title: Influenza not MERS CoV among returning Hajj and Umrah pilgrims with respiratory illness, Kashmir, north India, 2014-15.
abstract: BACKGROUND
  The increasing reports of Middle East Respiratory Syndrome (MERS) caused by MERS coronavirus (MERS-CoV) from many countries emphasize its importance for international travel. Muslim pilgrimages of Hajj and Umrah involve mass gatherings of international travellers. We set out to assess the presence of influenza and MERS-CoV in Hajj/Umrah returnees with acute respiratory infection. .
  
  
  METHODS
  Disembarking passengers (n = 8753) from Saudi Arabia (October 2014 to April 2015) were interviewed for the presence of respiratory symptoms; 977 (11%) reported symptoms and 300 (age 26-90, median 60 years; 140 male) consented to participate in the study. After recording clinical and demographic data, twin swabs (nasopharyngeal and throat) were collected from each participant, pooled in viral transport media and tested by real-time RT PCR for MERS-CoV and influenza A and B viruses and their subtypes.
  
  
  RESULTS
  The participants had symptoms of 1-15 days (median 5d); cough (90%) and nasal discharge (86%) being the commonest. None of the 300 participants tested positive for MERS-CoV; however, 33 (11%) tested positive for influenza viruses (A/H3N2 = 13, A/H1N1pdm09 = 9 and B/Yamagata = 11). Eighteen patients received oseltamivir. No hospitalizations were needed and all had uneventful recovery.
  
  
  CONCLUSIONS
  Despite a high prevalence of acute respiratory symptoms, MERS coV was not seen in returning pilgrims from Hajj and Umrah. However detection of flu emphasises preventive strategies like vaccination.
authors.affiliation: Department of Internal & Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences (SKIMS), Srinagar, J&K, India. Electronic address: parvaizk@gmail.com.
authors.forename: Parvaiz A
authors.initials: PA
authors.lastname: Koul
authors.affiliation: Department of Internal & Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences (SKIMS), Srinagar, J&K, India.
authors.forename: Hyder
authors.initials: H
authors.lastname: Mir
authors.affiliation: Influenza Division, US Centers for Disease Control & Prevention (CDC), India Office, New Delhi, India.
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Saha
authors.affiliation: National Institute of Virology, Pune, India.
authors.forename: Mandeep S
authors.initials: MS
authors.lastname: Chadha
authors.affiliation: National Institute of Virology, Pune, India.
authors.forename: Varsha
authors.initials: V
authors.lastname: Potdar
authors.affiliation: Influenza Division, US Centers for Disease Control & Prevention (CDC), Atlanta, GA, USA.
authors.forename: Marc-Alain
authors.initials: MA
authors.lastname: Widdowson
authors.affiliation: Influenza Division, US Centers for Disease Control & Prevention (CDC), India Office, New Delhi, India.
authors.forename: Renu B
authors.initials: RB
authors.lastname: Lal
authors.affiliation: Center for Community Medicine, All India Institute of Medical Sciences, (AIIMS), New Delhi, India.
authors.forename: Anand
authors.initials: A
authors.lastname: Krishnan
mesh_terms: D000208:Acute Disease / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018352:Coronavirus Infections / Q000453:epidemiology* / Q000821:virology; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D009980:Influenza A virus / Q000235:genetics / Q000302:isolation & purification; D009981:Influenza B virus / Q000235:genetics / Q000302:isolation & purification; D007251:Influenza, Human / Q000453:epidemiology*; D007514:Islam; D008297:Male; D008875:Middle Aged; D065207:Middle East Respiratory Syndrome Coronavirus / Q000235:genetics / Q000302:isolation & purification*; D009305:Nasopharynx / Q000821:virology; D010614:Pharynx / Q000821:virology; D016133:Polymerase Chain Reaction; D015995:Prevalence; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000821:virology; D012529:Saudi Arabia / Q000453:epidemiology; D014195:Travel
keywords: Acute respiratory infection; Hajj; Middle East Respiratory Virus syndrome; Pilgrimage