INFECTION HOT TOPIC
10.1111/1469-0691.12448
From the Hajj: it’s the flu, idiot D. Raoult1,2, R. Charrel2,3, P. Gautret1,4 and P. Parola1,4 1) Unite des Rickettsies, Unite de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE) CNRS-IRD-INSERM UMR 7278, Faculte de Medecine, Aix-Marseille Universite, 2) APHM, CHU Timone, P^ole Infectieux, 3) Unite des Virus emergents, UMR 190, Faculte de Medecine, Aix-Marseille Universite, and 4) Maladies Infectieuses et Tropicales (MIT), Marseille, France E-mail: [email protected] Article published online: 8 November 2013
Currently, the Hajj pilgrimage to Mecca is an exceptional event, mixing populations from various countries and viruses. Several outbreaks have been linked to this trip in the past, including meningococcal meningitis and pneumonia [1]. This year, the fear was that the new Middle East coronavirus could cause a massive outbreak [2]. This is because of hubris that overtook the scientific press, the WHO and governments about this disease, which is very rare and has low transmissibility [3]. The attention focused on this rare disease deflected attention from real infectious disease epidemics that are well known. Among them is influenza. The meeting in Mecca of pilgrims from regions where seasonal influenza has not started, such as the Maghreb and Europe (250 000 pilgrims on average from Europe go to Mecca), and regions where influenza is now particularly common, such as tropical Africa, means that pilgrims are exposed to a very high risk of acquiring this disease. This is what is happening now, and pilgrims returning to Marseille are very commonly infected with, H3N2, H1N1 and B influenza viruses (unpublished). Thus, as often in recent years, the false epidemics take precedence over real epidemics, and prevent the establishment of true studies on the surveillance and prevention of true epidemics. The recommendation for early vaccination for influenza among pilgrims would probably have prevented several thousands of influenza cases and, perhaps, the risk of secondary spread in countries
not yet affected by influenza, as the number of pilgrims returning infected is huge. In a preliminary, not published, study, as many as 9% of pilgrims this year came back to France with one influenza virus in the throat. We need to be reasonable and continue to take care of real and established contagious and epidemic diseases, and not divert our actions to diseases that have little known effect on the human population and vanish as rapidly as they appear.
Transparency Declaration No conflicts of interest to declare.
References 1. Benkouiten S, Charrel R, Belhouchat K et al. Circulation of respiratory viruses among pilgrims during the 2012 Hajj pilgrimage. Clin Infect Dis 2013; 57: 992–1000. 2. Zaki AM, van Boheemen S, Bestebroer TM, Osterhaus AD, Fouchier RA. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med 2012; 367: 1814–1820. 3. Assiri A, Al-Tawfiq JA, Al-Rabeeah AA et al. Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study. Lancet Infect Dis 2013; 13: 752–761.
ª2013 The Authors Clinical Microbiology and Infection ª2013 European Society of Clinical Microbiology and Infectious Diseases
10.1111/1469-0691.12448
From the Hajj: it’s the flu, idiot D. Raoult1,2, R. Charrel2,3, P. Gautret1,4 and P. Parola1,4 1) Unite des Rickettsies, Unite de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE) CNRS-IRD-INSERM UMR 7278, Faculte de Medecine, Aix-Marseille Universite, 2) APHM, CHU Timone, P^ole Infectieux, 3) Unite des Virus emergents, UMR 190, Faculte de Medecine, Aix-Marseille Universite, and 4) Maladies Infectieuses et Tropicales (MIT), Marseille, France E-mail: [email protected] Article published online: 8 November 2013
Currently, the Hajj pilgrimage to Mecca is an exceptional event, mixing populations from various countries and viruses. Several outbreaks have been linked to this trip in the past, including meningococcal meningitis and pneumonia [1]. This year, the fear was that the new Middle East coronavirus could cause a massive outbreak [2]. This is because of hubris that overtook the scientific press, the WHO and governments about this disease, which is very rare and has low transmissibility [3]. The attention focused on this rare disease deflected attention from real infectious disease epidemics that are well known. Among them is influenza. The meeting in Mecca of pilgrims from regions where seasonal influenza has not started, such as the Maghreb and Europe (250 000 pilgrims on average from Europe go to Mecca), and regions where influenza is now particularly common, such as tropical Africa, means that pilgrims are exposed to a very high risk of acquiring this disease. This is what is happening now, and pilgrims returning to Marseille are very commonly infected with, H3N2, H1N1 and B influenza viruses (unpublished). Thus, as often in recent years, the false epidemics take precedence over real epidemics, and prevent the establishment of true studies on the surveillance and prevention of true epidemics. The recommendation for early vaccination for influenza among pilgrims would probably have prevented several thousands of influenza cases and, perhaps, the risk of secondary spread in countries
not yet affected by influenza, as the number of pilgrims returning infected is huge. In a preliminary, not published, study, as many as 9% of pilgrims this year came back to France with one influenza virus in the throat. We need to be reasonable and continue to take care of real and established contagious and epidemic diseases, and not divert our actions to diseases that have little known effect on the human population and vanish as rapidly as they appear.
Transparency Declaration No conflicts of interest to declare.
References 1. Benkouiten S, Charrel R, Belhouchat K et al. Circulation of respiratory viruses among pilgrims during the 2012 Hajj pilgrimage. Clin Infect Dis 2013; 57: 992–1000. 2. Zaki AM, van Boheemen S, Bestebroer TM, Osterhaus AD, Fouchier RA. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med 2012; 367: 1814–1820. 3. Assiri A, Al-Tawfiq JA, Al-Rabeeah AA et al. Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study. Lancet Infect Dis 2013; 13: 752–761.
ª2013 The Authors Clinical Microbiology and Infection ª2013 European Society of Clinical Microbiology and Infectious Diseases
