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Beta Coronavirus Hajj Testing Concerns
Recombinomics Commentary 08:00
February 17, 2013

A cohort of 154 French Hajj pilgrims participating in the 2012 Hajj were systematically sampled using nasal swab prior to returning to France and screened for the novel HCoV-EMC coronavirus by two real-time RT-PCR assays. Despite a high rate of respiratory symptoms (83.4%) including 41.0% influenza like illness, no case of HCoV-EMC infection was detected.

The above comments from the abstract of a recent paper entitled “Lack of nasal carriage of novel coronavirus (HCoV-EMC) in French Hajj pilgrims returning from the Hajj 2012, despite high rate of respiratory symptoms” raise serious concerns that novel betacornavirus cases associated with Hajj pilgrims are being missed because screening has focused on samples collected from the upper respiratory tract, when WHO recommends testing of samples collected from the lower respiratory tract.
These concerns have been increased by the report suggesting the export of the novel coronavirus by a UK resident who developed symptoms while performing Umrah in Saudi Arabia.  He was lab confirmed for a co-infection involving the novel betacornavirus and H1N1pdm09 when he returned to the UK and is current on life support (attached to an ECMO machine).  His son and another family member, with no recent history of travel outside of the UK developed symptoms after the return of the index cases and both have been lab confirmed.  The son is currently hospitalized, while the second case is self-quarantined at home because the case was mild and has recovered without treatment. 

This mild cases coupled with the human to human transmission within the family has raised concerns that the number of cases in Saudi Arabia is significantly higher than the five confirmed and one probable case, which involved a cluster of four in Riyadh, which had a significant time gap in disease onset dates by two family members.  Moreover, the first confirmed case in a Qatari resident also developed symptoms while performing Umrah in Saudi Arabia.  Although the case was transported to the UK by air ambulance in September, he remains hospitalized.  Moreover, contacts, including health care workers developed mild symptoms and also self quarantined.  Those cases fully recovered and tested negative, but sample collections times were sub-optimal and the negative lab results may have been false.

The IHR report associated with the recent cluster in the UK has led to an alert in Indonesia for residents planning on traveling to Saudi Arabia to perform Umrah.  More information of the types of sample collections made on other symptomatic Hajj or Umrah pilgrims would be useful.

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