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Volume 17, Number 7—July 2011

Pandemic (H1N1) 2009 and Hajj Pilgrims Who Received Predeparture Vaccination, Egypt

Amr Kandeel, Michael DemingComments to Author , Eman Abdel Kereem, Samir El-Refay, Salma Afifi, Mohammed Abukela, Kenneth Earhart, Nasr El-Sayed, and Hatem El-Gabaly
Author affiliations: Author affiliations: Ministry of Health, Cairo, Egypt (A. Kandeel, E. Abdul Kereem, S. El-Refay, M. Abukela, N. El-Sayed, H. El-Gabaly); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (M. Deming); US Naval Medical Research Unit No. 3, Cairo, Egypt (S. Afifi, K. Earhart)

Main Article


Demographic characteristics, vaccination history, and influenza A infection prevalence among 551 pilgrims returning from the Hajj, Egypt, 2009

Characteristic No. pilgrims (weighted %)
Age group, y
<30 11 (2.2)
30–39 66 (12.4)
40–49 141 (23.9)
50–59 219 (40.2)
60–69 114 (21.2)
>70 0
<12* 1 (0.3)
1 (0.1)
M 311 (57.8)
240 (42.2)
Area of residence†
Coastal Egypt 12 (3.1)
Lower Egypt 298 (51.0)
Cairo metropolitan area 232 (43.8)
Upper Egypt
9 (2.1)
Verbal history of pandemic (H1N1) 2009 vaccination
Yes 542 (98.1)
9 (1.9)
Pilgrims infected with influenza A virus, by subtype‡
Seasonal (H1N1) 0
Seasonal (H3N2) 6 (1.0)
Pandemic (H1N1) 2009 0

*Outside the age limits recommended for Hajj pilgrims by the Ministry of Health, Saudi Arabia, and enforced by Egypt’s Ministry of Health.
†The proportion of the national population living in these 4 areas according to the 2006 census was 11.3%, 34.3%, 19.4%, and 34.9%, respectively (11). The areas were formed by grouping Egypt’s governorates as follows: Coastal Egypt: Alexandria, Damietta, Ismailia, Matrouh, North Sinai, Port-Said, Suez, Red Sea; Lower Egypt: Behera, Dakahlia, Gharbia, Kafr-ElSheikh, Menoufia, Sharkia; Cairo metropolitan area: Cairo, Giza, Kalyoubia; Upper Egypt: Aswan, Asyout, Beni-Suef, ElWadi ElGidid, Fayoum, Helwan, Luxor City, Menia, Qena, South Sinai, Suhag, and 6th October.
‡By real-time reverse transcription PCR testing.

Main Article

  1. Hajj and 2009 pandemic influenza A H1N1. Lancet. 2009;374:1724. DOIPubMedGoogle Scholar
  2. El-Sheikh  SM, El-Assouli  SM, Mohammed  KA, Albar  M. Bacteria and viruses that cause respiratory tract infections during the pilgrimage (Haj) season in Makkah, Saudi Arabia. Trop Med Int Health. 1998;3:2059.PubMedGoogle Scholar
  3. Alborzi  A, Aelami  MH, Ziyaeyan  M, Jamalidoust  M, Moeini  M, Pourabbas  B, Viral etiology of acute respiratory infections among Iranian Hajj pilgrims, 2006. J Travel Med. 2009;16:23942. DOIPubMedGoogle Scholar
  4. Balkhy  HH, Memish  ZA, Bafaqeer  S, Almuneef  MA. Influenza a common viral infection among Hajj pilgrims: time for routine surveillance and vaccination. J Travel Med. 2004;11:826. DOIPubMedGoogle Scholar
  5. Ahmed  AZ, Arabi  YM, Memish  ZA. Health risks at the Hajj. Lancet. 2006;367:100815. DOIPubMedGoogle Scholar
  6. Shafi  S, Rashid  H, Ali  K, El Bashir  H, Haworth  E, Memish  ZA, Influenza vaccine uptake among British Muslims attending Hajj, 2005 and 2006. BMJ. 2006;333:1220. DOIPubMedGoogle Scholar
  7. Ministry of Health. Saudi Arabia; World Health Organization (WHO); WHO Regional Office for the Eastern Mediterranean; US Centers for Disease Control and Prevention. International consultation: infectious disease prevention and control at Umra and Hajj (2009). Technical meeting. 5–7 Rajab, 1430 H, 28–30 June 2009, Jeddah Kingdom of Saudi Arabia [cited 2010 Mar 21].
  8. Deming  M, Kandeel  A, Soliman  A, Afifi  S, Labib  M, Teesdale  S, Adding real-time epidemiological surveillance to virological influenza surveillance for vaccine planning: steps needed and public health value, Egypt, 2009–2010 [abstract]. International Conference on Emerging Infectious Diseases 2010 Slide Session Abstracts. Emerg Infect Dis. 2010 Jul 29 [cited 2010 Sep 16].
  9. CDC protocol of realtime RTPCR for swine influenza A(H1N1). 28 April 2009, revision 1 (30 Apr 2009). Geneva: World Health Organization; 2009 [cited 2010 Mar 14].
  10. Ahmed  J, Eidex  R, Njenga  K, Nyoka  R, Gichangi  A, Mahamud  A, Nasopharyngeal versus oropharyngeal specimens for the diagnosis of influenza, including 2009 pandemic influenza A (H1N1), using real time reverse transcriptase–polymerase chain reaction. International Conference on Emerging Infectious Diseases; July 11–14, 2010; Atlanta, GA, USA [cited 2011 Mar 8].
  11. Central Agency for Public Moblization and Statistics. 2006 population, housing & establishments census. Governorates arranged in descending order by population size in 2006 census compared with 1996 census [cited 2010 Aug 3].
  12. FluNet, Global Influenza Surveillance Network. Global circulation of influenza viruses. Number of specimens positive for influenza by subtypes. Weeks 17 (2009)–5 (2010) from 19 April 2009 to 6 February 2010 [cited 2010 Apr 19].
  13. Handeel Al-Shalchi. Saudi official: 5 dead from swine flu at Hajj. The Associated Press [cited 2010 Jul 10].
  14. Haworth  E, Rashid  H, Booy  R. Prevention of pandemic influenza after mass gatherings—learning from Hajj. J R Soc Med. 2010;103:7980. DOIPubMedGoogle Scholar

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Page created: August 18, 2011
Page updated: August 18, 2011
Page reviewed: August 18, 2011
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