The observed association of H1N1 influenza vaccine with a lower prevalence rate of infection with any respiratory virus may simply be a marker for pilgrims who are more health conscious and perhaps use other preventive measures more frequently rather than due to the effect of H1N1

influenza vaccine on the acquisition of rhinovirus-enterovirus or coronaviruses. Although the majority of pilgrims in this study believed that H1N1 is a serious disease, only one fourth were aware of symptoms such as sore throat or cough Silmitasertib cost and less than half were aware of preventive measures such as hand hygiene and wearing a mask. The proportion of pilgrims using a face mask in this study was comparable to that of previous studies recruiting pilgrims from different nationalities23,24 but lower than among French and Malaysian pilgrims.20,25 It is interesting that some Muslims wrongly believe that covering the face (with a mask) during the Hajj is religiously prohibited. The low level of knowledge about H1N1 symptoms and preventive BKM120 mouse measures as well as the underutilization of face

masks may point to suboptimal education of pilgrims before the Hajj. Our study has many strengths, such as the large number of respiratory viruses we tested for, and the large sample size, among typically healthy pilgrims with or without upper respiratory symptoms (to encompass pilgrims who are incubating or just recovering from a viral upper respiratory infection), in the midst of a declared pandemic influenza A(H1N1) in a very crowded setting. Nevertheless, we acknowledge the inability to recruit the same pilgrims before and after the Hajj, and sound recruitment strategies were not feasible under the circumstances, which limited our ability to further study viral acquisition during the Hajj. In addition, it needs to be highlighted that this study was not intended to be a vaccine efficacy study, so any conclusions about protective

effects of the H1N1 vaccine need to be taken with caution. In conclusion, we found low pandemic influenza A(H1N1) influenza infection prevalence among a group of fairly ifenprodil healthy pilgrims in the midst of the H1N1 pandemic. Overpresentation of influenza low-risk groups rather than H1N1 vaccination may have contributed to the observed low H1N1 prevalence. We would like to acknowledge all who contributed to the survey and sample collection from pilgrims including: Dr S. Ebrahim, Dr M.S. Deming, Dr M. Alghamdi, Dr Y. Badawi, Dr A. Abo-Dawod, Dr N. AlShahrani, Dr N. AlMasri, Dr T. Baksh, Dr A. Munshi, Dr T. Shaik, Dr N. AlObaidi, Dr U. Abdurasheed, Dr G. AlHarbi, Dr K. AlMusa, H. Alashula, F.B. Abdusatar, and M. Asqar. The authors state that they have no conflicts of interest to declare. “
“Acetazolamide has been reported to be effective in the prevention of acute mountain sickness (AMS).