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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Acute respiratory infections among returning Hajj pilgrims—Jordan, 2014</title><author><name sortKey="Al Abdallat, Mohammad Mousa" sort="Al Abdallat, Mohammad Mousa" uniqKey="Al Abdallat M" first="Mohammad Mousa" last="Al-Abdallat">Mohammad Mousa Al-Abdallat</name><affiliation><nlm:aff id="aff0005">Communicable Diseases Directorate, Jordan Ministry of Health, Amman, Jordan</nlm:aff></affiliation></author><author><name sortKey="Rha, Brian" sort="Rha, Brian" uniqKey="Rha B" first="Brian" last="Rha">Brian Rha</name><affiliation><nlm:aff id="aff0010">Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA</nlm:aff></affiliation></author><author><name sortKey="Alqasrawi, Sultan" sort="Alqasrawi, Sultan" uniqKey="Alqasrawi S" first="Sultan" last="Alqasrawi">Sultan Alqasrawi</name><affiliation><nlm:aff id="aff0005">Communicable Diseases Directorate, Jordan Ministry of Health, Amman, Jordan</nlm:aff></affiliation></author><author><name sortKey="Payne, Daniel C" sort="Payne, Daniel C" uniqKey="Payne D" first="Daniel C." last="Payne">Daniel C. Payne</name><affiliation><nlm:aff id="aff0010">Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA</nlm:aff></affiliation></author><author><name sortKey="Iblan, Ibrahim" sort="Iblan, Ibrahim" uniqKey="Iblan I" first="Ibrahim" last="Iblan">Ibrahim Iblan</name><affiliation><nlm:aff id="aff0015">Jordan Field Epidemiology Training Program, Amman, Jordan</nlm:aff></affiliation></author><author><name sortKey="Binder, Alison M" sort="Binder, Alison M" uniqKey="Binder A" first="Alison M." last="Binder">Alison M. Binder</name><affiliation><nlm:aff id="aff0010">Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA</nlm:aff></affiliation><affiliation><nlm:aff id="aff0020">Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA</nlm:aff></affiliation></author><author><name sortKey="Haddadin, Aktham" sort="Haddadin, Aktham" uniqKey="Haddadin A" first="Aktham" last="Haddadin">Aktham Haddadin</name><affiliation><nlm:aff id="aff0025">Directorate of Laboratories, Jordan Ministry of Health, Amman, Jordan</nlm:aff></affiliation></author><author><name sortKey="Nsour, Mohannad Al" sort="Nsour, Mohannad Al" uniqKey="Nsour M" first="Mohannad Al" last="Nsour">Mohannad Al Nsour</name><affiliation><nlm:aff id="aff0030">Eastern Mediterranean Public Health Network, Amman, Jordan</nlm:aff></affiliation></author><author><name sortKey="Alsanouri, Tarek" sort="Alsanouri, Tarek" uniqKey="Alsanouri T" first="Tarek" last="Alsanouri">Tarek Alsanouri</name><affiliation><nlm:aff id="aff0025">Directorate of Laboratories, Jordan Ministry of Health, Amman, Jordan</nlm:aff></affiliation></author><author><name sortKey="Mofleh, Jawad" sort="Mofleh, Jawad" uniqKey="Mofleh J" first="Jawad" last="Mofleh">Jawad Mofleh</name><affiliation><nlm:aff id="aff0030">Eastern Mediterranean Public Health Network, Amman, Jordan</nlm:aff></affiliation></author><author><name sortKey="Whitaker, Brett" sort="Whitaker, Brett" uniqKey="Whitaker B" first="Brett" last="Whitaker">Brett Whitaker</name><affiliation><nlm:aff id="aff0010">Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA</nlm:aff></affiliation></author><author><name sortKey="Lindstrom, Stephen L" sort="Lindstrom, Stephen L" uniqKey="Lindstrom S" first="Stephen L." last="Lindstrom">Stephen L. Lindstrom</name><affiliation><nlm:aff id="aff0035">Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA</nlm:aff></affiliation></author><author><name sortKey="Tong, Suxiang" sort="Tong, Suxiang" uniqKey="Tong S" first="Suxiang" last="Tong">Suxiang Tong</name><affiliation><nlm:aff id="aff0010">Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA</nlm:aff></affiliation></author><author><name sortKey="Ali, Sami Sheikh" sort="Ali, Sami Sheikh" uniqKey="Ali S" first="Sami Sheikh" last="Ali">Sami Sheikh Ali</name><affiliation><nlm:aff id="aff0005">Communicable Diseases Directorate, Jordan Ministry of Health, Amman, Jordan</nlm:aff></affiliation></author><author><name sortKey="Dahl, Rebecca Moritz" sort="Dahl, Rebecca Moritz" uniqKey="Dahl R" first="Rebecca Moritz" last="Dahl">Rebecca Moritz Dahl</name><affiliation><nlm:aff id="aff0040">Maximus Federal, Atlanta, GA, USA</nlm:aff></affiliation></author><author><name sortKey="Berman, Lashondra" sort="Berman, Lashondra" uniqKey="Berman L" first="Lashondra" last="Berman">Lashondra Berman</name><affiliation><nlm:aff id="aff0035">Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA</nlm:aff></affiliation></author><author><name sortKey="Zhang, Jing" sort="Zhang, Jing" uniqKey="Zhang J" first="Jing" last="Zhang">Jing Zhang</name><affiliation><nlm:aff id="aff0010">Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA</nlm:aff></affiliation></author><author><name sortKey="Erdman, Dean D" sort="Erdman, Dean D" uniqKey="Erdman D" first="Dean D." last="Erdman">Dean D. Erdman</name><affiliation><nlm:aff id="aff0010">Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA</nlm:aff></affiliation></author><author><name sortKey="Gerber, Susan I" sort="Gerber, Susan I" uniqKey="Gerber S" first="Susan I." last="Gerber">Susan I. Gerber</name><affiliation><nlm:aff id="aff0010">Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28226273</idno><idno type="pmc">7106359</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7106359</idno><idno type="RBID">PMC:7106359</idno><idno type="doi">10.1016/j.jcv.2017.01.010</idno><date when="2017">2017</date><idno type="wicri:Area/Pmc/Corpus">000709</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000709</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Acute respiratory infections among returning Hajj pilgrims—Jordan, 2014</title><author><name sortKey="Al Abdallat, Mohammad Mousa" sort="Al Abdallat, Mohammad Mousa" uniqKey="Al Abdallat M" first="Mohammad Mousa" last="Al-Abdallat">Mohammad Mousa Al-Abdallat</name><affiliation><nlm:aff id="aff0005">Communicable Diseases Directorate, Jordan Ministry of Health, Amman, Jordan</nlm:aff></affiliation></author><author><name sortKey="Rha, Brian" sort="Rha, Brian" uniqKey="Rha B" first="Brian" last="Rha">Brian Rha</name><affiliation><nlm:aff id="aff0010">Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA</nlm:aff></affiliation></author><author><name sortKey="Alqasrawi, Sultan" sort="Alqasrawi, Sultan" uniqKey="Alqasrawi S" first="Sultan" last="Alqasrawi">Sultan Alqasrawi</name><affiliation><nlm:aff id="aff0005">Communicable Diseases Directorate, Jordan Ministry of Health, Amman, Jordan</nlm:aff></affiliation></author><author><name sortKey="Payne, Daniel C" sort="Payne, Daniel C" uniqKey="Payne D" first="Daniel C." last="Payne">Daniel C. Payne</name><affiliation><nlm:aff id="aff0010">Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA</nlm:aff></affiliation></author><author><name sortKey="Iblan, Ibrahim" sort="Iblan, Ibrahim" uniqKey="Iblan I" first="Ibrahim" last="Iblan">Ibrahim Iblan</name><affiliation><nlm:aff id="aff0015">Jordan Field Epidemiology Training Program, Amman, Jordan</nlm:aff></affiliation></author><author><name sortKey="Binder, Alison M" sort="Binder, Alison M" uniqKey="Binder A" first="Alison M." last="Binder">Alison M. Binder</name><affiliation><nlm:aff id="aff0010">Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA</nlm:aff></affiliation><affiliation><nlm:aff id="aff0020">Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA</nlm:aff></affiliation></author><author><name sortKey="Haddadin, Aktham" sort="Haddadin, Aktham" uniqKey="Haddadin A" first="Aktham" last="Haddadin">Aktham Haddadin</name><affiliation><nlm:aff id="aff0025">Directorate of Laboratories, Jordan Ministry of Health, Amman, Jordan</nlm:aff></affiliation></author><author><name sortKey="Nsour, Mohannad Al" sort="Nsour, Mohannad Al" uniqKey="Nsour M" first="Mohannad Al" last="Nsour">Mohannad Al Nsour</name><affiliation><nlm:aff id="aff0030">Eastern Mediterranean Public Health Network, Amman, Jordan</nlm:aff></affiliation></author><author><name sortKey="Alsanouri, Tarek" sort="Alsanouri, Tarek" uniqKey="Alsanouri T" first="Tarek" last="Alsanouri">Tarek Alsanouri</name><affiliation><nlm:aff id="aff0025">Directorate of Laboratories, Jordan Ministry of Health, Amman, Jordan</nlm:aff></affiliation></author><author><name sortKey="Mofleh, Jawad" sort="Mofleh, Jawad" uniqKey="Mofleh J" first="Jawad" last="Mofleh">Jawad Mofleh</name><affiliation><nlm:aff id="aff0030">Eastern Mediterranean Public Health Network, Amman, Jordan</nlm:aff></affiliation></author><author><name sortKey="Whitaker, Brett" sort="Whitaker, Brett" uniqKey="Whitaker B" first="Brett" last="Whitaker">Brett Whitaker</name><affiliation><nlm:aff id="aff0010">Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA</nlm:aff></affiliation></author><author><name sortKey="Lindstrom, Stephen L" sort="Lindstrom, Stephen L" uniqKey="Lindstrom S" first="Stephen L." last="Lindstrom">Stephen L. Lindstrom</name><affiliation><nlm:aff id="aff0035">Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA</nlm:aff></affiliation></author><author><name sortKey="Tong, Suxiang" sort="Tong, Suxiang" uniqKey="Tong S" first="Suxiang" last="Tong">Suxiang Tong</name><affiliation><nlm:aff id="aff0010">Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA</nlm:aff></affiliation></author><author><name sortKey="Ali, Sami Sheikh" sort="Ali, Sami Sheikh" uniqKey="Ali S" first="Sami Sheikh" last="Ali">Sami Sheikh Ali</name><affiliation><nlm:aff id="aff0005">Communicable Diseases Directorate, Jordan Ministry of Health, Amman, Jordan</nlm:aff></affiliation></author><author><name sortKey="Dahl, Rebecca Moritz" sort="Dahl, Rebecca Moritz" uniqKey="Dahl R" first="Rebecca Moritz" last="Dahl">Rebecca Moritz Dahl</name><affiliation><nlm:aff id="aff0040">Maximus Federal, Atlanta, GA, USA</nlm:aff></affiliation></author><author><name sortKey="Berman, Lashondra" sort="Berman, Lashondra" uniqKey="Berman L" first="Lashondra" last="Berman">Lashondra Berman</name><affiliation><nlm:aff id="aff0035">Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA</nlm:aff></affiliation></author><author><name sortKey="Zhang, Jing" sort="Zhang, Jing" uniqKey="Zhang J" first="Jing" last="Zhang">Jing Zhang</name><affiliation><nlm:aff id="aff0010">Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA</nlm:aff></affiliation></author><author><name sortKey="Erdman, Dean D" sort="Erdman, Dean D" uniqKey="Erdman D" first="Dean D." last="Erdman">Dean D. Erdman</name><affiliation><nlm:aff id="aff0010">Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA</nlm:aff></affiliation></author><author><name sortKey="Gerber, Susan I" sort="Gerber, Susan I" uniqKey="Gerber S" first="Susan I." last="Gerber">Susan I. Gerber</name><affiliation><nlm:aff id="aff0010">Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Clinical Virology</title><idno type="ISSN">1386-6532</idno><idno type="eISSN">1873-5967</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Highlights</title><p><list list-type="simple" id="lis0005"><list-item id="lsti0005"><label>•</label><p id="par0005">Surveillance for respiratory illness in Hajj pilgrims took place in Jordan in 2014.</p></list-item><list-item id="lsti0010"><label>•</label><p id="par0010">58% of the 125 subjects returning from Hajj tested positive for at least one virus.</p></list-item><list-item id="lsti0015"><label>•</label><p id="par0015">Rhino/enterovirus was the most commonly detected viral pathogen (47% of subjects).</p></list-item><list-item id="lsti0020"><label>•</label><p id="par0020">No cases of Middle East Respiratory Syndrome coronavirus were detected.</p></list-item></list></p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Memish, Z A" uniqKey="Memish Z">Z.A. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Clin Virol</journal-id><journal-id journal-id-type="iso-abbrev">J. Clin. Virol</journal-id><journal-title-group><journal-title>Journal of Clinical Virology</journal-title></journal-title-group><issn pub-type="ppub">1386-6532</issn><issn pub-type="epub">1873-5967</issn><publisher><publisher-name>Elsevier Science</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28226273</article-id><article-id pub-id-type="pmc">7106359</article-id><article-id pub-id-type="publisher-id">S1386-6532(17)30025-2</article-id><article-id pub-id-type="doi">10.1016/j.jcv.2017.01.010</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Acute respiratory infections among returning Hajj pilgrims—Jordan, 2014</article-title></title-group><contrib-group><contrib contrib-type="author" id="aut0005"><name><surname>Al-Abdallat</surname><given-names>Mohammad Mousa</given-names></name><xref rid="aff0005" ref-type="aff">a</xref><xref rid="fn0005" ref-type="fn">1</xref></contrib><contrib contrib-type="author" id="aut0010"><name><surname>Rha</surname><given-names>Brian</given-names></name><email>wif8@cdc.gov</email><xref rid="aff0010" ref-type="aff">b</xref><xref rid="fn0005" ref-type="fn">1</xref><xref rid="cor0005" ref-type="corresp">⁎</xref></contrib><contrib contrib-type="author" id="aut0015"><name><surname>Alqasrawi</surname><given-names>Sultan</given-names></name><xref rid="aff0005" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="aut0020"><name><surname>Payne</surname><given-names>Daniel C.</given-names></name><xref rid="aff0010" ref-type="aff">b</xref></contrib><contrib contrib-type="author" id="aut0025"><name><surname>Iblan</surname><given-names>Ibrahim</given-names></name><xref rid="aff0015" ref-type="aff">c</xref></contrib><contrib contrib-type="author" id="aut0030"><name><surname>Binder</surname><given-names>Alison M.</given-names></name><xref rid="aff0010" ref-type="aff">b</xref><xref rid="aff0020" ref-type="aff">d</xref></contrib><contrib contrib-type="author" id="aut0035"><name><surname>Haddadin</surname><given-names>Aktham</given-names></name><xref rid="aff0025" ref-type="aff">e</xref></contrib><contrib contrib-type="author" id="aut0040"><name><surname>Nsour</surname><given-names>Mohannad Al</given-names></name><xref rid="aff0030" ref-type="aff">f</xref></contrib><contrib contrib-type="author" id="aut0045"><name><surname>Alsanouri</surname><given-names>Tarek</given-names></name><xref rid="aff0025" ref-type="aff">e</xref></contrib><contrib contrib-type="author" id="aut0050"><name><surname>Mofleh</surname><given-names>Jawad</given-names></name><xref rid="aff0030" ref-type="aff">f</xref></contrib><contrib contrib-type="author" id="aut0055"><name><surname>Whitaker</surname><given-names>Brett</given-names></name><xref rid="aff0010" ref-type="aff">b</xref></contrib><contrib contrib-type="author" id="aut0060"><name><surname>Lindstrom</surname><given-names>Stephen L.</given-names></name><xref rid="aff0035" ref-type="aff">g</xref></contrib><contrib contrib-type="author" id="aut0065"><name><surname>Tong</surname><given-names>Suxiang</given-names></name><xref rid="aff0010" ref-type="aff">b</xref></contrib><contrib contrib-type="author" id="aut0070"><name><surname>Ali</surname><given-names>Sami Sheikh</given-names></name><xref rid="aff0005" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="aut0075"><name><surname>Dahl</surname><given-names>Rebecca Moritz</given-names></name><xref rid="aff0040" ref-type="aff">h</xref></contrib><contrib contrib-type="author" id="aut0080"><name><surname>Berman</surname><given-names>LaShondra</given-names></name><xref rid="aff0035" ref-type="aff">g</xref></contrib><contrib contrib-type="author" id="aut0085"><name><surname>Zhang</surname><given-names>Jing</given-names></name><xref rid="aff0010" ref-type="aff">b</xref></contrib><contrib contrib-type="author" id="aut0090"><name><surname>Erdman</surname><given-names>Dean D.</given-names></name><xref rid="aff0010" ref-type="aff">b</xref></contrib><contrib contrib-type="author" id="aut0095"><name><surname>Gerber</surname><given-names>Susan I.</given-names></name><xref rid="aff0010" ref-type="aff">b</xref></contrib></contrib-group><aff id="aff0005"><label>a</label>Communicable Diseases Directorate, Jordan Ministry of Health, Amman, Jordan</aff><aff id="aff0010"><label>b</label>Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA</aff><aff id="aff0015"><label>c</label>Jordan Field Epidemiology Training Program, Amman, Jordan</aff><aff id="aff0020"><label>d</label>Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA</aff><aff id="aff0025"><label>e</label>Directorate of Laboratories, Jordan Ministry of Health, Amman, Jordan</aff><aff id="aff0030"><label>f</label>Eastern Mediterranean Public Health Network, Amman, Jordan</aff><aff id="aff0035"><label>g</label>Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA</aff><aff id="aff0040"><label>h</label>Maximus Federal, Atlanta, GA, USA</aff><author-notes><corresp id="cor0005"><label>⁎</label>Corresponding author at: Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop A-34, Atlanta, GA 30333, USA. <email>wif8@cdc.gov</email></corresp><fn id="fn0005"><label>1</label><p id="npar0040">These authors contributed equally to this work.</p></fn></author-notes><pub-date pub-type="pmc-release"><day>8</day><month>2</month><year>2017</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="ppub"><month>4</month><year>2017</year></pub-date><pub-date pub-type="epub"><day>8</day><month>2</month><year>2017</year></pub-date><volume>89</volume><fpage>34</fpage><lpage>37</lpage><history><date date-type="received"><day>7</day><month>11</month><year>2016</year></date><date date-type="rev-recd"><day>9</day><month>1</month><year>2017</year></date><date date-type="accepted"><day>30</day><month>1</month><year>2017</year></date></history><permissions><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions><abstract abstract-type="author-highlights" id="abs0005"><title>Highlights</title><p><list list-type="simple" id="lis0005"><list-item id="lsti0005"><label>•</label><p id="par0005">Surveillance for respiratory illness in Hajj pilgrims took place in Jordan in 2014.</p></list-item><list-item id="lsti0010"><label>•</label><p id="par0010">58% of the 125 subjects returning from Hajj tested positive for at least one virus.</p></list-item><list-item id="lsti0015"><label>•</label><p id="par0015">Rhino/enterovirus was the most commonly detected viral pathogen (47% of subjects).</p></list-item><list-item id="lsti0020"><label>•</label><p id="par0020">No cases of Middle East Respiratory Syndrome coronavirus were detected.</p></list-item></list></p></abstract><abstract id="abs0010"><sec><title>Background</title><p>The emergence of Middle East Respiratory Syndrome coronavirus (MERS-CoV) has prompted enhanced surveillance for respiratory infections among pilgrims returning from the Hajj, one of the largest annual mass gatherings in the world.</p></sec><sec><title>Objectives</title><p>To describe the epidemiology and etiologies of respiratory illnesses among pilgrims returning to Jordan after the 2014 Hajj.</p></sec><sec><title>Study design</title><p>Surveillance for respiratory illness among pilgrims returning to Jordan after the 2014 Hajj was conducted at sentinel health care facilities using epidemiologic surveys and molecular diagnostic testing of upper respiratory specimens for multiple respiratory pathogens, including MERS-CoV.</p></sec><sec><title>Results</title><p>Among the 125 subjects, 58% tested positive for at least one virus; 47% tested positive for rhino/enterovirus. No cases of MERS-CoV were detected.</p></sec><sec><title>Conclusions</title><p>The majority of pilgrims returning to Jordan from the 2014 Hajj with respiratory illness were determined to have a viral etiology, but none were due to MERS-CoV. A greater understanding of the epidemiology of acute respiratory infections among returning travelers to other countries after Hajj should help optimize surveillance systems and inform public health response practices.</p></sec></abstract><kwd-group id="kwd0005"><title>Keywords</title><kwd>Hajj</kwd><kwd>Respiratory tract infections</kwd><kwd>Jordan</kwd><kwd>MERS-CoV</kwd><kwd>Viruses</kwd></kwd-group></article-meta></front><body><sec id="sec0005"><label>1</label><title>Background</title><p id="par0025">Each year, 2–3 million pilgrims from over 180 countries travel to the Hajj in the Kingdom of Saudi Arabia (KSA), where crowded conditions pose potential risks for transmission of respiratory tract infections, the most common infections acquired by Hajj pilgrims <xref rid="bib0005" ref-type="bibr">[1]</xref>, <xref rid="bib0010" ref-type="bibr">[2]</xref>, <xref rid="bib0015" ref-type="bibr">[3]</xref>. The emergence of Middle East Respiratory Syndrome coronavirus (MERS-CoV) prompted additional travel guidance and enhanced surveillance following Hajj, including in Jordan, which has reported cases of MERS-CoV and shares its eastern and southern borders with KSA <xref rid="bib0005" ref-type="bibr">[1]</xref>, <xref rid="bib0020" ref-type="bibr">[4]</xref>. Based upon the number of Hajj visas issued, approximately 5600 pilgrims from Jordan traveled to KSA for the 2014 Hajj. In October 2014, Jordan established targeted surveillance of acute respiratory illnesses in Hajj pilgrims returning to Jordan.</p></sec><sec id="sec0010"><label>2</label><title>Objectives</title><p id="par0030">In this report, we present the results of a surveillance initiative to describe cases of acute respiratory illnesses in Hajj pilgrims returning to Jordan and detect etiologies of disease, which included testing for MERS-CoV and other pathogens known to cause acute respiratory illnesses.</p></sec><sec id="sec0015"><label>3</label><title>Study design</title><p id="par0035">During October 8–23, 2014, a two-week period immediately following the conclusion of Hajj, 12 hospitals and outpatient clinical sentinel surveillance sites in the south, north, and central regions of Jordan conducted surveillance for respiratory illness among returning pilgrims. Pilgrims returning to Jordan with symptoms of respiratory infection were instructed to present to sentinel health facilities via health information cards at points of reentry, and through posted notices and healthcare workers at the sentinel health facilities. Persons were considered for enrollment in surveillance if they (1) traveled to the 2014 Hajj, and (2) presented with respiratory illness. Institutional Review Board approval was obtained in Jordan for this public health response, and verbal consent was obtained prior to enrollment. Targeted demographic and clinical information were collected (listed in <xref rid="tbl0005" ref-type="table">Table 1</xref>) by in-person interview using a brief, standardized questionnaire.<table-wrap position="float" id="tbl0005"><label>Table 1</label><caption><p>Characteristics of Hajj Pilgrims, Jordan, 2014.</p></caption><alt-text id="at0005">Table 1</alt-text><table frame="hsides" rules="groups"><thead><tr><th align="left">Characteristic</th><th colspan="2" align="left">All patients (<italic>n</italic> = 125)<hr></hr></th></tr><tr><th align="left"></th><th align="left"><italic>n</italic>/total</th><th align="left">%</th></tr></thead><tbody><tr><td colspan="3" align="left">Demographics</td></tr><tr><td colspan="3" align="left"> Age groups (years)</td></tr><tr><td align="left"> 18–64</td><td align="left">88/118</td><td align="left">75</td></tr><tr><td align="left"> 65+</td><td align="left">30/118</td><td align="left">25</td></tr><tr><td colspan="3" align="left"> Sex</td></tr><tr><td align="left"> Male</td><td align="left">76/123</td><td align="left">62</td></tr><tr><td align="left"> Female</td><td align="left">47/123</td><td align="left">38</td></tr><tr><td colspan="3" align="left">Clinical characteristics</td></tr><tr><td colspan="3" align="left"> Symptoms</td></tr><tr><td align="left"> Fever</td><td align="left">51/125</td><td align="left">41</td></tr><tr><td align="left"> Cough</td><td align="left">95/125</td><td align="left">76</td></tr><tr><td align="left"> Sore throat</td><td align="left">62/125</td><td align="left">50</td></tr><tr><td align="left"> Nasal discharge</td><td align="left">46/125</td><td align="left">37</td></tr><tr><td align="left"> Difficulty breathing</td><td align="left">20/125</td><td align="left">16</td></tr><tr><td colspan="3" align="left"> Comorbid conditions</td></tr><tr><td align="left"> Diabetes</td><td align="left">17/125</td><td align="left">14</td></tr><tr><td align="left"> Hypertension</td><td align="left">28/125</td><td align="left">22</td></tr><tr><td align="left"> Heart disease</td><td align="left">10/125</td><td align="left">8</td></tr><tr><td align="left"> Kidney disease</td><td align="left">1/125</td><td align="left">1</td></tr><tr><td align="left"> Cancer</td><td align="left">1/125</td><td align="left">1</td></tr><tr><td align="left"> Bronchial asthma</td><td align="left">2/125</td><td align="left">2</td></tr><tr><td align="left"> Current smoker</td><td align="left">24/107</td><td align="left">22</td></tr><tr><td align="left"> Currently pregnant</td><td align="left">3/42</td><td align="left">7</td></tr><tr><td colspan="3" align="left">Travel history</td></tr><tr><td colspan="3" align="left"> Exposures</td></tr><tr><td align="left"> Contact with sick person during Hajj</td><td align="left">31/119</td><td align="left">26</td></tr><tr><td align="left"> Contact with animal during Hajj</td><td align="left">3/115</td><td align="left">3</td></tr><tr><td align="left"> Visited market</td><td align="left">20/22</td><td align="left">91</td></tr><tr><td align="left"> Visited slaughterhouse</td><td align="left">2/22</td><td align="left">9</td></tr><tr><td align="left"> Visited health care facility prior to enrollment</td><td align="left">36/99</td><td align="left">36</td></tr><tr><td align="left"> Visited Hospital</td><td align="left">5/24</td><td align="left">21</td></tr><tr><td align="left"> Visited Center</td><td align="left">19/24</td><td align="left">79</td></tr><tr><td align="left"> Healthcare facility in KSA</td><td align="left">13/31</td><td align="left">42</td></tr><tr><td align="left"> Healthcare facility in Jordan</td><td align="left">18/31</td><td align="left">58</td></tr><tr><td colspan="3" align="left"> Mode of transportation</td></tr><tr><td align="left"> Bus</td><td align="left">93/125</td><td align="left">74</td></tr><tr><td align="left"> Car</td><td align="left">15/125</td><td align="left">12</td></tr><tr><td align="left"> Plane</td><td align="left">17/125</td><td align="left">14</td></tr></tbody></table></table-wrap></p><p id="par0040">Nasopharyngeal and oropharyngeal (NP/OP) swabs were sought from all enrolled subjects using flocked swabs. Swab specimens were combined in 2–3 mL of viral transport media, stored at 4 °C, and transported to the Central Public Health Laboratory in Amman, Jordan, within 48 h of collection and divided into aliquots. Total nucleic acid extraction was performed on 140 μL of sample from one aliquot per subject using a QIAamp Viral RNA Mini Kit (QIAGEN), and then tested using Centers for Disease Control and Prevention (CDC) real-time reverse transcription PCR (rRT-PCR) assays for influenza A, B (procedures available upon request at <ext-link ext-link-type="uri" xlink:href="https://www.cdc.gov/flu/clsis/" id="intr0005">https://www.cdc.gov/flu/clsis/</ext-link>), and MERS-CoV <xref rid="bib0025" ref-type="bibr">[5]</xref>.</p><p id="par0045">Frozen specimen aliquots were sent to CDC in Atlanta, Georgia, USA, for additional testing of non-MERS-CoV respiratory pathogens (listed in <xref rid="tbl0010" ref-type="table">Table 2</xref>). Total nucleic acids were extracted from 300 μL of each specimen aliquot using the NucliSENS easyMAG system (bioMerieux) and tested on a multi-pathogen TaqMan Array card (ThermoFischer Scientific) using CDC-developed singleplex rRT-PCR assays <xref rid="bib0030" ref-type="bibr">[6]</xref>, <xref rid="bib0035" ref-type="bibr">[7]</xref>, <xref rid="bib0040" ref-type="bibr">[8]</xref>.<table-wrap position="float" id="tbl0010"><label>Table 2</label><caption><p>Respiratory pathogens detected among Hajj Pilgrims, Jordan, 2014.</p></caption><alt-text id="at0010">Table 2</alt-text><table frame="hsides" rules="groups"><thead><tr><th align="left">Respiratory pathogen</th><th colspan="2" align="left">All patients (<italic>n</italic> = 125)<hr></hr></th></tr><tr><th align="left"></th><th align="left"><italic>n</italic>/total</th><th align="left">%</th></tr></thead><tbody><tr><td colspan="3" align="left">Virus</td></tr><tr><td align="left"> MERS coronavirus</td><td align="left">0/125</td><td align="left">0</td></tr><tr><td align="left"> Human coronavirus 229E</td><td align="left">8/125</td><td align="left">6</td></tr><tr><td align="left"> Human coronavirus NL63</td><td align="left">4/125</td><td align="left">3</td></tr><tr><td align="left"> Human coronavirus OC43</td><td align="left">4/125</td><td align="left">3</td></tr><tr><td align="left"> Human coronavirus HKU1</td><td align="left">0/125</td><td align="left">0</td></tr><tr><td align="left"> Influenza A<xref rid="tblfn0005" ref-type="table-fn">a</xref></td><td align="left">4/125</td><td align="left">3</td></tr><tr><td align="left"> Influenza B</td><td align="left">2/125</td><td align="left">2</td></tr><tr><td align="left"> Influenza C</td><td align="left">0/125</td><td align="left">0</td></tr><tr><td align="left"> Respiratory syncytial virus</td><td align="left">1/125</td><td align="left">1</td></tr><tr><td align="left"> Parainfluenza virus 1<xref rid="tblfn0010" ref-type="table-fn">b</xref></td><td align="left">1/125</td><td align="left">1</td></tr><tr><td align="left"> Parainfluenza virus 2</td><td align="left">0/125</td><td align="left">0</td></tr><tr><td align="left"> Parainfluenza virus 3</td><td align="left">2/125</td><td align="left">2</td></tr><tr><td align="left"> Parainfluenza virus 4</td><td align="left">0/125</td><td align="left">0</td></tr><tr><td align="left"> Human metapneumovirus</td><td align="left">0/125</td><td align="left">0</td></tr><tr><td align="left"> Rhino/enterovirus</td><td align="left">59/125</td><td align="left">47</td></tr><tr><td align="left"> Parechovirus</td><td align="left">0/125</td><td align="left">0</td></tr><tr><td align="left"> Adenovirus</td><td align="left">1/125</td><td align="left">1</td></tr><tr><td align="left"> ≥2 viruses<xref rid="tblfn0015" ref-type="table-fn">c</xref></td><td align="left">13/125</td><td align="left">10</td></tr><tr><td colspan="3" align="left">Bacteria</td></tr><tr><td align="left"> <italic>Bordetella pertussis</italic></td><td align="left">0/125</td><td align="left">0</td></tr><tr><td align="left"> <italic>Chlamydophila pneumoniae</italic></td><td align="left">0/125</td><td align="left">0</td></tr><tr><td align="left"> <italic>Mycoplasma pneumoniae</italic></td><td align="left">0/125</td><td align="left">0</td></tr><tr><td align="left"> <italic>Legionella pneumophila</italic></td><td align="left">0/125</td><td align="left">0</td></tr></tbody></table><table-wrap-foot><fn id="tblfn0005"><label>a</label><p id="npar0005">All influenza A-positive specimens were subtype H3N2.</p></fn></table-wrap-foot><table-wrap-foot><fn id="tblfn0010"><label>b</label><p id="npar0010">One specimen tested positive for parainfluenza virus 1 by panviral PCR.</p></fn></table-wrap-foot><table-wrap-foot><fn id="tblfn0015"><label>c</label><p id="npar0015">Specimens testing positive for two viruses included those with co-detection of rhino/enterovirus with human coronavirus 229E (<italic>n</italic> = 3), NL63 (<italic>n</italic> = 2), or OC43 (<italic>n</italic> = 2), influenza A (<italic>n</italic> = 2), parainfluenza virus 3 (<italic>n</italic> = 2), or adenovirus (<italic>n</italic> = 1). In addition, one specimen tested positive for three viruses: rhino/enterovirus, human coronavirus 229E, and influenza B (<italic>n</italic> = 1).</p></fn></table-wrap-foot></table-wrap></p><p id="par0050">Influenza-positive samples were further confirmed and influenza A-positive samples were sub-typed as human seasonal A(H3) or A(H1)pdm09 using CDC influenza rRT-PCR assays (procedures available upon request at <ext-link ext-link-type="uri" xlink:href="https://www.cdc.gov/flu/clsis/" id="intr0010">https://www.cdc.gov/flu/clsis/</ext-link>), while influenza-negative samples were additionally tested with broadly reactive panviral family/genus PCRs that were designed to amplify genomic sequences from both known and potentially novel members of the viral families/genera, including those known to be associated with respiratory diseases: Adenoviridae <xref rid="bib0045" ref-type="bibr">[9]</xref>, Coronavirinae <xref rid="bib0050" ref-type="bibr">[10]</xref>, Orthomyxoviridae <xref rid="bib0055" ref-type="bibr">[11]</xref>, Paramyxovirinae <xref rid="bib0060" ref-type="bibr">[12]</xref>, Parvovirinae (unpublished in-house PCR), Polyomaviridae <xref rid="bib0065" ref-type="bibr">[13]</xref>, and Reoviridae (orthoreovirus) <xref rid="bib0070" ref-type="bibr">[14]</xref>.</p><p id="par0055">Differences among subjects were assessed for significance (<italic>α</italic> = 0.05) using <italic>χ</italic><sup>2</sup>, Fisher's exact, and Wilcoxon rank sum tests, where appropriate. All data were analyzed using SAS version 9.3 (SAS Institute, Cary, NC).</p></sec><sec id="sec0020"><label>4</label><title>Results</title><p id="par0060">Epidemiologic data and respiratory specimens were collected from 125 subjects (<xref rid="tbl0005" ref-type="table">Table 1</xref>) with a median age of 51.5 years (range 25–86). Common underlying medical conditions reported included hypertension (22%), diabetes (14%), and heart disease (8%); 22% of those responding reported current smoking. Onset of symptoms ranged from September 20 to October 20, occurring prior to departure to KSA in five subjects. Most participants (89%) reported at least one of the following symptoms captured by the questionnaire: cough, sore throat, fever, nasal discharge, or difficulty breathing. Of those subjects responding, 31 (26% of 119) reported a history of contact with an ill person during the Hajj, and 36 (36% of 99) reported visiting a healthcare facility prior to enrollment, including 13 who reported having visited a healthcare facility in KSA. NP/OP swabs were obtained from 99 (79%) subjects; 26 (21%) subjects refused NP swabs and provided only OP swab specimens.</p><p id="par0065">Considering all specimen types, at least one virus was detected in 73 (58%) specimens, with 59 (47%) testing positive for rhino/enterovirus (<xref rid="tbl0010" ref-type="table">Table 2</xref>). Rhino/enterovirus-positive subjects were more likely to present with difficulty breathing than subjects that tested negative for rhino/enterovirus (24% vs. 9%; <italic>p</italic> = 0.0258) (<xref rid="tbl0015" ref-type="table">Table 3</xref>). Other viruses detected included common human coronavirus species (<italic>n</italic> = 16; 13%), influenza A (<italic>n</italic> = 4, all H3N2; 3%) or B (<italic>n</italic> = 2; 2%), parainfluenza viruses types 3 (<italic>n</italic> = 2; 2%) and 1 (<italic>n</italic> = 1; 1%), RSV (<italic>n</italic> = 1; 1%), and adenovirus (<italic>n</italic> = 1; 1%) (<xref rid="tbl0010" ref-type="table">Table 2</xref>). MERS-CoV was not detected in any subject, and none of the bacterial pathogens tested (<italic>Bordetella pertussis, Chlamydophila pneumoniae, Mycoplasma pneumoniae, Legionella pneumophila</italic>) were detected. Viral co-detections were observed in 13 (10%) of participants, all of which were rhino/enterovirus-positive. Except for one specimen in which parainfluenza type 1 was identified, panviral family/genus PCR did not add additional clinically relevant results beyond what was already detected by multi-pathogen array cards. There were no significant differences in detection of any single pathogen between NP/OP and OP-only specimens (data not shown).<table-wrap position="float" id="tbl0015"><label>Table 3</label><caption><p>Comparison of patient characteristics by rhino/enterovirus (RV/EV) detection (<italic>n</italic> = 125).</p></caption><alt-text id="at0015">Table 3</alt-text><table frame="hsides" rules="groups"><thead><tr><th align="left">Characteristic</th><th align="left">RV/EV-negative (<italic>n</italic> = 66)</th><th align="left">RV/EV-positive (<italic>n</italic> = 59)</th><th align="left"><italic>p</italic> value<xref rid="tblfn0020" ref-type="table-fn">a</xref></th></tr><tr><th align="left"></th><th align="left">No. (%)</th><th align="left">No. (%)</th><th align="left"></th></tr></thead><tbody><tr><td colspan="4" align="left">Demographics</td></tr><tr><td align="left"> Age years, median<xref rid="tblfn0025" ref-type="table-fn">b</xref> [range]</td><td align="left">55 [32–77]</td><td align="left">50 [25–86]</td><td align="left">0.2865</td></tr><tr><td align="left"> Gender – male</td><td align="left">35 (54)</td><td align="left">41 (71)</td><td align="left">0.0550</td></tr><tr><td colspan="4" align="left">Symptoms</td></tr><tr><td align="left"> Fever</td><td align="left">26 (40)</td><td align="left">25 (42)</td><td align="left">0.7351</td></tr><tr><td align="left"> Cough</td><td align="left">49 (74)</td><td align="left">46 (78)</td><td align="left">0.6265</td></tr><tr><td align="left"> Sore throat</td><td align="left">33 (50)</td><td align="left">29 (49)</td><td align="left">0.9246</td></tr><tr><td align="left"> Nasal discharge</td><td align="left">21 (32)</td><td align="left">25 (42)</td><td align="left">0.2219</td></tr><tr><td align="left"> Difficulty breathing</td><td align="left">6 (9)</td><td align="left">14 (24)</td><td align="left">0.0258</td></tr><tr><td colspan="4" align="left">Comorbid conditions</td></tr><tr><td align="left"> Diabetes</td><td align="left">7 (11)</td><td align="left">10 (17)</td><td align="left">0.3017</td></tr><tr><td align="left"> Hypertension</td><td align="left">16 (24)</td><td align="left">12 (20)</td><td align="left">0.6013</td></tr><tr><td align="left"> Heart disease<xref rid="tblfn0030" ref-type="table-fn">c</xref></td><td align="left">5 (8)</td><td align="left">5 (8)</td><td align="left">0.2523</td></tr><tr><td align="left"> Kidney disease<xref rid="tblfn0030" ref-type="table-fn">c</xref></td><td align="left">0</td><td align="left">1 (2)</td><td align="left">0.4720</td></tr><tr><td align="left"> Cancer<xref rid="tblfn0030" ref-type="table-fn">c</xref></td><td align="left">0</td><td align="left">1 (2)</td><td align="left">0.4720</td></tr><tr><td align="left"> Bronchial asthma<xref rid="tblfn0030" ref-type="table-fn">c</xref></td><td align="left">1 (1)</td><td align="left">1 (2)</td><td align="left">0.5025</td></tr><tr><td align="left"> Current smoker<xref rid="tblfn0035" ref-type="table-fn">d</xref></td><td align="left">9 (16)</td><td align="left">15 (29)</td><td align="left">0.1218</td></tr><tr><td align="left"> Currently pregnant<xref rid="tblfn0030" ref-type="table-fn">c</xref></td><td align="left">1 (5)</td><td align="left">2 (9)</td><td align="left">0.9999</td></tr></tbody></table><table-wrap-foot><fn id="tblfn0020"><label>a</label><p id="npar0020"><italic>χ</italic><sup>2</sup> test <italic>p</italic>-value unless otherwise indicated.</p></fn></table-wrap-foot><table-wrap-foot><fn id="tblfn0025"><label>b</label><p id="npar0025">Wilcoxon rank sum test <italic>p</italic>-value.</p></fn></table-wrap-foot><table-wrap-foot><fn id="tblfn0030"><label>c</label><p id="npar0030">Fisher's exact test <italic>p</italic>-value.</p></fn></table-wrap-foot><table-wrap-foot><fn id="tblfn0035"><label>d</label><p id="npar0035">Current smoker vs. previous smoker or never smoked.</p></fn></table-wrap-foot></table-wrap></p><p id="par0070">Among the 28 (22%) participants enrolled at hospitals, three were admitted, one requiring ICU admission. The subject that required ICU admission was positive for rhino/enterovirus and parainfluenza type 3; the other two admitted cases were rhino/enterovirus-positive and influenza A/H3N2-positive, respectively. No deaths were reported.</p></sec><sec id="sec0025"><label>5</label><title>Discussion</title><p id="par0075">Of the 125 pilgrims who presented for respiratory illness upon return to Jordan after attending the 2014 Hajj, 58% tested positive for a viral etiology, of which rhino/enterovirus was most common. Subjects tested included those who reported specific opportunities for exposures to viral illnesses during the Hajj, such as contact with other ill persons, and previous visits to healthcare facilities, including those in KSA. Transmission of MERS has been shown to be associated with healthcare facilities <xref rid="bib0075" ref-type="bibr">[15]</xref>, yet despite this potential increased exposure risk, no subjects tested positive for MERS-CoV.</p><p id="par0080">To date, MERS-CoV infection has not been detected among Hajj pilgrims <xref rid="bib0015" ref-type="bibr">[3]</xref>, <xref rid="bib0080" ref-type="bibr">[16]</xref>, <xref rid="bib0085" ref-type="bibr">[17]</xref>, <xref rid="bib0090" ref-type="bibr">[18]</xref>, <xref rid="bib0095" ref-type="bibr">[19]</xref>, <xref rid="bib0100" ref-type="bibr">[20]</xref>. In previous studies, the range of rhinovirus positivity among individuals returning from the Hajj with respiratory symptoms has been 5.9–48.8%; our investigation detected rhino/enterovirus positivity at the higher end of this range (47%) <xref rid="bib0015" ref-type="bibr">[3]</xref>, <xref rid="bib0085" ref-type="bibr">[17]</xref>, <xref rid="bib0095" ref-type="bibr">[19]</xref>, <xref rid="bib0100" ref-type="bibr">[20]</xref>. Although the contribution of rhino/enteroviruses to clinical illness may be difficult to ascertain due to the lack of asymptomatic controls, among our subjects, rhino/enterovirus-positive patients were more likely to have difficulty breathing. Less commonly, other respiratory viruses were detected among these individuals, which could reflect seasonality of these viruses during the time of the Hajj or closeness among individuals from other countries where these viruses were circulating.</p><p id="par0085">Our surveillance collected only limited clinical information regarding course of illness and outcomes, and the cross-sectional nature of the study limited our ability to confirm timing of acquisition of infection. However, given that symptomatic pilgrims presented in the two-week surveillance window immediately following Hajj suggests that the large majority of infections would have been acquired during the Hajj pilgrimage. Our surveillance employed geographically diverse sentinel sites and comprehensive targeted health messaging, but it is possible that symptomatic cases were incompletely captured, particularly in pilgrims with milder illness who may have been less likely to present to medical care after their return. Finally, although a minority of subjects refused NP swabs, lower rates of pathogen detection were not observed in these subjects. Despite these limitations, our findings are consistent with previous surveillance studies which suggest they are representative of the epidemiology of post-Hajj respiratory infections.</p><p id="par0090">Understanding the epidemiology and clinical features of acute respiratory infections among returning travelers to other countries after Hajj is important for designing optimal surveillance systems to detect MERS-CoV. Surveillance of returning travelers at risk for MERS-CoV infection should not only help further such understanding, but would also help optimize public health response practices.</p></sec><sec id="sec0030"><title>Disclaimer</title><p id="par0095">The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.</p></sec><sec id="sec0035"><title>Funding</title><p id="par0100">This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.</p></sec><sec id="sec0040"><title>Competing interests</title><p id="par0105">The authors declare no conflicts of interest.</p></sec><sec id="sec0045"><title>Ethical approval</title><p id="par0110">Institutional Review Board approval was obtained in Jordan for this public health response.</p></sec></body><back><ref-list id="bibl0005"><title>References</title><ref id="bib0005"><label>1</label><element-citation publication-type="journal" id="sbref0005"><person-group person-group-type="author"><name><surname>Memish</surname><given-names>Z.A.</given-names></name><name><surname>Zumla</surname><given-names>A.</given-names></name><name><surname>Alhakeem</surname><given-names>R.F.</given-names></name></person-group><article-title>Hajj: infectious disease surveillance and control</article-title><source>Lancet</source><volume>383</volume><issue>9934</issue><year>2014</year><fpage>2073</fpage><lpage>2082</lpage><pub-id pub-id-type="pmid">24857703</pub-id></element-citation></ref><ref id="bib0010"><label>2</label><element-citation publication-type="journal" id="sbref0010"><person-group person-group-type="author"><name><surname>Al-Tawfiq</surname><given-names>J.A.</given-names></name><name><surname>Zumla</surname><given-names>A.</given-names></name><name><surname>Memish</surname><given-names>Z.A.</given-names></name></person-group><article-title>Respiratory tract infections during the annual Hajj: potential risks and mitigation strategies</article-title><source>Curr. 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Dis.</source><volume>21</volume><issue>4</issue><year>2015</year><fpage>726</fpage><lpage>727</lpage><pub-id pub-id-type="pmid">25811672</pub-id></element-citation></ref></ref-list><ack id="ack0005"><title>Acknowledgements</title><p>The authors thank the following for their support and assistance in this work: the directors and staff of the health facilities that participated in this surveillance; Mohammad Isam, Mohammad Almaayeh, Saed Alnserat, Zeenah Khrisat, Ala’a Hamd Allah, Nizar Maswadi (Jordan Field Epidemiology Training Program); Rawan Araj (Eastern Mediterranean Public Health Network); Teresa Peret (Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention). This project was supported in part by an appointment (of A. M. B.) to the Research Participation Program at the Centers for Disease Control and Prevention administered by the <funding-source id="gs1">Oak Ridge Institute for Science and Education</funding-source> through an interagency agreement between the <funding-source id="gs3">US Department of Energy</funding-source> and <funding-source id="gs4">CDC</funding-source>.</p></ack></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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