title: Prevalence of MERS-CoV nasal carriage and compliance with the Saudi health recommendations among pilgrims attending the 2013 Hajj.
abstract: BACKGROUND
  Annually, Saudi Arabia is the host of the Hajj mass gathering. We aimed to determine the Middle East respiratory syndrome coronavirus (MERS-CoV) nasal carriage rate among pilgrims performing the 2013 Hajj and to describe the compliance with the Saudi Ministry of Health vaccine recommendations.
  
  
  METHODS
  Nasopharyngeal samples were collected from 5235 adult pilgrims from 22 countries and screened for MERS-CoV using reverse transcriptase-polymerase chain reaction. Information regarding the participants' age, gender, country of origin, medical conditions, and vaccination history were obtained.
  
  
  RESULTS
  The mean age of the screened population was 51.8 years (range, 18-93 years) with a male/female ratio of 1.17:1. MERS-CoV was not detected in any of the samples tested (3210 pre-Hajj and 2025 post-Hajj screening). According to the vaccination documents, all participants had received meningococcal vaccination and the majority of those from at-risk countries were vaccinated against yellow fever and polio. Only 22% of the pilgrims (17.5% of those ≥65 years and 36.3% of diabetics) had flu vaccination, and 4.4% had pneumococcal vaccination.
  
  
  CONCLUSIONS
  There was no evidence of MERS-CoV nasal carriage among Hajj pilgrims. While rates of compulsory vaccinations uptake were high, uptake of pneumococcal and flu seasonal vaccinations were low, including among the high-risk population.
authors.affiliation: Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health College of Medicine, Alfaisal University, Riyadh.
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Memish
authors.affiliation: Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Assiri
authors.affiliation: Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health.
authors.forename: Malak
authors.initials: M
authors.lastname: Almasri
authors.affiliation: Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health.
authors.forename: Rafat F
authors.initials: RF
authors.lastname: Alhakeem
authors.affiliation: Makkah Regional Health Affairs, Ministry of Health, Jeddah.
authors.forename: Abdulhafeez
authors.initials: A
authors.lastname: Turkestani
authors.affiliation: Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health.
authors.forename: Abdullah A
authors.initials: AA
authors.lastname: Al Rabeeah
authors.affiliation: Saudi Aramco Medical Services Organization, Dhahran, Kingdom of Saudi Arabia Indiana University School of Medicine, Indianapolis.
authors.forename: Jaffar A
authors.initials: JA
authors.lastname: Al-Tawfiq
authors.affiliation: Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Alzahrani
authors.affiliation: Special Infectious Diseases Unit, King Abdualziz University, King Fahad Medical Research Center, Jeddah.
authors.forename: Essam
authors.initials: E
authors.lastname: Azhar
authors.affiliation: Jeddah Regional Laboratory and Blood Bank, Ministry of Health.
authors.forename: Hatem Q
authors.initials: HQ
authors.lastname: Makhdoom
authors.affiliation: Riyadh Regional Laboratory and Blood Bank, Ministry of Health.
authors.forename: Waleed H
authors.initials: WH
authors.lastname: Hajomar
authors.affiliation: General Directorate of Laboratory Services, Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Ali M
authors.initials: AM
authors.lastname: Al-Shangiti
authors.affiliation: Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health.
authors.forename: Saber
authors.initials: S
authors.lastname: Yezli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002353:Carrier State / Q000453:epidemiology* / Q000821:virology; D018352:Coronavirus Infections / Q000453:epidemiology* / Q000821:virology; D003441:Crowding; D003710:Demography; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D065207:Middle East Respiratory Syndrome Coronavirus / Q000302:isolation & purification*; D009305:Nasopharynx / Q000821:virology*; D015995:Prevalence; D012529:Saudi Arabia / Q000453:epidemiology; D014611:Vaccination / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Hajj pilgrimage; MERS-CoV; nasal carriage; screening; vaccination