Etiological agent of upper respiratory tract infection among international hajjis arriving at King Abdul-Aziz International Airport Jeddah during hajj season 1431H (2010 G)
Acute respiratory infections present a major challenge to the health care system during Hajj. This study was conducted to identify the etiological agents for upper respiratory tract infection (URI) among hajjis arriving at King Abdul Aziz International Airport Jeddah during Hajj season, 1431H (2010 G) and to describe the association of these agents with the demographic characteristics, presenting symptoms, influenza vaccine uptake and use of empirical treatment in the study population.
Methodology
A cross sectional study was conducted among hajjis arriving through King Abdul-Aziz International Airport, Jeddah suffering from any of the constitutional symptoms, along with any of the local symptoms of URI. A structured questionnaire was used to collect the information. Two throat swabs were taken from each patient and sent to Jeddah Regional Laboratory for viral and bacterial identification.
Results
A total of 713 hajjis were included in study with mean age of 48.9 ± 12.2 years and 68.2% males. Most common nationality among the study population was Indonesian (22.6%), followed by Turkish (13.2%) and Pakistani (10.4%). Among the constitutional symptoms of URI, fever was most common (79.9 %) and among local symptoms most common was sneezing (81.8%). Antibiotics were used by 30.2% and antipyretics were consumed by 72.7% hajjis. Influenza vaccine was received by 26.9% during the preceding six months. Two hundred and thirteen (29.9%) hajjis were positive for microorganism. Bacteria were isolated from 134(18.8%) hajjis and viruses were isolated from 79(11.1%) hajjis. The most commonly isolated microorganism was beta hemolytic group A streptococci (82; 11.5%). Respiratory Syncytial Virus and Influenza A /H1N1 were the commonest viruses i.e. 22 (3.1%) each. Variation in the distribution of bacteria and viruses among the different regions was statistically significant (P=0.005). Regarding symptoms, runny nose and difficulty in breathing were significantly more pronounced in viral infection compared to bacterial infection (P=0.003 and 0.0356 respectively). There was no significant difference in throat swab positivity between genders, or between those who were vaccinated or not, or those who received antibiotics or not.
Conclusion
Almost 30% of throat swabs among hajjis with symptoms of URI were positive with predominance of bacteria over viruses. Among influenza viruses H1N1 was the most common virus and all influenza virus subtypes isolated were included in the seasonal influenza vaccine. Fever was the commonest constitutional symptom and antipyretics were consumed by 72.7% of the patients in preceding 12 hours. Antibiotics were consumed by 30.2% patients in preceding 72 hours and 26.9% patients were vaccinated against influenza in the preceding 6 months. Screening of incoming hajjis with URI should be regularly performed to map microorganisms imported into Hajj from around the world; especially focusing on identification of circulating serotype of influenza virus. Hajjis from sub-Saharan Africa should be regularly screened for meningococcal carriage with serotyping. Coordinate with ministries of health of other countries to encourage influenza vaccination among pilgrims especially among the elderly; and also promote rational use of antibiotics.