The inevitable Hajj cough: Surveillance data in French pilgrims, 2012–2014

BACKGROUND: Respiratory tract infections are the most common infection affecting Hajj pilgrims, and the ‘‘Hajj cough’’ is considered by pilgrims almost de rigueur. METHODS: French pilgrims were recruited between January 2012–December 2014 and information on demographics, medical history, compliance with preventive measures and health problems during travel were collected. RESULTS: A total of 382 pilgrims were included with 39.3% aged ≥65 years and 55.1% suffering from a chronic disease, most frequently hypertension and diabetes. The prevalence of cough was 80.9% and a high proportion presented with associated sore throat (91.0%), rhinitis (78.7%) and hoarseness (63.0%). Myalgia was reported in 48.3% of cases and subjective fever in 47.3%. The incubation time of respiratory symptoms was 7.7 days (range 0–25 days) and 51.9% of pilgrims presenting with a cough during their stay were still symptomatic on return. Among pilgrims with a cough, 69.4% took antibiotics. The prevalence of cough was significantly higher among females than men, but age, chronic conditions and preventive measures had no significant effect. CONCLUSIONS: The Hajj cough is highly common, likely a result of crowded conditions at religious places. Pilgrims should be advised to carry symptomatic relief for the Hajj cough such as cough suppressant, soothing throat lozenges and paracetamol. Use of antibiotics should be discouraged.