahrani</surname><given-names>AG</given-names></name><name><surname>Choudhry</surname><given-names>AJ</given-names></name><name><surname>Al Mazroa</surname><given-names>MA</given-names></name><name><surname>Turkistani</surname><given-names>AH</given-names></name><name><surname>Nouman</surname><given-names>GS</given-names></name><name><surname>Memish</surname><given-names>ZA</given-names></name><etal></etal></person-group><article-title>Pattern of diseases among visitors to Mina health centers during the Hajj season, 1429 H (2008 G)</article-title><source>J Infect Public Health</source><year>2012</year><volume>5</volume><fpage>22</fpage><lpage>34</lpage><pub-id pub-id-type="pmid">22341840</pub-id></element-citation></ref><ref id="ref4"><label>4</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Al-Tawfiq</surname><given-names>JA</given-names></name><name><surname>Gautret</surname><given-names>P</given-names></name><name><surname>Benkouiten</surname><given-names>S</given-names></name><name><surname>Memish</surname><given-names>ZA</given-names></name></person-group><article-title>Mass gatherings and the spread of respiratory infections. Lessons from the Hajj</article-title><source>Ann Am Thorac Soc</source><year>2016</year><volume>13</volume><fpage>759</fpage><lpage>65</lpage><pub-id pub-id-type="pmid">27088298</pub-id></element-citation></ref><ref id="ref5"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Haworth</surname><given-names>E</given-names></name><name><surname>Barasheed</surname><given-names>O</given-names></name><name><surname>Memish</surname><given-names>ZA</given-names></name><name><surname>Rashid</surname><given-names>H</given-names></name><name><surname>Booy</surname><given-names>R</given-names></name></person-group><article-title>Prevention of influenza at Hajj: Applications for mass gatherings</article-title><source>J R Soc Med</source><year>2013</year><volume>106</volume><fpage>215</fpage><lpage>23</lpage><pub-id pub-id-type="pmid">23761581</pub-id></element-citation></ref><ref id="ref6"><label>6</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Alfelali</surname><given-names>M</given-names></name><name><surname>Barasheed</surname><given-names>O</given-names></name><name><surname>Badahdah</surname><given-names>AM</given-names></name><name><surname>Bokhary</surname><given-names>H</given-names></name><name><surname>Azeem</surname><given-names>MI</given-names></name><name><surname>Habeebullah</surname><given-names>T</given-names></name><etal></etal></person-group><collab>Hajj Research Team</collab><article-title>Influenza vaccination among Saudi Hajj pilgrims: Revealing the uptake and vaccination barriers</article-title><source>Vaccine</source><year>2018</year><volume>36</volume><fpage>2112</fpage><lpage>8</lpage><pub-id pub-id-type="pmid">29555221</pub-id></element-citation></ref><ref id="ref7"><label>7</label><element-citation publication-type="book"><article-title>World Health Organization. WHO MERS-CoV Global Summary and Assessment of Risk, August 2018 (WHO/MERS/RA/August18)</article-title><source>Middle East respiratory syndrome coronavirus (MERS-CoV) Summary of Current Situation August 2018</source><year>2018</year><publisher-loc>Geneva, Switzerland</publisher-loc><publisher-name>WHO</publisher-name></element-citation></ref><ref id="ref8"><label>8</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Soliman</surname><given-names>T</given-names></name><name><surname>Cook</surname><given-names>AR</given-names></name><name><surname>Coker</surname><given-names>RJ</given-names></name></person-group><article-title>Pilgrims and MERS-coV: What's the risk?</article-title><source>Emerg Themes Epidemiol</source><year>2015</year><volume>12</volume><fpage>3</fpage><pub-id pub-id-type="pmid">25717340</pub-id></element-citation></ref><ref id="ref9"><label>9</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cho</surname><given-names>SY</given-names></name><name><surname>Kang</surname><given-names>JM</given-names></name><name><surname>Ha</surname><given-names>YE</given-names></name><name><surname>Park</surname><given-names>GE</given-names></name><name><surname>Lee</surname><given-names>JY</given-names></name><name><surname>Ko</surname><given-names>JH</given-names></name><etal></etal></person-group><article-title>MERS-coV outbreak following a single patient exposure in an emergency room in South Korea: An epidemiological outbreak study</article-title><source>Lancet</source><year>2016</year><volume>388</volume><fpage>994</fpage><lpage>1001</lpage><pub-id pub-id-type="pmid">27402381</pub-id></element-citation></ref><ref id="ref10"><label>10</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Koul</surname><given-names>PA</given-names></name><name><surname>Mir</surname><given-names>H</given-names></name><name><surname>Saha</surname><given-names>S</given-names></name><name><surname>Chadha</surname><given-names>MS</given-names></name><name><surname>Potdar</surname><given-names>V</given-names></name><name><surname>Widdowson</surname><given-names>MA</given-names></name><etal></etal></person-group><article-title>Influenza not MERS coV among returning Hajj and Umrah pilgrims with respiratory illness, Kashmir, North India, 2014-15</article-title><source>Travel Med Infect Dis</source><year>2017</year><volume>15</volume><fpage>45</fpage><lpage>7</lpage><pub-id pub-id-type="pmid">27932291</pub-id></element-citation></ref><ref id="ref11"><label>11</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Brittain-Long</surname><given-names>R</given-names></name><name><surname>Nord</surname><given-names>S</given-names></name><name><surname>Olofsson</surname><given-names>S</given-names></name><name><surname>Westin</surname><given-names>J</given-names></name><name><surname>Anderson</surname><given-names>LM</given-names></name><name><surname>Lindh</surname><given-names>M</given-names></name><etal></etal></person-group><article-title>Multiplex real-time PCR for detection of respiratory tract infections</article-title><source>J Clin Virol</source><year>2008</year><volume>41</volume><fpage>53</fpage><lpage>6</lpage><pub-id pub-id-type="pmid">18093871</pub-id></element-citation></ref><ref id="ref12"><label>12</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Maertzdorf</surname><given-names>J</given-names></name><name><surname>Wang</surname><given-names>CK</given-names></name><name><surname>Brown</surname><given-names>JB</given-names></name><name><surname>Quinto</surname><given-names>JD</given-names></name><name><surname>Chu</surname><given-names>M</given-names></name><name><surname>de Graaf</surname><given-names>M</given-names></name><etal></etal></person-group><article-title>Real-time reverse transcriptase PCR assay for detection of human metapneumoviruses from all known genetic lineages</article-title><source>J Clin Microbiol</source><year>2004</year><volume>42</volume><fpage>981</fpage><lpage>6</lpage><pub-id pub-id-type="pmid">15004041</pub-id></element-citation></ref><ref id="ref13"><label>13</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname><given-names>CY</given-names></name><name><surname>Arden</surname><given-names>KE</given-names></name><name><surname>Greer</surname><given-names>R</given-names></name><name><surname>Sloots</surname><given-names>TP</given-names></name><name><surname>Mackay</surname><given-names>IM</given-names></name></person-group><article-title>A novel duplex real-time PCR for HPIV-4 detects co-circulation of both viral subtypes among ill children during 2008</article-title><source>J Clin Virol</source><year>2012</year><volume>54</volume><fpage>83</fpage><lpage>5</lpage><pub-id pub-id-type="pmid">22361219</pub-id></element-citation></ref><ref id="ref14"><label>14</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wong</surname><given-names>S</given-names></name><name><surname>Pabbaraju</surname><given-names>K</given-names></name><name><surname>Pang</surname><given-names>XL</given-names></name><name><surname>Lee</surname><given-names>BE</given-names></name><name><surname>Fox</surname><given-names>JD</given-names></name></person-group><article-title>Detection of a broad range of human adenoviruses in respiratory tract samples using a sensitive multiplex real-time PCR assay</article-title><source>J Med Virol</source><year>2008</year><volume>80</volume><fpage>856</fpage><lpage>65</lpage><pub-id pub-id-type="pmid">18360899</pub-id></element-citation></ref><ref id="ref15"><label>15</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Deng</surname><given-names>Y</given-names></name><name><surname>Gu</surname><given-names>X</given-names></name><name><surname>Zhao</surname><given-names>X</given-names></name><name><surname>Luo</surname><given-names>J</given-names></name><name><surname>Luo</surname><given-names>Z</given-names></name><name><surname>Wang</surname><given-names>L</given-names></name><etal></etal></person-group><article-title>High viral load of human bocavirus correlates with duration of wheezing in children with severe lower respiratory tract infection</article-title><source>PLoS One</source><year>2012</year><volume>7</volume><fpage>e34353</fpage><pub-id pub-id-type="pmid">22479609</pub-id></element-citation></ref><ref id="ref16"><label>16</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>van Elden</surname><given-names>LJ</given-names></name><name><surname>van Loon</surname><given-names>AM</given-names></name><name><surname>van Alphen</surname><given-names>F</given-names></name><name><surname>Hendriksen</surname><given-names>KA</given-names></name><name><surname>Hoepelman</surname><given-names>AI</given-names></name><name><surname>van Kraaij</surname><given-names>MG</given-names></name><etal></etal></person-group><article-title>Frequent detection of human coronaviruses in clinical specimens from patients with respiratory tract infection by use of a novel real-time reverse-transcriptase polymerase chain reaction</article-title><source>J Infect Dis</source><year>2004</year><volume>189</volume><fpage>652</fpage><lpage>7</lpage><pub-id pub-id-type="pmid">14767819</pub-id></element-citation></ref><ref id="ref17"><label>17</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Gautret</surname><given-names>P</given-names></name><name><surname>Benkouiten</surname><given-names>S</given-names></name><name><surname>Al-Tawfiq</surname><given-names>JA</given-names></name><name><surname>Memish</surname><given-names>ZA</given-names></name></person-group><article-title>Hajj-associated viral respiratory infections: A systematic review</article-title><source>Travel Med Infect Dis</source><year>2016</year><volume>14</volume><fpage>92</fpage><lpage>109</lpage><pub-id pub-id-type="pmid">26781223</pub-id></element-citation></ref><ref id="ref18"><label>18</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Koul</surname><given-names>PA</given-names></name><name><surname>Khan</surname><given-names>UH</given-names></name><name><surname>Asad</surname><given-names>R</given-names></name><name><surname>Yousuf</surname><given-names>R</given-names></name><name><surname>Broor</surname><given-names>S</given-names></name><name><surname>Lal</surname><given-names>RB</given-names></name><etal></etal></person-group><article-title>Contribution of influenza to acute exacerbations of chronic obstructive pulmonary disease in Kashmir, India, 2010-2012</article-title><source>Influenza Other Respir Viruses</source><year>2015</year><volume>9</volume><fpage>40</fpage><lpage>2</lpage><pub-id pub-id-type="pmid">25524051</pub-id></element-citation></ref><ref id="ref19"><label>19</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Koul</surname><given-names>PA</given-names></name><name><surname>Mir</surname><given-names>H</given-names></name><name><surname>Akram</surname><given-names>S</given-names></name><name><surname>Potdar</surname><given-names>V</given-names></name><name><surname>Chadha</surname><given-names>MS</given-names></name></person-group><article-title>Respiratory viruses in acute exacerbations of chronic obstructive pulmonary disease</article-title><source>Lung India</source><year>2017</year><volume>34</volume><fpage>29</fpage><lpage>33</lpage><pub-id pub-id-type="pmid">28144057</pub-id></element-citation></ref><ref id="ref20"><label>20</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Koul</surname><given-names>PA</given-names></name><name><surname>Broor</surname><given-names>S</given-names></name><name><surname>Saha</surname><given-names>S</given-names></name><name><surname>Barnes</surname><given-names>J</given-names></name><name><surname>Smith</surname><given-names>C</given-names></name><name><surname>Shaw</surname><given-names>M</given-names></name><etal></etal></person-group><article-title>Differences in influenza seasonality by latitude, Northern India</article-title><source>Emerg Infect Dis</source><year>2014</year><volume>20</volume><fpage>1723</fpage><lpage>6</lpage><pub-id pub-id-type="pmid">25279651</pub-id></element-citation></ref><ref id="ref21"><label>21</label><element-citation publication-type="journal"><collab>Health Protection Agency (HPA) UK Novel Coronavirus Investigation Team</collab><article-title>Evidence of person-to-person transmission within a family cluster of novel coronavirus infections, United Kingdom, February 2013</article-title><source>Euro Surveill</source><year>2013</year><volume>18</volume><fpage>20427</fpage><pub-id pub-id-type="pmid">23517868</pub-id></element-citation></ref><ref id="ref22"><label>22</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Guery</surname><given-names>B</given-names></name><name><surname>Poissy</surname><given-names>J</given-names></name><name><surname>el Mansouf</surname><given-names>L</given-names></name><name><surname>Séjourné</surname><given-names>C</given-names></name><name><surname>Ettahar</surname><given-names>N</given-names></name><name><surname>Lemaire</surname><given-names>X</given-names></name><etal></etal></person-group><article-title>Clinical features and viral diagnosis of two cases of infection with Middle East respiratory syndrome coronavirus: A report of nosocomial transmission</article-title><source>Lancet</source><year>2013</year><volume>381</volume><fpage>2265</fpage><lpage>72</lpage><pub-id pub-id-type="pmid">23727167</pub-id></element-citation></ref><ref id="ref23"><label>23</label><element-citation publication-type="webpage"><article-title>Ministry of Health – Kingdom of Saudi Arabia. Health requirements for travellers to Saudi Arabia for pilgrimage to Makkah (2016/1437H Hajj). Ministry of Health – Kingdom of Saudi Arabia</article-title><year>2016</year><date-in-citation>accessed on April 30, 2017</date-in-citation><comment>Available from: <uri xlink:type="simple" xlink:href="http://www.moh.gov.sa/en/hajj/pages/healthregulations.aspx">http://www.moh.gov.sa/en/hajj/pages/healthregulations.aspx</uri></comment></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/CovidV2/Data/Pmc/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000879 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd -nk 000879 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Sante
|area= CovidV2
|flux= Pmc
|étape= Corpus
|type= RBID
|clé= PMC:6251276
|texte= Respiratory viruses in returning Hajj & Umrah pilgrims with acute respiratory illness in 2014-2015
}}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/RBID.i -Sk "pubmed:30425224" \
| HfdSelect -Kh $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd \
| NlmPubMed2Wicri -a CovidV2
| This area was generated with Dilib version V0.6.33. |  |