Outbreaks of infectious diseases that spread via respiratory route, e.g. influenza, are common amongst Hajj congregation in Mecca, Saudi Arabia. The Saudi Arabian authority successfully organized the Hajj 2009 amidst fear of pandemic influenza. While severe influenza A(H1N1) pdm09 was rare, the true burden of pandemic influenza at Hajj that year remains speculative. In this article we review the latest evidence on influenza control and discuss our experience of influenza and its prevention at Hajj and possible application to other mass gatherings. Depending on study design the attack rate of seasonal influenza at Hajj has ranged from 6% in polymerase chain reaction or culture confirmed studies to 38% in serological surveillance. No significant effect of influenza vaccine or the use of personal protective measures against influenza has been established from observational studies, although the uptake of the vaccine and adherence to face masks and hand hygiene has been low. In all, there is a relatively poor evidence base for control of influenza. Until better evidence is obtained, vaccination coupled with rapid antiviral treatment of symptomatic individuals remains the mainstay of prevention at Hajj and other mass gatherings. Hajj pilgrimage provides a unique opportunity to test the effectiveness of various preventive measures that require a large sample size, such as testing the efficacy of plain surgical masks against laboratory-confirmed influenza. After successful completion of a pilot trial conducted among Australian pilgrims at the 2011 Hajj, a large multinational cluster randomized controlled trial is being planned. This will require effective international collaboration.
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King Saud Bin Abdulaziz Univ Hlth Sci, Dept Crit Care & Internal Med, King Abdulaziz Med City 11426, Riyadh, Saudi ArabiaKing Saud Bin Abdulaziz Univ Hlth Sci, Dept Crit Care & Internal Med, King Abdulaziz Med City 11426, Riyadh, Saudi Arabia
Baharoon, Salim
Al-Jandali, Hamdan
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King Saud Bin Abdulaziz Univ Hlth Sci, Dept Crit Care & Internal Med, King Abdulaziz Med City 11426, Riyadh, Saudi ArabiaKing Saud Bin Abdulaziz Univ Hlth Sci, Dept Crit Care & Internal Med, King Abdulaziz Med City 11426, Riyadh, Saudi Arabia
Al-Jandali, Hamdan
Al Hashmi, Jamal
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King Abdulaziz Univ, Dept Crit Care, Jeddah 21413, Saudi ArabiaKing Saud Bin Abdulaziz Univ Hlth Sci, Dept Crit Care & Internal Med, King Abdulaziz Med City 11426, Riyadh, Saudi Arabia
Al Hashmi, Jamal
Memish, Ziad A.
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Infect Prevent & Control Program, King Abdulaziz Med City, Riyadh, Saudi ArabiaKing Saud Bin Abdulaziz Univ Hlth Sci, Dept Crit Care & Internal Med, King Abdulaziz Med City 11426, Riyadh, Saudi Arabia
Memish, Ziad A.
Ahmed, Qanta A.
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Med Univ S Carolina, Dept Med, Charleston, SC 29425 USAKing Saud Bin Abdulaziz Univ Hlth Sci, Dept Crit Care & Internal Med, King Abdulaziz Med City 11426, Riyadh, Saudi Arabia
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King Saud bin Abdulaziz Univ, Dept Pediat, King Abdulaziz Medical C, Riyadh, Saudi ArabiaKing Saud bin Abdulaziz Univ, Dept Pediat, King Abdulaziz Medical C, Riyadh, Saudi Arabia
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Childrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, AustraliaChildrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, Australia
Booy, Robert
Khandaker, Gulam
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Childrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, AustraliaChildrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, Australia
Khandaker, Gulam
Heron, Leon G.
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Childrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, AustraliaChildrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, Australia
Heron, Leon G.
Yin, Jiehui
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Childrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, AustraliaChildrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, Australia
Yin, Jiehui
Doyle, Bridget
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Greater So Area Hlth Serv, Publ Hlth Unit, Albury, NSW, AustraliaChildrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, Australia
Doyle, Bridget
Tudo, Katherine K.
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Inst Clin Pathol & Med Res, Ctr Infect Dis & Microbiol, Sydney, NSW, AustraliaChildrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, Australia
Tudo, Katherine K.
Hueston, Linda
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Inst Clin Pathol & Med Res, Ctr Infect Dis & Microbiol, Sydney, NSW, AustraliaChildrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, Australia
Hueston, Linda
Gilbert, Gwendolyn L.
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Inst Clin Pathol & Med Res, Ctr Infect Dis & Microbiol, Sydney, NSW, AustraliaChildrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, Australia
Gilbert, Gwendolyn L.
MacIntyre, C. Raina
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Univ New S Wales, Sch Publ Hlth & Community Med, Fac Med, Sydney, NSW, AustraliaChildrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, Australia
MacIntyre, C. Raina
Dwyer, Dominic E.
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Inst Clin Pathol & Med Res, Ctr Infect Dis & Microbiol, Sydney, NSW, AustraliaChildrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, Australia
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King Saud Bin Abdulaziz Univ Hlth Sci, Dept Crit Care & Internal Med, King Abdulaziz Med City 11426, Riyadh, Saudi ArabiaKing Saud Bin Abdulaziz Univ Hlth Sci, Dept Crit Care & Internal Med, King Abdulaziz Med City 11426, Riyadh, Saudi Arabia
Baharoon, Salim
Al-Jandali, Hamdan
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King Saud Bin Abdulaziz Univ Hlth Sci, Dept Crit Care & Internal Med, King Abdulaziz Med City 11426, Riyadh, Saudi ArabiaKing Saud Bin Abdulaziz Univ Hlth Sci, Dept Crit Care & Internal Med, King Abdulaziz Med City 11426, Riyadh, Saudi Arabia
Al-Jandali, Hamdan
Al Hashmi, Jamal
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King Abdulaziz Univ, Dept Crit Care, Jeddah 21413, Saudi ArabiaKing Saud Bin Abdulaziz Univ Hlth Sci, Dept Crit Care & Internal Med, King Abdulaziz Med City 11426, Riyadh, Saudi Arabia
Al Hashmi, Jamal
Memish, Ziad A.
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Infect Prevent & Control Program, King Abdulaziz Med City, Riyadh, Saudi ArabiaKing Saud Bin Abdulaziz Univ Hlth Sci, Dept Crit Care & Internal Med, King Abdulaziz Med City 11426, Riyadh, Saudi Arabia
Memish, Ziad A.
Ahmed, Qanta A.
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h-index: 0
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Med Univ S Carolina, Dept Med, Charleston, SC 29425 USAKing Saud Bin Abdulaziz Univ Hlth Sci, Dept Crit Care & Internal Med, King Abdulaziz Med City 11426, Riyadh, Saudi Arabia
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King Saud bin Abdulaziz Univ, Dept Pediat, King Abdulaziz Medical C, Riyadh, Saudi ArabiaKing Saud bin Abdulaziz Univ, Dept Pediat, King Abdulaziz Medical C, Riyadh, Saudi Arabia
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Childrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, AustraliaChildrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, Australia
Booy, Robert
Khandaker, Gulam
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Childrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, AustraliaChildrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, Australia
Khandaker, Gulam
Heron, Leon G.
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Childrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, AustraliaChildrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, Australia
Heron, Leon G.
Yin, Jiehui
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Childrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, AustraliaChildrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, Australia
Yin, Jiehui
Doyle, Bridget
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Greater So Area Hlth Serv, Publ Hlth Unit, Albury, NSW, AustraliaChildrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, Australia
Doyle, Bridget
Tudo, Katherine K.
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Inst Clin Pathol & Med Res, Ctr Infect Dis & Microbiol, Sydney, NSW, AustraliaChildrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, Australia
Tudo, Katherine K.
Hueston, Linda
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Inst Clin Pathol & Med Res, Ctr Infect Dis & Microbiol, Sydney, NSW, AustraliaChildrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, Australia
Hueston, Linda
Gilbert, Gwendolyn L.
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Inst Clin Pathol & Med Res, Ctr Infect Dis & Microbiol, Sydney, NSW, AustraliaChildrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, Australia
Gilbert, Gwendolyn L.
MacIntyre, C. Raina
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Univ New S Wales, Sch Publ Hlth & Community Med, Fac Med, Sydney, NSW, AustraliaChildrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, Australia
MacIntyre, C. Raina
Dwyer, Dominic E.
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Inst Clin Pathol & Med Res, Ctr Infect Dis & Microbiol, Sydney, NSW, AustraliaChildrens Hosp Westmead, Natl Ctr Immunisat Res & Surveillance Vaccine Pre, Sydney, NSW, Australia